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How to Earn a 5 Star Rating on HCAHPS Patient Experience Questions

The Centers for Medicare and Medicaid Services recently rolled out a star rating system for hospitals, similar to what has been in place for health insurers but using HCAHPS-scores as a basis.

What does it mean for language service programs in hospitals?

dr patient

First, let’s cover some details on how the ratings work.

The ratings, like the HCAHPS surveys, measure patient experience during their hospital stay with scores ranging from zero to five stars. The results will be published on the CMS Hospital Compare website and available to the public  as a resource for choosing a hospital in the future.

Star ratings are earned based on a hospital’s scoring in eleven different categories of HCAHPS survey questions:

  1. Communication with Nurses (3 questions)
  2. Communication with Doctors (3 questions)
  3. Responsiveness of Hospital Staff (2 questions)
  4. Pain Management (2 questions)
  5. Communication about Medicines (2 questions)
  6. Discharge Information (2 questions)
  7. Care Transition (3 questions)
  8. Cleanliness of Hospital Environment (1 question)
  9. Quietness of Hospital Environment (1 question)
  10. Overall Hospital Rating (1 question)
  11. Recommend the Hospital (1 question)

This system creates a concern for hospitals: low ratings may negatively impact an organization’s reputation. Additionally, failure to execute in the rated categories puts hospitals at risk for increased patient readmissions, jeopardizing reimbursement rates under the Affordable Care Act.

Your facility has likely reexamined their processes to ensure high HCAHPS scores, but with the introduction of the 5 Star Rating system, let’s take another look at the role a great language service department can play in increasing scores. 


Patient communication is a common thread in the 11 categories, putting language service managers in a favorable position to impact their organization. Three of the 11 categories mention “communication” outright, and most of the others – Responsiveness, Pain Management, Discharge Info, and Care Transition – depend heavily on whether a patient felt heard and understood and whether they  understood the hospital’s explanations and directions.

We believe these three factors impact communication and therefore give language service programs the opportunity to demonstrate value to their leadership and organization:

  1. Language – Language Access = Satisfaction

Whether you use employees or outsource, language service managers have justification for their funding in contributing to the hospital’s overall goals of increasing patient satisfaction. According to the latest research (of which healthcare respondents contributed significantly), speaking in someone’s preferred language improves satisfaction. And the same research indicated that using remote interpreters produced the same or better satisfaction scores over bilingual staff.

  1. Culture – An Unspoken Second Language

Language services departments can elevate the level of care for patients by training staff in the cultural norms of those who make up the surrounding community, ensuring that these differences don’t hinder patient communication.

A patient’s cultural background can be as impactful as the language they speak – cultural norms and customs often play a role below the surface. Some cultures hold highly educated people like doctors in high esteem and consider it rude to ask them questions, even when they need clarification. Others have standards for how people of differing ages or genders should converse which differ from those typical in the US.

  1. Health Literacy – Extra Attention for LEP Individuals

LEP individuals may not have the same level of health literacy as the general population. The Joint Commission’s“What Did the Doctor Say?:” Improving Health Literacy to Protect Patient Safety explains that “Many patients who have low literacy skills mask what they feel are their inadequacies. For them, there is too much shame in admitting that they do not read well, or that they do not understand.”

According to the most recent National Assessment of Adult Literacy conducted by the USDE, 90 million Americans lackhealth literacy – that is, “the ability to obtain, process, and understand health information and use that information to make appropriate decisions about one’s health and medical care.” For these patients, it’s often necessary to slow down and make things incredibly simple to avoid patient confusion – better to explain something slowly once than to have a patient readmit because they didn’t understand their doctor’s instructions.

The introduction of the 5 Star Rating system for hospitals is an opportunity for language service departments to demonstrate their strategic value. What are you doing to show your value? If you have stories to share, comment on this post or email We won’t share your name or information unless you give us permission.

New Resource Available: Joint Commission Standards for Language Access  View Page