In support of the national implementation of the Home Health Care CAHPS® (HHCAHPS) Survey, the Centers for Medicare & Medicaid Services (CMS) conducted a mode experiment from September 2009 through January 2010 to determine whether patients respond differently to the survey based on different data collection modes (mail, telephone or a mixed-mode approach). Data from the mode experiment were used to support development of appropriate adjustments to the data during the national implementation of HHCAHPS. Mode experiment data were also used to determine whether ratings of home health care varies by patient characteristics. The results of the HHCAHPS Survey mode experiment showed no significant differences in results based on survey mode. There were, however, differences in responses attributable to patient mix characteristics. Therefore, patient mix adjustments are made on HHCAHPS Survey results that are publicly reported using selected patient characteristics identified during the mode experiment, but no adjustments are being made for mode differences.

To assess the feasibility of implementing a web-based survey administration and to test a shortened instrument, CMS implemented another mode experiment of the HHCAHPS Survey in 2022. This mode experiment tested four survey administration modes: mail only, telephone only, mail with telephone follow-up, and web with mail follow-up.

Using data from this mode experiment, CMS reviewed the variables included in the patient-mix adjustment model to determine if any changes needed to be introduced with the updated survey. CMS found that while no patient-mix variables needed to be added, the diagnosis adjustments for schizophrenia and dementia were no longer statistically significant frequently enough to be included. CMS therefore dropped the diagnosis adjustments for the updated survey. Additionally, as mode effects were observed, CMS added a mode adjustment with the updated survey. Patient-mix adjustment will be performed within each quarter of data after data cleaning and before mode adjustment. Mail-only mode will serve as the reference mode as it is the most frequently used survey mode for HHCAHPS. The mode adjustments are available on the HHCAHPS website under the “General Information” menu. The patient-mix adjustment coefficients will be updated quarterly as national implementation data are available.