Patient satisfaction is a buzzword in health care and in Washington. If you Google “patient satisfaction,” you will get more than 7.4 million results.
Explore This IssueACEP News: Vol 31 – No 09 – September 2012
The results range from commentary and scholarly articles to details about the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey. Innumerable companies will help you “improve your patient satisfaction scores.”
This focus appears to be well deserved. If Americans are going to spend $2.3 trillion on health care (of which 31% represents inpatient care), then they should be satisfied too, right? Maybe not.
In a national study of patient satisfaction, health care utilization, expenditures, and mortality published by investigators from the University of California, Davis, higher patient satisfaction with doctors was associated with higher inpatient utilization, higher cost, and increased mortality, compared with less-satisfied patients (Arch. Intern. Med. 2012;172:405-11). The ultimate conclusion of this observational study is that we really don’t know how patient satisfaction is related to other aspects of high-quality care. It has certainly been suggested that patient satisfaction is directly linked to high-value care (that is, quality divided by cost = value), but this current study raises serious questions about that conclusion.
More important to this discussion is the plan to link hospital reimbursement and financial payments to doctors based on patient satisfaction scores as measured by the HCAHPS survey.
In light of the available evidence, is this a good thing? Probably not. Unfortunately, in an effort to rein in the growth of health care expenditures in this county, our government is experimenting on the health care system. In the Institute for Healthcare Improvement model, change is seen as inherently good whether you are moving forward or backward. If everything is changing (even in a willy-nilly fashion), a positive breakthrough is more likely to occur. That sounds nice on paper, but these changes can and predictably will have adverse consequences that may hurt our patients more than help.
I would like to share a personal story that highlights the complexity of patient satisfaction and high-value care. As an employee of the Cleveland Clinic, I had an opportunity last spring to reduce my health insurance premiums if I participated in a program that included routine preventive care, exercise, and adoption of healthy behaviors. As a 43-year-old man, I was active and otherwise healthy, and up to that point I had never required a regular doctor. I contacted a colleague to be “my doctor,” as I needed a statement from him if I were going to participate in this program. At this point, my satisfaction score was low; I didn’t want to see a doctor at all.