Do Patient Satisfaction Scores Truly Portray Quality Care?

Although touted as important indicators of quality patient care, patient satisfaction measures aren’t an accurate portrayal of positive outcomes and effective treatment, say Justin B. Cohen, MD, MS, Terence M. Myckatyn, MD, and Keith Brandt, MD.

In a recent op-ed published in the Journal of the American Society of Plastic Surgeons, the trio explained that patient satisfaction measures and surveys were first implemented to help steer the nation toward lowering healthcare costs while improving the quality of care provided.

According to the authors, the US spent $2.9 billion on healthcare in 2013, or 17.4 percent of the GDP. That compares to an average 9.3 percent of the GDP in 33 other developed nations.

In order to reduce spending, the Institute of Medicine suggested attaching incentive payments to high patient satisfaction scores, ideally driving providers to deliver high quality healthcare. The Affordable Care Act also established a provision for value-based purchasing, which created a set of quality measures that included patient satisfaction scores.

But those scores have been ineffective in actually improving quality healthcare, the authors said, influencing the way physicians deliver treatment potentially for the worse. In an attempt to avoid penalizations for low patient satisfaction scores, many physicians alter their practice in ways that don’t improve patient wellness and outcomes.

“The danger of these patient surveys is that they do not accurately quantify the physician’s skill, technical ability, or clinical outcomes,” the researchers said. “This point has not been lost on a diverse group of physicians who have written that patient satisfaction is overrated and often irresponsible.”

As hospital and practice administrators focus on obtaining high reimbursement rates, they promote often conflicting agendas: delivering outcomes-based care while keeping the patient happy. Some providers have trouble reconciling the two priorities, the authors stated.

For example, some emergency doctors may prescribe an antibiotic without running tests to determine a diagnosis simply to satisfy the patient and get her through the ER more quickly. Some providers might over-prescribe pain medication to avoid negative reviews (although HHS has proposed an agenda to reduce this problem).

Additionally, the authors said providers might forego important population health management questions to avoid offending a patient. These doctors might avoid conversations about smoking cessation, weight loss, and drug and alcohol use in order to offer a more pleasant experience to their patients, despite their clinical instincts.

“Behavior motivated by patient satisfaction becomes especially dangerous when ratings are directly tied to compensation,” the authors asserted. “Health care administrators appear to be sending a mixed message by saying that patient satisfaction outweighs outcomes.”

Hospital administrators may also be funneling their money and efforts toward amenities that are not related to quality care, the authors stated.

“The focus on patient feedback has already skewed hospital administrators’ agendas, and long-term hospital plans now center on renovating the physical buildings, elevators, lobbies, and patient floors, and also investing in luxuries such as valet parking and gourmet meals,” they noted. “One could argue that these costly expenses have more to do with the perception of health care quality rather than actual outcomes.”

The authors contend that there are other financial implications for patient satisfaction surveys. Providers who overprescribe drugs, order tests, and admit patients to appease them may run up high healthcare costs.

Additionally, issuing the patient satisfaction surveys also costs practices. Healthcare organizations reportedly spend anywhere from $150 annually to $100 monthly administering patient satisfaction surveys. And although costs have been quelled as CMS developed HCAHPS surveys, their standardized measures of hospital quality and patient satisfaction may not paint an accurate picture, the authors said.

The authors do concede that some studies point to no negative effect of patient satisfaction surveys. Some research suggests that patients who are more satisfied are more likely to take better care of themselves, they said.

Ultimately, the authors acknowledged the importance of collecting patient satisfaction scores, despite the fact that current systems may be flawed and skew provider decision-making.

“We hesitate to discard or supplant the notion of patient satisfaction as a focus of health care because of the humanistic concern that we should be caring for and improving people’s lives both objectively and subjectively,” the authors said. “What is clear is that these new rubrics currently do not consistently predict improved outcomes and satisfaction.”

Because patient satisfaction is inherently important, the authors suggested an overhaul of how it is measured. Patient satisfaction should measure quality measures in a better way, putting satisfaction in the context of proven care quality improvement. Making patient satisfaction specialty-specific may help in ensuring it actually measures the quality outcomes as perceived by the patient.

Additionally, the authors assert that providers focus on the aspects of patient satisfaction that they themselves can control: delivering high-quality, empathic care to their patients.

“We should do as we always have: be dedicated to the care of each patient with all of our talents to the best of our ability with the understanding that no physician is perfect and some patients will be disappointed despite our best intentions,” they concluded.

Dig Deeper:

• Patient Satisfaction and HCAHPS: What It Means for Providers
• Why Patient Satisfaction is More Than “Making Patients Happy”