Download PQRS CAHPS Frequently Asked Questions

PQRS CAHPS Frequently Asked Questions
Q: What is the CAHPS for PQRS Survey?
A: The Physician Quality Reporting Systems (PQRS) Consumer Assessment of Health Providers and
Systems (CAHPS) is a standard survey instrument CMS has created to measure a patient’s experience
with his/her primary healthcare provider and visits to a medical practice. This instrument specifically asks
questions related to:
 Getting Timely Care, Appointments, & Information
 How Well Providers Communicate
 Patient’s Rating of Provider
 Access to Specialists
 Health Promotion and Education
 Shared Decision Making
 Health Status &Functional Status
 Courteous & Helpful Office Staff
 Helping you Take Medications as Directed
 Care Coordination
 Stewardship of Patient Resources
 Between Visit Communication
Q: Who is required to participate in PQRS CAHPS in 2015?
A: For performance year 2015, which will be administered between November 2015 and February 2016,
medical groups (single tax identification numbers) with 100 or more eligible professionals (EPs) that
participate in PQRS through ANY group practice reporting option (GPRO) are required to participate. The
survey will not be paid for or administered by CMS. Participating groups will be required to contract with a
CMS-certified vendor to administer the CAHPS for PQRS survey. Press Ganey has submitted an
application to become a CAHPS for PQRS survey vendor. We will attend training in July 2015 and
become a certified vendor following the training.
Q: Are other medical groups able to participate in PQRS CAHPS in 2015,
voluntarily?
A: For performance year 2015 medical groups of 2-99 EPs submitting their PQRS data as a group
through ANY reporting option are able to voluntarily participate in PQRS CAHPS data collection. The
survey will not be paid for or administered by CMS. Participating groups will be required to contract with a
CMS-certified vendor to administer the CAHPS for PQRS survey. CAHPS for PQRS survey
administration will occur between November 2015 and February 2016.
Q: Has CMS finalized any plans to expand the PQRS CAHPS program in the
coming years?
A: For performance year 2016 (with data collection likely occurring November 2016 – February 2017),
CMS originally proposed expanding the PQRS CAHPS requirement to all medical groups with 25 or more
eligible professionals that submit their PQRS data using ANY group reporting option. This was not
included in the October 2014 Physician Fee Schedule Final Rule, however Press Ganey anticipates the
passing of this expansion in future rule making.
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Q: I meet the criteria for mandatory or voluntary participation for PQRS CAHPS
performance year 2015; do I need to contract with a vendor?
A: Yes. The survey will not be paid for or administered by CMS. Medical groups will be required to
contract with a CMS-certified vendor to administer the CAHPS for PQRS survey. CAHPS for PQRS
survey administration will occur between November 2015 and February 2016.
Q: How are a medical group’s patients identified and sampled for PQRS CAHPS
for the 2018 performance year?
A: CMS will identify and select a random sample of Medicare beneficiaries who have received primary
care within the medical group (this group must use the group practice reportin option (GPRO) for PQRS).
The CAHPS sample will be limited to beneficiaries age 18 or older, who are not known to be
institutionalized or deceased.
The number of patients sampled will vary depending on the size of the medical group. For medical groups
of 100 or more eligible professionals, CMS will draw a sample of 860 beneficiaries. If the medical group
has fewer than 860 beneficiaries, but more than 415 beneficiaries, CMS will survey all eligible
beneficiaries in program year 2015. If the medical group has fewer than 416 beneficiaries, the survey
cannot be conducted.
For medical groups with 25 to 99 eligible providers, CMS will draw a sample of 860 beneficiaries. If the
medical group has fewer than 860 beneficiaries, but more than 254 beneficiaries, CMS will survey all
eligible beneficiaries in program year 2015. If the medical group has fewer than 125 beneficiaries, the
survey cannot be conducted.
Q: How often will the CAHPS for PQRS survey be conducted?
A: The official CAHPS for PQRS Survey will be conducted on an annual basis.
Q: Which CAHPS for PQRS survey version will CMS use?
A: Press Ganey believes that CMS will use a survey version aligned with the CAHPS for ACOs ACO-12
survey version to conduct an annual audit of your patients’ experiences. This is a retrospective version of
the CGCAHPS survey with a 6-month look-back and includes additional domains and questions focused
on topics like shared decision making, access to specialists and health promotion and education.
Q: What survey modes will be approved?
A: The CAHPS for PQRS survey will be conducted using mixed mode protocol. Administration will begin
with a mail pre-notification, followed by mail survey(s), with telephone follow-up for anyone who does not
respond to the paper survey(s) similar to the CAHPS for ACOs survey mode protocol.
Q: Is eSurvey an approved mode for the PQRS CAHPS data collection?
A: At this time there has been no approval of the use of eSurvey for the CAHPS for PQRS survey tool.
Q: What other programs besides PQRS CAHPS and ACO CAHPS include
CGCAHPS as part of their measurement?
A: Currently, NCQA and selected state initiatives leverage CGCAHPS as part of their patient experience
measurement. There are other State CAHPS programs and requirements for various medical boards.
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Q: Can a group be surveyed under both PQRS CAHPS and Patient Centered
Medical Home (PCMH) CAHPS?
A: Yes. PQRS is a program run by CMS. Medical home certification is offered by many organizations
including the Joint Commission, URAC and NCQA. A medical group can participate in CAHPS data
collection as part of each program. While some similar questions appear on both surveys, they are not
identical and cannot be substituted for one another. Each program has different requirements and
CAHPS measurement options.
Q: What survey does Press Ganey recommend for performance improvement?
A: Press Ganey recommends surveying continuously using our visit-specific survey to capture patient
feedback by individual physician. This continuous, visit-specific methodology allows you to pinpoint areas
for improvement and identify best practices. We recommend using a multimode approach of mail
combined with eSurvey to maximize the number of surveys that can be sent and correspondingly
received, allowing for significant sample sizes and impactful results that will allow you to improve your
performance and scores on the official CAHPS for PQRS survey.
Q: What happens to our current CGCAHPS surveys we are continuously sampling
during the official PQRS CAHPS administration?
A: Press Ganey recommends surveying continuously using our visit-specific survey to capture patient
feedback by individual physician. This continuous, visit-specific methodology allows you to pinpoint areas
for improvement and identify best practices. When vendors are certified, Press Ganey will be able to
implement a duplicate check. The duplicate check will ensure that the limited sample size of patients
selected to participate in the PQRS CAHPS program will not be surveyed as part of your continuous
CGCAHPS data collection process.
Disclaimer: Information and timelines presented herein are based solely upon Press Ganey's experience with other CAHPS initiatives and our
interpretation of CMS rulemaking and policy statements. The information presented herein does not reflect the views or policies of CMS or any other
governmental agency. Official CMS policy is distributed as part of their normal rulemaking process. Information regarding the use of a visit-specific
survey for targeted performance improvement is Press Ganey’s recommendation based on our experience and expertise. The information herein does
not represent the views or policies of CMS or any other governmental agency.
© 2015 Press Ganey Associates, Inc.
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