Ninety-eight percent of patients say feedback is easy to give. Half of them ever see anything come of it. Chris and Reed spend this episode on the half that goes quiet.

The prompt came from the Alchemer 2026 Healthcare Experience Report, a vendor study Reed flagged in the TPS report. Its numbers do the setup work. Patients can speak, and about half watch nothing come back. The most useful finding is the one about the people who never responded at all. Roughly half of them said nobody asked. Only about ten percent said they figured it would not matter. The industry has been building campaigns to re-engage patients it never invited.

Chris and Reed then push past the vendor data into the instrument the whole industry runs on. HCAHPS launched in 2006 as a standardized public accountability measure, and it does that job. It is also a payment mechanism. A quarter of a hospital's value-based purchasing score comes from it, and CMS withholds two percent of base operating DRG payments into the pool it feeds. When the score moves money, the organization manages the score. Saving one upset patient earns nothing on that scoreboard.

Reed draws the line between a rating and a review, then finds the hole underneath both. A system can act on feedback, fix the process for the next patient, and the person who raised it never learns a thing. Healthcare is not built to be visible about its own quality improvement. He also names the unglamorous version of the problem, the intake screen where somebody keys in a fake phone number to advance to the next field, which quietly guarantees nobody can ever reach that patient again.

In this episode, Chris and Reed cover:

Why the silence after a bad experience is an invitation problem, not an apathy problem
The 22-point gap between patients who feel acknowledged and patients who see action
How a survey tied to reimbursement ends up managing a score instead of a relationship
What Schwab and Apple settled fifteen years ago that healthcare still argues about
Why a real-time feedback tool on a short-staffed unit can make things worse
Feedback as an early safety signal, and why marketing usually owns the platform it arrives on

Acknowledgment is not action. If the only thing that ever comes back to a patient is thanks for your feedback, you closed the ticket and left the loop open.

Mentions from the Show:

Alchemer, 2026 Healthcare Experience Report (vendor study, disclosed on air): https://www.alchemer.com/resources/e-guide/2026-healthcare-experience-report/
Penn LDI, Surveys of Hospital Patients Evolve to Use Email, Phone and Mail, 2025 (HCAHPS response rates, survey timing): https://ldi.upenn.edu/our-work/research-updates/surveys-of-hospital-patients-evolve-to-use-email-phone-and-mail-and-even-narratives/
Susan Edgman-Levitan, AHRQ CAHPS principal investigator, on response bias, 2025: https://www.patientguidesolutions.com/beyond-the-new-hcahps
CMS Hospital Value-Based Purchasing, HCAHPS weighting and the 2% DRG withhold: https://www.cms.gov/medicare/quality/value-based-programs/hospital-value-based-purchasing
Becker's Hospital Review, A New HCAHPS Survey for a New Year (Rick Evans, NewYork-Presbyterian e-survey pilot), 2024: https://www.beckershospitalreview.com/patient-experience/a-new-hcahps-survey-for-a-new-year/
The Beryl Institute, Closing the Loop: Using Real-Time Feedback to Improve Patient Experience (Providence Holy Cross): https://theberylinstitute.org/product/closing-the-loop-using-real-time-feedback-to-improve-patient-experience/
Bain & Company, Closing the Loop (Net Promoter System, Charles Schwab and Apple, inner and outer loop): https://www.bain.com/insights/closing-the-loop/
Press Ganey, patient safety and likelihood to recommend (measurement vendor): https://www.pressganey.com/resources/blog/patient-experience-2025-new-trends/
CMS Patient Safety Structural Measures, 2025 (patient and family involvement as one of five components): CONFIRM URL before publish
Baldrige Performance Excellence Program, voice of the customer criteria: https://www.nist.gov/baldrige
TP68, Yelp or HCAHPS: Which is Better to Measure Patient Experience? (May 2018): https://touchpoint.health/podcast/tp68-yelp-or-hcahps-which-is-better-to-measure-patient-experience/
Unbound Snacks, Chris's recommendation (flavored walnuts): https://www.unboundsnacks.com/
Reed Smith on LinkedIn: https://www.linkedin.com/in/reedtsmith/
Chris Boyer on LinkedIn: https://www.linkedin.com/in/chrisboyer/
Chris Boyer website: http://www.christopherboyer.com/
Chris Boyer on BlueSky: https://bsky.app/profile/chrisboyer.bsky.social
Reed Smith on BlueSky: https://bsky.app/profile/reedsmith.bsky.social

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