Success Story

CG-CAHPS survey with Digital Empathy™ improves response rates and increases government incentive payments


The Silver Avenue Family Health Center (SAFHC) didn’t believe their CG-CAHPS results were accurately representative of their actual performance.

The Silver Avenue Family Health Center (SAFHC) didn’t believe their CG-CAHPS results were accurately representative of their actual performance, and they struggled to collect adequate data to understand the patient experience. They faced a common challenge seen across healthcare, where response rates to CG-CAHPS surveys are as low as 34% and on the decline.

After thorough analysis, it was found that the issue could be tied to a number of factors:


response rates with paper-based CG-CAHPS surveys
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Inefficient survey delivery
Physically handing surveys to patients or mailing them after visits results in poor response rates; such methods of delivery are also more likely to upset or dissatisfy patients, biasing results.

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High cost of mailing out surveys
Mail-out surveys cost approximately $10 USD per completed survey, so it is difficult to administer CG-CAHPS surveys in a cost-effective way. The CAHPS program also recommends 5 to 6 follow-up phone calls per survey to encourage survey completion, which further increases administrative costs.

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Difficult wording
The paper-based surveys are not engaging for patients, with confusing wording that decreases accessibility. The surveys are long and difficult for patients to properly read, understand, and fill out.

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Delayed response times
Even when they are completed, mail-out surveys have long turnaround times. Feedback can be delayed as much as 2–3 months. This slows a clinic’s receptivity to patient needs, increasing patient frustration.

Lack of patient experience data adds to increasing administrative costs and difficulty representing diverse populations. As a result, SAFHC could not gather sufficient patient satisfaction feedback to receive accreditation or improve care.


Silver Avenue Family Health Center asked Tickit Health to improve their response rates and lower survey administration costs using a digitized CG-CAHPS survey with Digital Empathy.

In collaboration with the University of California, San Francisco, Tickit Health created an evidence-based, multilingual, low-literacy digital CG-CAHPS survey at the fifth grade reading level for SFPDH to capture the voice of a wider, more diverse sample of patients. The Tickit™ approach resulted in a digital CG-CAHPS survey sensitive to cultural needs, which enabled SAFHC to reach patients in a more accessible, timelier way.

The Tickit Health team shortened the CG-CAHPS survey from 31 questions to just 17 and then compared it with the original to check for similarity in responses. The Tickit™ survey included colourful icons and graphics to enhance readability and increase patient engagement. In a previous case study with CG-CAHPS on the Tickit™ platform, these modifications led to a 79% increase in survey completion and improved disclosure rates so that SAFHC could collect better quality data.


in survey completion and improved disclosure rates
CG-CAHPS results diagram


9.55% quality improvement

SAFHC used the data collected through Tickit™’s CG-CAHPS survey to calculate the clinic’s composite baseline score in the Getting Timely Appointments, Care, and Information category of the CG-CAHPS. They set a goal to improve this baseline score by at least 4% over the course of a year. Streamlined data collection through the Tickit™ CG-CAHPS survey guided the clinic’s quality improvement work so they could change programming and improve patient experiences. With Tickit™, SAFHC exceeded their patient satisfaction goals and improved their baseline score by 9.55% from January 2015 to January 2016.

Unlocked government incentive payments

Prior to using the digital CG-CAHPS, SAFHC had not been able to gather sufficient data to report to the government for payment incentives. With Tickit™, SAFHC could easily collect, report, and leverage their patient satisfaction data for quality improvement, resulting in a government incentive payment of $2,667.


in incentive payments

“The Tickit responses helped us ensure that our efforts aligned with actual priorities of our patients.”

– Physician

Conclusions and Impact

Understanding the patient experience through patient-reported data is more important now than ever before.

Patient experience measures are used by many insurance payers to assess the quality of care at a clinic, shaping the way clinics receive payments. Clinics that track and report patient experience data can receive accreditation (certifying that they provide high quality care) and government tax credits.

Recently, the Centers for Medicare and Medicaid Services (CMS) mandated that Medicare clinicians must submit CG-CAHPS patient experience data on a yearly basis to qualify for the Merit-based Incentive Payment System (MIPS); CG-CAHPS is the only valid tool for MIPS reporting. CAHPS for MIPS counts as one of six quality performance measures that Medicare clinicians must report every year. It is a high-priority measure for CMS. Medicare clinics that collect and report patient experience data may be eligible for bonus payments, while clinics that do not are subject to a financial penalty. More and more, healthcare payers are seeing the value in patient experience reporting and the patient voice.


The CG-CAHPS (Clinician and Group Consumer Assessment of Healthcare Providers and Systems) survey was developed by the Agency for Healthcare Research and Quality and is widely used to gauge patients’ experiences with health care providers and staff. The survey comes with a standardized, evidence-based set of questions for adults and children who have accessed health care in either a primary care or specialized care setting. Survey results help patients make informed decisions when choosing a care provider and advise practitioners on how to improve their practices to increase patient satisfaction.

One variant of CG-CAHPS, CAHPS for MIPS, is used as a quality measure for Medicare clinics participating in the MIPS program. CAHPS for MIPS generates patient experience scores that count towards a clinic’s final MIPS score, which is then used to determine whether clinicians receive a bonus, penalty, or no adjustment to their Medicare payments.

To learn more about the Tickit™ CG-CAHPS survey, read a related case study on the effectiveness of the digital CG-CAHPS survey conducted by the University of California, San Francisco Centre for Vulnerable Populations. For collaboration opportunities, please contact Tickit Health.

Their network has expanded across Canada to include over 12,000 employees, 100 offices, 70 clinics and 13 pharmacies – delivering services in local communities.

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