How patient satisfaction scores reward rich hospitals

Medicare 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, also on FacebookTwitterGoogle+, and LinkedIn.

View 7 Comments >

Most Popular

✓ Join 150,000+ subscribers
✓ Get KevinMD's most popular stories