How patient satisfaction scores reward rich hospitals

How patient satisfaction scores reward rich hospitalsMedicare is beginning to tie financial bonuses to hospital patient satisfaction scores.

Although patient satisfaction is important, I’ve voiced concern in the past about giving hospitals a financial incentive to cater to patient surveys.

In a previous USA Today column, I wrote, “already, more than 80% of doctors … said patient pressure influenced their medical decisions. And in primary care, linking bonus pay to patient satisfaction could cause physicians to be more selective in who they see, subtly keeping patients who they know will score them well, and referring disagreeable ones to other providers.”

In the New York Times, which examines the issue, there are a myriad of other unintended consequences. Most concerning of which are the fact that hospital amenities influence patient satisfaction:

… hospitals are worried that assessments from patients … can be influenced not just by the quality of their care, but also by amenities like single rooms, renovated units and tasty food …

NYU Medical Center, for instance, found that newer facilities improved patient satisfaction scores — even as the medical staff stayed the same:

When NYU moved its cardiology unit to a renovated floor in 2008, patient rankings shot up even though the procedures and employees were the same. NYU found that long waits at its elevators drove down its scores, so now it is building a new bank of elevators.

Rich hospitals are better positioned to take advantage of this, as they can incorporate such hotel-like luxuries and spend money to improve patient services.

Again, at NYU Medical Center, money is spent on touches that have little to do with improving patient care:

NYU is scrambling to find lots of little ways to please patients. Nurses in the emergency room are instructed to greet people at the door within 30 seconds. Several floors have started happy hours, providing chips and cookies for family members. The maternity ward has been experimenting with giving women cellphones so they can text their nurses. When new mothers leave, they are given cards signed by doctors and nurses.

I’m not saying the patient experience can’t be improved. It certainly can, and should be a top priority for hospitals.

But are patient satisfaction surveys the right instrument to, in part, base hospital reimbursement on? As it stands, such surveys only incentivize hospitals to spend more money to build new luxurious new buildings, and provide superfluous amenities like patient happy hours.

At a time when our health system teeters on bankruptcy, with more than 50 million Americans uninsured, that doesn’t sound like the best use of resources to me.

 is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

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  • heartsurgeryguide.net/

    agree 100 percent. let us not confuse pandering with better clinical outcomes. this is another reason to reconstruct our healthcare system so as to incentivize providers for maintaining patient health, not reimbursement for specific tasks. it may be too utopian, but i would like to see patient satisfaction driven by feeling their providers rendered effective, compassionate care, not by the ambiance of the office, waiting area or hospital room.

  • http://drrjv.wordpress.com/ drrjv

    Wonder if hospitals will go the way colleges have, with fancy dorms and other amenities which have little to do with the actual goal of the institution?

    Some are suggesting that increased narcotic prescriptions are related to patient ‘surveys’ – Are doctors supposed to make their patients ‘happy’ or provide good health care?

    • Anonymous

      Narcotics–you are very correct on that one.  I don’t remember the survey, but it does back up what you said.
      There are some things patient satisfaction surveys can help with–concern shown, effectiveness of explanations, etc, but don’t add in “overall satisfaction”–generic generalized scores are truly worthless at evaluating medical care.

  • http://twitter.com/Atlantic_Health Matt Schneider

    The ways in which hospitals are getting reimbursed for patient satisfaction is quite convoluted. It is ironic because they are spending all this time and money to appease the happiness of patients, when in reality all they want is basic quality care from a doctor that simply wants them to get well.  There are minor ways for physicians and their practices or hospital systems to take steps to improve patient care, with genuine passion, the revenue will come later.  We talk about some ways for physicians to lead this in our blog post.

  • http://twitter.com/Atlantic_Health Matt Schneider

    The ways in which hospitals are getting reimbursed for patient
    satisfaction is quite convoluted. It is ironic because they are spending
    all this time and money to appease the happiness of patients, when in
    reality all they want is basic quality care from a doctor that simply
    wants them to get well.  There are minor ways for physicians and their
    practices or hospital systems to take steps to improve patient care,
    with genuine passion, the revenue will come later.  We talk about some
    ways for physicians to lead this in our blog post: http://blog.myatlantichealthsolutions.com/Atlantic-Health-Solutions/bid/96251/5-Steps-to-Improving-Your-Practice-s-Patient-Experience

  • Doug Capra

    Good article, Kevin. I agree that “customer service” can go overboard, but you write: “I’m not saying the patient experience can’t be improved. It certainly can, and should be a top priority for hospitals.
    But are patient satisfaction surveys the right instrument to, in part, base hospital reimbursement on?”
    Some hospitals, as with any institution, are so embedded with group think that some external force is need to get them moving toward patient satisfaction. Institutions often tend to focus inward on what’s best for them not what’s best for their clients. Look at the Penn State scandal. These surveys may not be the best vehicle, but if not, then we need to look at other ways to force patient-focused decision making. Why? You write: “NYU Medical Center, for instance, found that newer facilities improved patient satisfaction scores — even as the medical staff stayed the same.” To what degree do psychological issues play a role in patient health and contribute to their getting better?  What message about the importance of their education do we give children when the schools they attend are falling apart and need major repairs? The teaching may be the same quality as in more affluent schools, but you can’t underestimate the psychology. Perceptions can make a huge difference in feelings patients have about their dignity and safety. For all of us, perceptions can become reality if we react and behave based upon those perceptions — whether they actually represent the reality or not.

  • http://twitter.com/drbetsyb Betsy Bennett, Ph.D.

    Kevin – Great post, and I agree with both you and Doug Capra: We have to find some way to force hospitals to pay attention to the patient experience, and I’m very interested in how satisfaction surveys can be designed to do it well. My recent blog post dealt with this issue from the patient perspective (www.strategy4change.com). To briefly summarize, as a patient I was quite dissatisfied with the satisfaction survey I received from a major university medical center. One astute reader suggested that what I really wanted was a real conversation with a real person who is empowered to make changes in the hospital organization. So true, and so ironic that the very idea of a conversation felt to me like  ”out of the box” thinking! :-)

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