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CMS adjustments applied to CAHPS responses before public reporting
The case-mix and survey-mode adjustments CMS applies to CAHPS Hospice Survey responses — controlling for factors like patient age, diagnosis, and caregiver characteristics — before public reporting.
Bereaved Family Survey Weighting refers to the adjustments CMS applies to bereaved family caregivers' responses on the CAHPS Hospice Survey before those responses are publicly reported: case-mix adjustment, survey-mode adjustment, and equal weighting of measures into the summary star rating (CAHPS Hospice Survey Case-Mix Adjustment document)[1]. The purpose is to make scores comparable across hospices that serve different patient and caregiver populations.
CAHPS Hospice responses are first converted to top-box scores, the proportion of respondents giving the most favorable answer, and then adjusted for case mix and for the mode of survey administration (CAHPS Hospice Star Ratings Technical Notes, August and November 2025 reporting periods, https://www.hospicecahpssurvey.org/globalassets/hospice-cahps4/public-reporting/star-ratings/cahps-hospice-star-ratings-technical-notes-august-november-2025-reporting-periods-final.pdf). Case-mix adjustment controls for factors outside the hospice's control that influence how caregivers respond, including decedent and respondent age, payer for hospice care, primary diagnosis, length of the final episode of hospice care, respondent education, the caregiver's relationship to the decedent, language, and a response percentile based on response lag time (CAHPS Hospice Survey Case-Mix Adjustment document)[1]. Mode adjustment corrects for measurable differences in how respondents answer by mail, phone, or web. For the summary star rating, the adjusted measure results are converted to individual measure star ratings, and the summary Family Caregiver Survey Rating is calculated by averaging the composite-measure star ratings together with the averaged pair of global-rating stars, so no single measure is given extra weight (CAHPS Hospice Star Ratings FAQs)[2].
Case-mix adjustment makes scores comparable across hospices by controlling for patient and caregiver characteristics outside the hospice's influence, including age, diagnosis, and caregiver education, but it does not insulate any hospice from weak performance in its actual service delivery. The equal-weighting design means a single persistently weak area — such as help for pain and symptoms — pulls down the summary star as much as any other composite. Bereavement follow-up has a direct pathway into CAHPS scores as well: the survey reaches caregivers after death, and their experience of the hospice's post-death contact shapes responses that feed these adjusted scores.
To make scores comparable across hospices by controlling for patient and caregiver characteristics and survey mode that affect responses but are outside the hospice's control (CAHPS Hospice Survey Case-Mix Adjustment document)[1].
Decedent and respondent age, payer, primary diagnosis, length of the final hospice episode, respondent education, caregiver relationship to the decedent, language, and a response-lag percentile (CAHPS Hospice Survey Case-Mix Adjustment document)[1].
No; the summary Family Caregiver Survey Rating averages the composite-measure stars with the averaged global-rating stars, so no single measure carries extra weight (CAHPS Hospice Star Ratings FAQs)[2].
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