"If CMS implements yet another survey relevant to ambulatory surgical patients, then patients would receive three separate but similar surveys for exactly the same care episode," she said.
In addition, Thompson noted that CAHPS already survey physicians, hospitals, nursing homes, dialysis facilities and home health agencies, and there are plans to build surveys for emergency departments and hospice care.
"Patients who receive care in two or more of these settings could receive multiple surveys," Thompson said. "Typically, surveys are not distributed until days or weeks after a patient has received their care. This may create confusion about which provider or facility is actually being assessed. A patient may inadvertently attribute a positive or negative experience to the wrong organization."
Thompson raised concerns about the cost and administrative burdens of the surveys and suggested that CMS allow hospitals to choose lower cost surveys to mitigate the financial burden imposed by the process.
In addition, she said CMS could enhance existing CAHPS surveys by reassessing how scores are adjusted for the severity of patient illness. She pointed to a Cleveland Clinic study which found that patient satisfaction scores declined significantly as the severity of the illness worsens.
"These findings indicate that hospitals that treat the most severely ill patients may have systematically lower scores," Thompson said. "We believe this trend also may affect scores for other surveys in the CAHPS family. We encourage CMS to conduct an analysis that assesses the extent of the issue, and identifies potential mechanisms for enhancing how CAHPS scores are adjusted for patient factors."