Keeping up patient-satisfaction scores may be having an unintended price
Studies show focus on keeping patients happy can have unintended costs
Agroup of physicians in the UCLA Health System faced a quandary last year. They had decided that a patient was ready for discharge to a rehabilitation facility, but the patient was refusing to leave.
In a push-and-pull seen frequently in hospitals across the nation, the California physicians acceded to the patient’s request to delay the clinically appropriate discharge because of their desire to keep the patient happy.
“Sometimes we are inclined to give the patient what they are asking for because we want them to have a positive experience, but we’ve learned that even if they are asking for something, it is for their own benefit to set boundaries,” says Tony Padilla, director of patient affairs for the Los Angeles system.
Padilla says such “overshooting” — where their clinicians allow patients to dictate some unneeded care that does not improve their health, but increases spending because of a disproportionate focus on patient satisfaction—is less common than it was several years ago when the health system began a large push around patient satisfaction.
But as patient- satisfaction measures have gained their first real teeth in Medicare, new questions are emerging about whether such tools carry unintended consequences.
Patient-satisfaction responses constitute 30% of each hospital’s score under the federal value-based purchasing system, which will either increase or decrease a hospital’s overall Medicare payments by up to 1% in 2013. The Medicare reimbursement changes come amid new evidence that providers say shows patient-satisfaction efforts may be counterproductive to efforts to improve care quality and patient outcomes or to control spiraling healthcare spending.
Some hospital executives and physicians question whether patient satisfaction—as it is currently measured—is an appropriate yardstick for rewarding or penalizing hospitals. And some recent studies, they say, indicate a disconnect between improved patient satisfac- tion and quality of care.
The issue came to the fore at last month’s meeting of the Medicare Payment Advisory Commission, when Dr. Rita Redberg, a cardiologist and MedPAC member, cited findings from an unreleased MedPAC analysis of 2011 Medicare claims data and cost reports that found similar patient ratings for hospitals with high and low mortality rates and those found to have high and low Medicare costs.
“If I were a patient, I would notice more how quickly I was seen, how good the food was, whether the nurses were responsive,” she says about the MedPAC finding. “And while that’s important, it’s probably not related to what we’re looking at in terms of quality and cost of care.”
Such findings, she says, echo a disconnect between patient satisfaction, quality and cost identified in a March 2012 study published in the Archives of Internal Medicine. That prospective cohort study of nearly 52,000 patients and the care they received concluded that higher patient satisfaction was associated with greater inpatient care use, higher overall healthcare and prescription drug spending and increased mortality.
The research “documents a correlation between satisfaction and healthcare utilization,” says Dr. Joshua Fenton, one of the authors of the study. “That is the part that clinicians notice.”
Fenton credits the link between patient-satisfaction scores and increased healthcare services to clinicians’ increasing desire to accede to requested treatments to please public and private payers, which have increasingly linked their reimbursements to patient satisfaction.
Meanwhile, the push for evidence-based, standardized care as a way to improve overall clinical outcomes while lowering costs has included placing patients in care settings deemed appropriate. In the patients’ eyes, that might seem counter to their best interests.
“We are emphasizing that care coordination is everyone’s job and everyone must find ways to keep patients out of the expensive sites of care such as hospitals but still maintain high levels of quality and patient satisfaction,” John Sheehan, executive vice president and chief operating officer at St. Luke’s Hospital, Cedar Rapids, Iowa, said in an e-mailed response to questions. “That said, many patients still perceive these efforts as reducing or withholding care and are not always satisfied with these new approaches.”
But efforts to restrain patients’ requests for unnecessary care also include the addition of services. For instance, St. Luke’s has added a pilot program to increase care
Recent studies show a disconnect between the level of patient satisfaction and the quality of patient care.