CAHPS Hospice Survey

The CAHPS Hospice Survey asks primary informal caregivers (i.e., family members or friends) of patients who died while receiving hospice care about experiences with hospice care. The purpose of the survey is to:

• Provide a source of information on patient and caregiver experiences that can be publicly reported to beneficiaries and their family members to help them select a hospice program.
• Support hospices with their internal quality improvement efforts and external benchmarking with other facilities.
• Provide the Centers for Medicare & Medicaid Services (CMS) with information for monitoring the care provided by hospices.

Use of the Survey

The Centers for Medicare & Medicaid Services (CMS) implements the CAHPS Hospice Survey nationally. More than 4,000 hospices across the country use this survey to publicly report data to CMS. As part of the Hospice Quality Reporting Program, CMS reports the results of the CAHPS Hospice Survey on Care Compare. First released in February 2018, these results are updated quarterly.

How To Get the CAHPS Hospice Survey and Administration Guidance

To access this survey and all supporting documentation for survey administration, please visit CMS's CAHPS Hospice Survey website. CMS provides translations of the CAHPS Hospice Survey in several languages. These materials are not available on the Agency for Healthcare Research and Quality (AHRQ) website.

For technical assistance with this survey, please contact hospicecahpssurvey@HSAG.com or 1-844-472-4621.

Quality Measures From the CAHPS Hospice Survey

Effective April 2025, the CAHPS Hospice Survey has 38 questions and produces nine measures of care experience: six composite (multi-item) measures and three single-item measures (including two global ratings). Composite measures combine two or more survey questions that are statistically and conceptually related. The measures are as follows:

Composite Measures:

• Communication With Family.
• Getting Timely Help.
• Treating Patient With Respect.
• Emotional and Spiritual Support.
• Help for Pain and Symptoms.
• Care Preferences (new measure as of April 2025).

Single-Item Measures:

• Training Family to Care for Patient (substantively revised measure as of April 2025).
• Rating of Hospice.
• Willing to Recommend This Hospice.

For more details on the measures, please see the CAHPS Hospice Survey Fact Sheet (PDF, 185 KB).

Development of the CAHPS Hospice Survey

In 2012, CMS contracted with RAND to design and test a survey that would assess the experiences with hospice care.¹  Survey development included a public call for topic areas; a literature review; input from many stakeholders, including other government agencies, industry representatives, consumer groups, and other key individuals and organizations involved in hospice care; cognitive interviews with family caregivers of those who died while receiving hospice care; a field test among 33 hospice programs providing care across a range of settings (home, nursing home, acute care hospital, freestanding hospice inpatient unit); and extensive psychometric analyses. 

Mode experiments. Since the initial development of the CAHPS Hospice Survey, CMS has conducted two mode experiments. The first, in 2015, assessed the effects of administering the survey in Mail Only, Telephone Only, and Mail Telephone on survey response rates and patterns, and was used to calculate mode adjustments for calculating publicly reported CAHPS Hospice Survey measure scores. In 2021, CMS conducted an additional mode experiment to test a Web Mail mode of survey administration, as well as revisions to survey instrument content and administration procedures designed to improve overall response rates.

Based on the results of this experiment, CMS made several important changes, effective April 2025: 

• Introduced a revised version of the survey instrument:
  • Reduced the number of survey items from 47 to 38.
  • Added a new Care Preferences measure.
  • Replaced the existing multi-item Getting Hospice Care Training measure with a single-item measure that is conceptually similar.
  • Simplified and updated survey language.
• Added a Web Mail mode (in addition to Mail Only, Telephone Only, and Mail and Telephone).
• Added a pre-notification letter.

Measure endorsement. In 2016 and 2020, the Board of Directors of the National Quality Forum, CMS’s consensus-based entity at the time, formally endorsed the measures from the original CAHPS Hospice Survey instrument as performance measures for use in accountability and quality improvement. In 2023, the Consensus Standards Approval Committee of CMS’s current consensus-based entity, the Partnership for Quality Measurement, endorsed the nine measures from the updated CAHPS Hospice Survey. 

Since November 2014, the Office of Management and Budget has provided approval for national implementation of the CAHPS Hospice Survey.

The survey, its methodology, and the results it produces are in the public domain.

^1. Anhang Price R, Quigley DD, Bradley MA, et al. (2014). Hospice Experience of Care Survey: Development and Field Test (Research Report). RAND Health. Sponsored by the Centers for Medicare & Medicaid Services. Available at https://www.rand.org/pubs/research_reports/RR657.html.  Accessed 6/30/25.