Patient satisfaction should not influence how doctors are paid


Medicare is thinking of using patient satisfaction scores in part to determine bonuses to hospitals.

According to Kaiser Health News,

… patient gripes soon will affect how much hospitals get paid by Medicare.

The Centers for Medicare & Medicaid Services is finalizing details for the new reimbursement method, required by last year’s health care law. Consumer advocates say tying patient opinions to payments will result in better care. But many hospital officials are wary, arguing the scores don’t necessarily reflect the quality of the care and are influenced by factors beyond their control.

This is seriously misguided policy.

I wrote last year, in a USA Today op-ed, that patient satisfaction scores should never influence how doctors are paid:

Satisfaction scores give patients a needed voice to express their concerns, which can help medical professionals improve their patient relations. But it’s a mistake to use patient satisfaction as a doctor’s financial carrot.

After all, a totally happy patient isn’t necessarily one who has received the best medical care.

Indeed, as progressive columnist Paul Krugman wrote in the New York Times,

medical care, after all, is an area in which crucial decisions — life and death decisions — must be made. Yet making such decisions intelligently requires a vast amount of specialized knowledge. Furthermore, those decisions often must be made under conditions in which the patient is incapacitated, under severe stress, or needs action immediately, with no time for discussion, let alone comparison shopping.

That’s why placing such an emphasis on patient satisfaction can endanger the almost “sacred” relationship that Krugman mentions.  Although we’re treating patients more like customers these days,  in medicine, the customer isn’t always right.  A financial motive to increase patient satisfaction scores may lead some to order a test or prescribe a drug that goes against their better medical judgment, all to meet a certain patient expectation of the encounter.

Don’t get me wrong. It’s important that patients be given a way to provide constructive feedback to doctors. We need to hear about it when we fail, and be receptive to suggestions on how to improve.  Patient surveys are an essential, and necessary, tool.  But it should be mutually exclusive from money.

Because it’s important to realize that, sometimes, the best medical practice means not always giving patients what they want.

Kevin Pho is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of, also on FacebookTwitter, and LinkedIn.


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