With all the talk about consumer-directed healthcare and other value-based purchasing regimes, physicians and hospitals are directing increasing amounts of attention to meeting their patients' needs.
To date, the impact of this focus has been limited, as patient satisfaction and quality still take a back seat to cost in employers' healthcare purchasing decisions.
Patients also appear to be more interested in cost. Pollster Harris Interactive reported in August that the No. 1 consideration in selecting a doctor (46% of those surveyed) or hospital (32%) is whether the provider accepts a person's insurance plan.
In contrast, report cards and other much-hyped performance measures are important to a mere 8% of patients when choosing a physician, according to the Harris survey of U.S. adults.
More than any other factor, consumers believe that a strong reputation reflects the quality of care they can expect from a specific physician or hospital, the poll indicates.
About 65% of respondents say a physician's reputation is among their three most important indicators of care quality, while 57% cite a referral from another doctor and 56% rely on a personal recommendation from friends or family. Just one in five respondents believes a high rating in published evaluations reflects physician quality, according to the poll.
"We would not disagree with that at all," says Robert Wolosin, a research associate for Press Ganey Associates, a South Bend, Ind., company that tracks trends in healthcare satisfaction. "It is the personal aspects of care, the relating and relationships of the staff to the patients--that's what seems to make the most difference."
How hospitals handle clinical and administrative errors is more significant than whether an error actually occurred, Wolosin says. Proper error recovery can prevent malpractice suits, he says.
"We believe that you don't sue your friends," Wolosin says. "Somebody has to be angry. There has to be something that seems to be amiss, like a broken promise."
David Nash, M.D., director of health policy and outcomes at Jefferson Medical College of Thomas Jefferson University in Philadelphia, says the traditional drivers of patient satisfaction are "availability, affability and ability of physicians." He says insurance coverage probably will continue to drive healthcare choices, not consumer information.
Report cards and other current measures of healthcare performance are not resonating with patients, quality experts say.
"They don't make sense and they aren't presented in a way that is salient, that the average person can understand," says Arnold Milstein, M.D., medical director of the Pacific Business Group on Health, San Francisco, and co-founder of the Leapfrog Group, a coalition of large corporate healthcare purchasers.
Milstein says morbidity and mortality rates mean little to the public. "The risk of harm makes much more sense to the average person," says Milstein. "What makes sense is: 'Am I going to suffer a medical error?' These are measures patients can relate to at an individual level."
Kenneth Kizer, M.D., president and CEO of the National Quality Forum, a Washington-based organization that seeks to improve the reporting of healthcare performance data, says patients simply want information specific to their condition, their hospital and their physician.
"Most of the information that the public has available to them is not particularly relevant to their doctor," says Kizer. "We've never had a social marketing campaign in this country that explains to the public what all of this means and why they should care about it."
Payers are satisfaction drivers
Even if patients are slow to catch on to patient satisfaction measurement, payers are starting to give physicians and hospitals financial incentives to keep patients happy:
- In California, six major health plans have agreed to pay physicians extra for meeting performance goals as part of a three-year program from the Integrated Healthcare Association. Patient satisfaction surveys will provide 40% of the performance measurement, the Walnut Creek, Calif.-based policy organization says.
- Blue Cross and Blue Shield of Massachusetts this year began paying bonuses to specialty practices based on patient satisfaction and access, quality of care and cost.
- CMS is working out an agreement with the AMA for a Medicare demonstration project to determine the effectiveness of physician performance measurement sets for at least eight specific chronic conditions and ambulatory treatment regimens.
"This is going to get people's attention." Milstein says.