What Home Health agencies need to know and do right now

For the first time since its introduction in 2009, the Home Health Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is undergoing a major overhaul. Effective April 1st, the updated survey brings sweeping changes that will reshape how agencies are evaluated, how patients experience their care, and ultimately, how organizations compete in an increasingly transparent marketplace.

This article distills key insights from a recent fireside chat between Bud Langham, a 20-year home health and hospice veteran, and Lindsey Doak, Vice President of Data and Research at Health Pivots - one of the foremost voices in HCAHPS research and consulting.

Watch the full conversation here:

Why these changes matter more than ever

When HCAHPS launched in 2009, it standardized patient satisfaction measurement across home health. But the industry has changed dramatically since then. The survey had grown long, averaging 12 minutes to complete, and was no longer capturing the true patient experience of care.

CMS recognized this and went back to the drawing board. The result is a streamlined, patient-centered survey that takes approximately nine minutes to complete and places renewed emphasis on the qualities that patients actually care about most.

"This is a lot for CAHPS. We haven't really seen anything like this in any of our past experience." - Lindsay Doak

The changes also carry significant financial implications. HCAHPS now directly impacts two key areas every agency must watch:

• Star Ratings - publicly reported scores will be updated in October 2027, giving agencies a window to act before results go live.

• Value-Based Purchasing (VBP) - CAHPS measures were reduced from five to two, but those two questions now carry 1.5 times their previous individual weight. A 1% improvement in either score can yield three to four times more Total Performance Score (TPS) points than many OASIS measures.

The two questions that will define your scores

Among all the survey changes, two newly added questions in the "Care of Patients" section stand out as the most consequential. Based on years of research into what predicts patient satisfaction, Lindsey Doak predicts these questions will become the strongest indicators of whether a patient rates an agency a 9 or 10 - or is willing to recommend them.

1. Did your care team care about you as a person?

This question sits at the very heart of patient-centered care. It moves beyond clinical tasks and asks something deeply human: did the people caring for you treat you as a whole person?

The implication for agencies is clear. Clinicians who rush in and out of homes, focused solely on wound care or medication management, will struggle to score well here. Those who take a moment to connect, ask how a patient is feeling, and demonstrate genuine interest in their wellbeing will stand apart.

"I can't believe that anyone would get care from a team they felt cared about them as a person and then leave unhappy." - Lindsay Doak

2. Did the agency help you take care of your health?

This question is deliberately broad - and intentionally so. It recognizes that "health" means something different to every patient. For one person, it means regaining the ability to dress independently. For another, it means managing pain or simply being comfortable in the final stages of life.

Answering this question well requires agencies to:

• Prioritize health literacy - patients must understand their condition to take ownership of it.

• Practice motivational interviewing - especially with resistant patients who struggle with exercise, diet, or medication adherence.

• Set goals collaboratively - the patient's goals, not the clinician's, must be the organizing principle of the care plan.

From silos to a holistic data strategy

One of the most common mistakes agencies make is treating CAHPS, OASIS, and hospitalization metrics as separate problems to solve in isolation. The data tells a different story: these outcomes are deeply interconnected.

Lindsey Doak puts it plainly: know your data. Agencies that understand their patient mix, identify hospitalization risk, and implement targeted interventions will see downstream improvements in CAHPS scores - not the other way around.

• Reducing potentially preventable hospitalizations improves willingness-to-recommend scores.

• Improving discharge to community improves overall satisfaction ratings.

• Identifying patients who are better served by hospice - and having those difficult conversations - protects both the patient and the agency's outcomes.

For agencies managing patients referred by hospitals who are actually appropriate for hospice, the challenge is real but addressable. Resources like Ariadne Labs' serious illness conversation guides offer practical frameworks for navigating these sensitive discussions with compassion and clarity.

Technology as a force multiplier

Two emerging technologies were highlighted as especially promising for improving CAHPS performance:

AI-Powered patient check-ins

Tools like Care Bestie use AI agents to conduct regular, empathetic check-ins with patients between visits. These agents gather meaningful information - how the patient is feeling, any concerns or changes - and feed it directly to the clinical team before their next visit.

The impact on that critical HHCAHPS question about clinician preparedness is tangible. When a clinician walks in already knowing what's been happening with a patient, it builds trust and confidence in a way that a cold introduction simply cannot.

Ambient scribing

Research from hospital settings consistently shows that doctors who maintain eye contact and engage directly with patients - rather than typing notes - generate higher satisfaction scores. Ambient listening and scribing technology removes that barrier in the home health setting, allowing clinicians to be fully present during visits.

Combined, these technologies address both the human connection and the clinical preparedness dimensions that the new HHCAHPS survey rewards most.

Key takeaways: What agencies should do right now

1. Don't wait and see.

The first surveys under the new format will be mailed in May, covering patients who begin care in April. Agencies that wait until October 2027 to review their scores will have a difficult and costly improvement journey ahead. The time to act is now.

2. Train staff on what the new questions are really asking.

The shift to questions about caring for the patient "as a person" and helping them "take care of their health" requires a mindset change across the clinical team. Patient-centered care is not a checkbox - it is a practice that must be embedded in every visit.

3. Look at your data holistically.

CAHPS scores don't live in a vacuum. Pull your patient mix data, hospitalizations, and OASIS outcomes together. Understand the connections. Target your interventions where the data tells you they will have the greatest impact.

4. Embrace emerging technologies.

AI-powered check-ins and ambient scribing are not futuristic experiments - they are available today and showing real promise. Agencies that adopt them early will be better positioned as the industry navigates a growing Medicare population and a shrinking clinical workforce.

5. Remember: doing what's best for patients drives all the metrics.

Whether a patient's goal is functional recovery, chronic disease management, or end-of-life comfort - the agency's job is to align with that goal. Outcomes across every measure follow from doing right by the individual in front of you.

Watch the fireside conversation here:

About our contributors

Bud Langham is a physical therapist and 20-year home health and hospice veteran based in Dallas, TX. He provides advisory services to post-acute organizations and new technology providers including Care Bestie.

Lindsey Doak is Vice President of Data and Research at Health Pivots, where she specializes in home health and hospice data strategy, HHCAHPS consulting, and research. She has over 20 years of experience in the industry.