National Research (NASDAQ:NRC) leaders Sarah Fryda and Jason Messerli told webcast attendees that hospitals can use Net Promoter Score (NPS) and other real-time patient feedback tools to strengthen performance on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, arguing the two measures reflect many of the same underlying drivers of patient experience.
Why NPS and HCAHPS can look disconnected
Fryda said organizations often struggle when HCAHPS results and feedback gathered through patient experience platforms appear to conflict. She emphasized, however, that the measures are “strongly related” and that both are needed to support an effective patient experience strategy. Using NRC Health data, she said trending inpatient NPS alongside CMS-reported HCAHPS shows similar trend lines over time, adding that the relationship holds not only for the HCAHPS “would recommend” and overall rating questions, but “for every dimension” of HCAHPS and NPS.
Financial stakes and the risk of “analysis paralysis”
Fryda warned that when data sources tell “slightly different stories,” organizations can fall into analysis paralysis—hesitating or delaying decisions and missing opportunities to improve. She also said hospitals tend to focus heavily on HCAHPS because it is publicly reported and tied to reimbursement.
As a reminder of the stakes, Fryda said HCAHPS performance accounts for a quarter of a hospital’s total performance score under CMS’s Value-Based Purchasing Program, and that hospitals can lose or earn back up to 2% of Medicare inpatient payments. She added that underperformance—or not fully participating—can lead to financial loss, and that hospitals that do not understand the true drivers of experience may leave revenue unclaimed from the incentive pool.
Timely feedback, service recovery, and who responds
Messerli argued that rapid feedback matters not only for speed of improvement but also for who is represented in the data. He said HCAHPS response patterns skew older, citing NRC Health partner data showing roughly 63% of HCAHPS responses come from patients aged 65 and over, with some client examples rising to 70%, 75%, and even 80%.
He said that skew can make some HCAHPS dimensions harder to move because older cohorts are more medically complex and may face additional challenges. Messerli described a client example in which contemporary outreach showed improvement while HCAHPS was plateauing; by comparing groups, the organization found older respondents were the most loyal but reported more struggles with communication, while younger cohorts had fewer communication issues but were less loyal. He said the analysis helped identify where to focus behaviors such as confirming understanding, encouraging questions, and ensuring support for unaccompanied patients.
He also emphasized “timely feedback” as a tool for rapid-cycle improvement and employee recognition, arguing organizations should balance coaching with positive reinforcement and avoid positioning service alerts and recovery as “another task.” Messerli said quick “closing the loop” improves the chance of successful service recovery, adding that many situations become difficult to recover once issues extend beyond several days. He noted that effective service recovery can increase loyalty because patients see that the organization responds when something goes wrong.
NRC Health proof point: HCAHPS improvement from 2022 to 2024
Fryda said NRC Health data shows organizations using real-time feedback, closing the loop quickly, and focusing improvement strategies are improving “faster and more reliably” on HCAHPS. She cited a comparison of NRC Health customer HCAHPS performance from 2022—described as the lowest-scoring period of the pandemic—to 2024, stating that hospitals partnering with NRC Health improved at a higher rate across all 10 HCAHPS dimensions. She highlighted the largest improvements in Staff Responsiveness, Overall Hospital Rating, and Hospital Quietness.
Fryda said the goal is not choosing between metrics but using them together: real-time feedback as an immediate, actionable signal and HCAHPS as a standardized, high-stakes benchmark that ultimately reflects improvements made for all patients.
Audience Q&A: practical guidance on strategy, sampling, and culture
During Q&A, Messerli cautioned against trying to build separate improvement teams for every HCAHPS domain simply because domains are equally weighted in value-based purchasing. Instead, he recommended focusing on what matters most to patients and what correlates most with overall rating and willingness to recommend. He said nursing communication metrics often have broad influence because nurses spend the most time with patients, and noted that in 2025 he frequently saw Care Coordination measures emerge as top correlates in client data.
Additional guidance included:
- Service recovery speed and manager engagement: Messerli said organizations should balance coaching with recognition, suggesting a strong positive-to-negative ratio and framing service recovery as “how we do what we do,” not additional work.
- When contemporary outreach rises but HCAHPS is stagnant: Messerli advised reviewing respondent demographics (age, gender, language) to identify blind spots. He also noted that adding web as a modality could bring in new respondent groups.
- Small hospitals with limited volume: Fryda recommended using real-time feedback in the emergency department, noting that many inpatients come through the ED and that ED experience can influence inpatient HCAHPS ratings.
- Sampling strategy: Messerli said sampling depends on volume and organizational goals, and mentioned recommending at least 150% of the CMS minimum HCAHPS threshold while preserving room for contemporary outreach when possible.
- Culture and leadership rounding: Messerli said executive leadership rounding can help build accountability and support if it is done as a supportive—not punitive—practice, with leaders visibly helping staff.
The presenters closed by encouraging attendees to submit additional questions through the webcast tools and noted that a recording link would be shared after the event.
About National Research (NASDAQ:NRC)
National Research Corp (NASDAQ: NRC), also known as NRC Health, is a healthcare analytics and performance improvement company specializing in patient and employee experience measurement. The company’s cloud-based platform enables healthcare providers to collect real-time feedback through patient satisfaction surveys, post-discharge outreach, and employee engagement tools. NRC Health integrates clinical, operational and financial data to deliver actionable insights that support quality improvement initiatives and value-based care programs.
Since its founding in the early 1990s and headquartered in Lincoln, Nebraska, National Research has expanded beyond its regional roots to serve more than 1,600 hospitals and 12,000 care sites across the United States and Canada.
