Recently, Dr. Kevin Pho published a thought provoking opinion piece in USA Today about physician ratings on social media sites. Dr. Pho notes that the “Best physicians aren’t always the ones who have high satisfaction rates among patients.” Practicing emergency physicians feel the pressure of trying to meet patient expectations, while providing the correct diagnosis and treatment. Subjective survey questions focusing on throughput times and physician interpersonal skills run contrary to higher satisfaction scores when we have to discuss the death of a loved one or explain that the antibiotics or CT that the patient wants so badly is unnecessary. Regardless, hospital pay and our salaries are tied to these survey results.

There are concerns that the surveys influence physician behavior negatively. In theory, improving communication with the patient should improve quality of care. Studies show that improved communication improves patient adherence to the treatment plans, their understanding of their disease, and increases patient safety. Positive rapport and communication with the patient decreases the physician’s risk of liability; however, fear of a negative survey seems to influence the physician in the opposite way that we want. In a 2012 JAMA Internal Medicine review of more than 50,000 HCAHPS surveys, there was a disturbing correlation between higher patient satisfaction and higher health care costs, higher hospitalization rates, and higher death rates. In my opinion, the HCAHPS survey is not improving outcomes.

That said, the Patient Experience surveys are here to stay. And we all agree that improving the patient experience it is important. Hospitals and our in-patient physician colleagues have been submitting HCAHPS scores to Medicare since 2007, and we’ve learned from their experiences. And now, Medicare’s Value Based Purchasing program ties a portion of our hospitals’ Medicare reimbursement to HCAHPS scores, with physician Medicare PQRS payments soon to follow. Medicare views the CAHPS program as core to transitioning provider payment from quantity to quality: “the indispensible outcome.”

For years now, emergency physicians have dealt with patient satisfaction scores from private vendors. We analyzed the non-standardized survey questions and made the best of low response rates coupled with skewed percentile ranking systems. Emergency physicians used these surveys to accomplish their mission of improving care and patient outcomes by efforts such as demanding resources for throughput initiatives and improving both interdepartmental and individual physician communication skills. We listen better, keep the patient informed, and we mindfully explain our diagnosis and treatment plans to the patients and families. We also learned rounding techniques and follow up strategies to ensure that the patient gets the care they need or help if they get sicker. All these efforts result in better departments and better care for patients.