Health plans have been under pressure to improve service. Now, the heat is on providers.
Employers and health plans are starting to demand that hospitals and physicians measure patient satisfaction.
Ultimately, many want surveys to be standardized and made public.
In some markets, variations in price and geographic coverage have disappeared, creating demand for new ways to distinguish providers. It's also become apparent that satisfaction with health plans is tied to satisfaction with providers; both must be measured.
"I think there is the beginning of a recognition that part of the reason people change (health) plans is they're not happy with the provider networks," said David Furse, president of NCG Research of Nashville, Tenn., which is part of Dallas-based Solution Point. NCG measures satisfaction rates for 200 hospital clients, up from 140 a year ago. Data from NCG clients, such as Bon Secours-Maryview Medical Center in Portsmouth, Va., demonstrate the potential costs of patient dissatisfaction (See chart).
Blue Cross of California is stepping up efforts to survey contracted providers. In the past year, Blue Cross took the unusual step of requiring hospitals to measure patient satisfaction. It also increased fourfold the patient surveys it conducts on its 150 medical groups and independent practice associations under contract.
The goal is not to exclude the bad apples but to help them improve, said Jeff Rideout, M.D., vice president of quality management at Blue Cross. Employers have asked to see the data, but Blue Cross has refused because the data are inadequate to guide purchasing decisions, he said.
"I think Blue Cross is probably doing as much or more than anybody to collect data at the provider level. I'm still cautious about how to use that data," Rideout said.
Nevertheless, employers in states such as California, Ohio and Wisconsin are eager to give patient satisfaction data to employees to help them pick providers.
In California, the Pacific Business Group on Health and the Medical Quality Commission are sponsoring the Physician Value Check Survey, collecting data from 55 medical groups and IPAs. A survey of hospital patients is also on the agenda.
Many plans include the same providers, so picking a physician can be more critical than picking a plan, said David Hopkins, director of health information improvement for the Pacific Business Group on Health.
Several officials of provider associations and accrediting bodies interviewed expect provider-level satisfaction measures to gain importance. Many are trying to develop standards and benchmarks-not just to measure satisfaction for purchasing decisions but to help providers pinpoint areas that need improvement.
Numerous surveys are on the market, and payers probably will have to offer financial incentives to get providers to use the same measurement tools. Some payers would like to see providers conduct the surveys in order to have larger sample sizes and better response rates.
The Pacific Business Group on Health and the Medical Quality Commission would like to see their survey become the standard in California.
Likewise, providers have responded with their own initiatives. The American Medical Group Association created a database to establish benchmarks for specialty doctors. So far, 12 clinics with 781 doctors in 39 specialties are included. It has collected 38,000 surveys and expects to have 100,000 by year-end.
The American Medical Association has said it will incorporate patient satisfaction measures into its newly unveiled physician accreditation program.
Dean Medical Center in Madison, Wis., started measures for its 400 physicians, physician assistants and nurse practitioners last fall, partly in response to a request from employers. Fifty patients are surveyed for each of the providers, who can see how their results compare with overall measures in various departments. The data are part of the AMGA database.
The process has been an eye-opener for practitioners, said Sheryl Thies, Dean's vice president for marketing. Even though each doctor's results are confidential, some have shared their data with colleagues in an effort to improve performance.
Dean's survey is done while a patient is in the office, eliminating costs for phone calls and mailing. It costs an estimated $70,000 per year.
However, Thies said, several issues have yet to be addressed before consumers can compare satisfaction rates of providers in the market. Each hospital uses a different measurement system, but employers don't want to drive up costs by forcing some of them to change or duplicate their efforts.
Employers have expressed willingness to pay some of the costs of a new survey tool, but, she said, "We don't have a resolution yet." Also, the data that are released might be too general to help an employee pick a particular physician or department.