Now that hospitals have six years of experience with the HCAHPS survey, safety net hospitals' concerns are being validated with research papers like this one, she says.
She gave three examples of how HCAHPS answers may be biased against safety net hospitals.
First, she says, "the methodology does not adjust for whether a patient comes in for emergency care, or requires other specialized services that may have required a transfer to the large regional safety net hospital from a smaller community hospital," she says. "And if you have a patient who was transferred, they don't necessarily have that personal or community connection, and may be less likely to rate their care highly.
Second, she says, safety net hospitals treat large numbers of patients with behavioral, mental or substance abuse issues. And while the HCAHPS survey is not sent to patients with those problems listed as a primary diagnosis, the survey is sent to patients who have those issues as a secondary diagnosis.
"That may not be the primary reason why the patient is hospitalized, she says, "but it is still one of the health challenges the individual is facing and it could color their response."
Third, she says, "there is some work, although not yet published in a peer reviewed journal, that patients that are sicker rate their care experience lower, regardless of other characteristics. It sort of makes a lot of sense intuitively. Well we know safety net hospitals care for more intense patient case mix than other hospitals."
Feldpush summed up that it's unclear whether any of these three factors influence HCAHPS responses, but with more survey experience, some of these impacts should be investigated, she says.
"We don't know if that's the case, but these are the types of questions that, now that we've been using the HCAHPS for about six years, we need to go back and ask."