A doctor guilty of fraud has great patient satisfaction scores

A paper in JAMA Surgery noted that patient satisfaction ratings have very little to do with the quality of care provided by a hospital. The study analyzed data from 31 hospitals that participated in patient satisfaction surveys, the CMS Surgical Care Improvement Project (SCIP), and employee safety attitudes questionnaires. They found that patient satisfaction did not correlate at all with the rates of hospital compliance with SCIP process measures nor the opinions of employees about the culture of the institution for half the categories questioned.

They concluded that “patient satisfaction may provide information about a hospital’s ability to provide good service as a part of the patient experience; however, further study is needed before it is applied widely to surgeons as a quality indicator.”

What about patient satisfaction and the quality of medical care provided by doctors?

This is only an anecdote, but it does say volumes about the subject. In April, a New York area cardiologist admitted to defrauding government and private insurers of $19 million. This was described as the largest healthcare scam by a single physician ever recorded in New York or New Jersey. Thousands of patients underwent unnecessary and possibly dangerous tests and treatments.

He also employed unlicensed and unqualified personnel who treated patients. As noted by Dan Diamond, managing editor of the Daily Briefing, the Healthgrades patient satisfaction scores for Dr. Katz ranged from very good to excellent. In fact, Dr. Katz has received not one … not two … but three Healthgrades Quality Awards still in evidence on their website, which also reports no sanctions against him. I guess $19 million worth of fraud is not enough to impact one’s Healthgrades ratings.

Although these next two vignettes are about customer satisfaction and have nothing to do with patients, they further illustrate the folly of basing one’s opinion on satisfaction scores alone.

According to the Consumerist blog, a subsidiary of Consumer Reports, certain well-known companies have based employee pay raises and promotions on the results of customer satisfaction surveys:

Apparently, the companies considered anything less than a perfect 5 rating as failure. This resulted in employees telling patrons to either give them a 5 rating or — if they could not do so — to decline to take the survey. A friend said that when he takes his car to the dealer for service, they tell him they will be sending him a survey in the mail. Then they say if he can’t give them all 5s, he should skip the survey, and instead call and speak to the manager so they can do better next time.

I have seen this phenomenon in hospitals too. Personnel are coached about what to say to patients to help persuade them to give higher scores. I think it’s called “gaming the system.” How much weight can we really put on patient satisfaction surveys?

“Skeptical Scalpel” is a surgeon who blogs at his self-titled site, Skeptical Scalpel.

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  • Steven Reznick

    Coaching for satisfaction scores occurs everywhere. Each time I purchase a car the sales people plead with me to give them a 9 or a 10 when I receive a post visit survey even if I do not buy a vehicle from that dealershipt. The service departments for my wife’s , children and my vehicle ( all different companies) do the same thing.
    The fact that the physician is good at what he does , gets excellent ratings and is a criminal are apparently unrelated. New England Patriots Tight End Aaron Hernandez plays football at an all pro level. He is a fan favorite. His also being investigated and charged with murder.

    • Skeptical Scalpel

      Yes, some bad docs I know are loved by their patients.

  • darbsnave

    Did he post his own patient satisfaction scores??

    • Skeptical Scalpel

      It’s possible, but I don’t know how you could prove it.

  • Sara Stein MD

    Well, they say Ted Bundy was very charming!

    • Cyndee Malowitz

      Exactly – some of the worst doctors I know have the best bedside manners. Especially those who are involved in unethical practices that are highly profitable.

      • Guest

        Totally agree. We have one at our hospital. The physician is completely incompetent, incredibly rude to everyone, unprofessional, and yet receives the most positive feedback from patients and patient requests.

  • Suzi Q 38

    It is so easy to post your Health grades scores.
    Just ask every close friend and family member to post a good rating for you on the site.
    It goes by email; I don’t even think that they trace it back to individual computers..I could be wrong.

    Once I was venting and posted a negative evaluation on a physician, not really bad, but not 5 stars.
    I listed some things that he could have improved upon.

    I realized that it was somewhat unfair because I had not expressed my concerns when I visited the office for an appointment.
    I tried to get it changed, but they couldn’t even figure out how to do that.

    Once it is posted, that is it.

    I will be more careful next time.

  • Suzi Q 38

    My friend works as the director of radiology at a local hospital.
    She said the same thing…that they needed 5 stars or don’t bother.

    I thought she was just “talking” stories, LOL.
    Now I realize it is true.

    I rarely give a doctor or any service 5 stars. How could that be???
    No one is perfect.

  • Suzi Q 38

    I had physical therapy recently. I was really coached.
    I finally had to say that the service was fantastic.
    I told her my PT was fantastic, compared to the last PT I had a year ago. The evaluator did NOT want to hear about the last person that did not do very well.
    My guess is that if I the PT felt that I was not happy, I would NOT have gotten an evaluation.

    When I complained about the first PT employee, his manager said: “Well, we get near perfect patient evaluations.” Yes, if the patients were “coached” and you only send them to patients that you think were happy with your services,” I told him. Luckily for me, he did not argue, as that was a mean thing to say.

    The second time around (after I complained to the manager of the department), I received a very seasoned, and experienced physical therapist that specialized in spinal injuries. She was very “hands on” and patient. She gives me a full 45 minutes or more every time I see her, and spends 90% of the time working on me, instead of filling in time with ice treatments that I could do at home.
    She thinks hard about everything she does for me, and does not have me doing common and easy exercises that I could do at the gym without her.

    Sometimes, complaining in the right way helps. If I got one of those evaluations in the mail, I would love the opportunity to give her all 5′s, even though I truly believe that no one is perfect.

  • Skeptical Scalpel

    Suzi, Thanks for the comments. The idea of coaching people to give 5-star comments may be widespread. If true, then satisfaction surveys are even more useless than I thought.

  • EmilyAnon

    Sometimes those doctor rating sites can be useful for the patient when reading the complaints. A doctor can be great, but those around him can be real turn-offs. Especially rude or inconsiderate staff. If you read many comments spread out over time with the same type of complaints, I believe them. If those complaints are in an area I’m sensitive about, that will affect my decision whether to make an appointment. I think most doctors probably don’t have a clue if their staff is so difficult to the point of losing patients, current or potential new ones.

    As a personal anecdote, I stopped going to my longtime gynecologist because of bad treatment by his office staff. It was to the point that I dreaded calling for an appointment or even approaching the reception counter without a knot in my stomach. After 15 years with this doctor I really liked, I made the decision to just disappear.

    • Skeptical Scalpel

      The problem with reading the complaints is that a vocal minority may outweigh the many silent but satisfied patients.

      Your personal experience is what made you change doctors. To me, that’s more important.

    • SBornfeld

      If you really liked this gynecologist, you would (perhaps you did, but not mentioned) have contacted him/her. Very often, there is no way for a doctor to know about what’s bothering patients–unless they’re told.
      This has happened to me on a few occasions–the patient’s complaints (usually written) were answered courteously (by me). The situations in question changed, and the patients remained in my practice.

      • EmilyAnon

        Yes, I did think of writing a personal note to the doctor, or even make an appointment just to discuss my frustration. But, the problem was so long in the making, and my discomfort in any kind of confrontation, especially in a medical setting, stopped me from complaining.

        I also felt I would have put the doctor on the spot expecting him to question or take sides with staff that has been embedded for years, and who really rule the roost, a full complement of people servicing a 6 doctor practice. Which loss would be greater to him, losing a patient or antagonizing defensive staff that might jeopardize office harmony. Business sense would be to sacrifice the patient.

        Unfortunate for me as I didn’t see this doctor just for well woman visits. He assisted in my cancer surgery and actively managed my remission for many years. As I had standing appointments, I wondered if he would miss me and be curious about my absence. But he never called.

        • SBornfeld

          …and (hard as that is) you can’t take that personally either.
          I can understand finding it hard to speak up. Your aim is to help the doctor–he can use the information or not. You’re not asking the doctor to take sides (nor were my patients).
          If this staff member offended you, you can be pretty sure she’s offended others. That’s the way you’ve got to look at it. It’s certainly OK to feel you’ve got to find a new doc because you can’t tolerate the staff.

        • Guest

          Funny, Emily, I left an OB for the same reason. His medical staff kept treating me like trash and I had enough. What I felt bad about is that I worked with my OB and I know he thought I dumped him because I was dissatisfied with his care. I was happy with his care!

          I never explained myself either. It’s hard to discuss those things!

          • EmilyAnon

            Now that you mention it, I wonder if my doctor thought I dumped him. If he even missed me, that is. But don’t doctors have hundreds or is it thousands of patients? What would remind them that one person in their care isn’t around anymore. Most likely for a busy doctor it’s out of sight, out of mind.

      • FeedbackMatters

        The point about it being really difficult for a Doctor to know what is bothering patients is a really important one: we’ve been advocating asking patients structured questions about each stage of their care journey (balancing both operational and more qualitative satisfaction-related questions) in order to build a more comprehensive picture of drivers of patient satisfaction (or dissatisfaction) that Doctors might otherwise be unaware of.

        For example, one set of Practices we work with is asking patients specific questions about how easily they could get through by telephone, whether their reception team was polite and courteous, and whether call-backs came at the time the patient was expecting.

        All of these things sit on the periphery of patient care, but can have a huge impact on overall levels of satisfaction.

        There’s a side benefit to taking the time to ask this sort of thing too: if you’re getting high ratings by patients, you’ve then got the opportunity to recognise the contribution made by the rest of your team – especially if they sometimes feel that their efforts go unnoticed.

  • http://www.twitter.com/SociallyMD TJ Derham

    Whenever I look up a doctor to gauge their interest in social media, the first thing I find out is whether or not they are aware that these patient ratings sites are now Internet users’ first stop in discovering who they are. Those who do have good ratings that were clearly prompted (though still could be sincere). Those who don’t know/care have bad ones.

    This presents two problems. The first — that of these sites’ usefulness — is well outlined in the other comments below. The second problem is that, should you be a practitioner looking to start a blog, or build a website, or do whatever to advance your practice online, you inevitably have to contend with the SEO expertise of these sites. Ergo, if you want to take any part of your profession online, you will have to compete with your own name as listed on healthgrades, vitals, etc. for page-rank.

    I am annoyed on your behalf for both reasons. Good post, SkSc!

    • Skeptical Scalpel

      Thanks for reading and commenting. That’s a good point about the SEO issue. For many docs, the first five pages of a Google search are ratings from the myriad sites that collect them. And most of them do not list the doctor’s phone number unless you go deep into the site.

  • SBornfeld

    …and then there’s yelp…with its notorious filter.

    • http://www.twitter.com/SociallyMD TJ Derham

      Yelp is for finding fish tacos and hipster salons. Were I a doctor, I would find a way to “Fakeblock” the Dickens out of Yelp. Currently, the only way I can find to do so is to post a plethora of inappropriate content on your page until they delete your account. Have fun with that!

      • SBornfeld

        Brilliant. Sounds risky though. Does it work?

        • http://www.twitter.com/SociallyMD TJ Derham

          Stand by. Going to med school, getting a license, starting a practice, signing up for Yelp, writing content on how Nazis got a bad rap for my page. BRB.

      • Noni

        Sounds like someone is an Arrested Development fan….but, I digress.

  • Noni

    Today at the hospital I work at I saw a sign that said “You deserve 5 star care. If you do not feel you are receiving 5 star care please inform an employee.”
    For some reason it made me laugh. What is “5 star care?” Would you tell an employee “I feel I am receiving care at a level of 3.5 stars, I felt I should let you know.”

    • Skeptical Scalpel

      Yes, the concept of rating care is somewhat vague and as many have shown, not related to quality at all.

  • drgh

    well Healthgrades must have read this! They downgraded Dr. Katz’s scores. What is also ironic is that there is a surgeon who was in trouble with the board and died last year (likely was a suicide). His practice info is still up with all the reviews that are good-even though he was also in trouble with the board.

    • http://www.twitter.com/SociallyMD TJ Derham

      They did last week. Check it:

    • Skeptical Scalpel

      Yes. They contacted me on Twitter and thanked me for bringing this to their attention. Oddly, the revised ratings are based on only 9 patient surveys while there were 13 in the original ratings. I will attempt to find out why 4 surveys were deleted.