In April 2015, the U.S. government will begin boiling down [Medicare required] patient satisfaction surveys to a five-star rating for consumers researching hospitals, doctors, surgeons. Patient surveys have long been a debated topic in the healthcare industry.
The government's hope is to make it easier for consumers to digest the information now available on Medicare's Hospital Compare website.
Some may argue that revealing patient scores will increase transparency and trust. But hospitals have a different viewpoint on this issue.
Hospitals View Patient Satisfaction Scores Too Simplistic
Most hospitals will say judging an entire institution and all of its services on a scale of 1-10 [or any scale] is too simplistic. There can be a conflict in what patients are saying to doctors and nurses compared to what actually shows up on the survey.
Medicare requires a minimum of 300 surveys per year. Hospitals say Medicare doesn’t take into account that these surveys aren’t exact and sometimes come from a mere 100 patients/year.
Obamacare's Role in Hospital Ratings
The Affordable Care Act increased the importance and incentive of hospitals scoring well on these surveys. Each hospital's scores directly influences Medicare's quality ratings and pay rates. Ironically, most hospitals that were doing well on these surveys 5 years ago tend to be the ones continuing to do well. The question is do these surveys separate the hospitals that can quickly adapt to patient feedback and find solutions to improve?
What Patient Satisfaction Surveys Measure
TOP ISSUES THAT RELATE TO LOW SCORES
- Long emergency room wait times
- Wait times in general
- Care transition
- Cleanliness of hospital
- Quietness of hospital environment
- Communication about medicines / pain management
- Physician and nurse care, responsiveness, attention and communication to patient especially during surgery
- Hospital environment and patient room facilities: creating a more welcoming and warm place for patients
- Personalized touches
- Example: In one hospital, nurses make note of personal facts about the patient on a white board in their room.
- Not returning phone calls in a timely manner
- Patients claim they were not charged correctly or overcharged
- Inappropriate staff conduct
Hospital Rating Scores Online
The government will institute these ratings across many websites online that compare hospital quality ratings.
Currently consumers can look up information about hospitals on:
Patient Scores May Create Confusion
A recent study released in March from the Journal Health Affairs evaluated the surveys as creating more confusion for patients. Researchers found the surveys showed different ratings for hospitals across comparable websites like US News & World Report, Consumer Reports, Healthgrades, Leapfrog Group among others. No hospital was considered to be a high performer across all four websites. Some were considered to be a high performer on one website and a low performer on another. Researchers predict this causes further confusion instead of alleviating the overwhelming search for hospital quality for patients.
Patient Viewpoint v. Doctor's Autonomy Over Care
From a physicians perspective, this could bring into question a proper balance between patient satisfaction and a doctor’s autonomy to decide what the best care is. If doctors weigh patient satisfaction too heavily, it may create a tremendous burden on both physicians and health care facilities. It also may warp the incentives when doctors practice medicine.
For example, post-surgery, a patient may rate the surgeon based on how much pain they felt, even if they were given the best care and proper medication.
Link Between Patient Survey Scores and Pain Medication Abuse
Because of the surveys power to reduce funding to hospitals, it can put pressure on doctors to do whatever they can to increase their ratings. Some predict this could lead to unintended or harmful consequences. Critics claim doctors should be able to practice medicine in the way they deem best for their patients, not be hired or fired based on surveys that don’t tell the full picture.
Two Senators from Iowa and California took this issue further. They both are currently exploring the link between surveys and pain medication abuse across US. One even said:
“There is growing anecdotal evidence that these surveys may be having the unintended effect of encouraging practitioners to prescribe (opioid pain relievers) unnecessarily and improperly, which can ultimately harm patients and further contribute to the United States’ prescription (opioid pain relievers) epidemic”
Some physicians have reported that they have prescribed pain relief medication for the sole purpose of improving their patient satisfaction scores.
This issue is an ongoing one for hospitals and the healthcare industry and it brings into the question the reality of surveys across many industries. How much can we actually trust them?