A new report by the Hastings Center suggests patient-satisfaction surveys that Medicare uses to assess healthcare providers are seriously flawed. The authors question whether the government should be relying on them in quality initiatives such as value-based purchasing.
“Good ratings depend more on manipulable patient perceptions than on good medicine,” states the report, entitled Patient-Satisfaction Survey on a Scale of 0 to 10. “In fact, the pressure to get good ratings can lead to bad medicine.
The healthcare industry remains under pressure to boost transparency and provide information meant to help patients make informed decisions about their healthcare options. The evaluation of patient experience and satisfaction has emerged as a key area of concern.
In response, some hospitals have added patient experience leaders to the C-suite to help change hospital culture and prioritize patient satisfaction. Others have hired consulting groups to evaluate and suggest strategies to boost satisfaction.
In April, the CMS added to the consumer website Hospital Compare a new rating that assesses performance on publicly reported measures from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, which evaluates patient experiences. But the results showed that U.S. hospitals continue to struggle. Of more than 3,500 hospitals to be evaluated, just 251 got the highest score of five stars on the rating system.
It might be time to re-evaluate whether the focus on patient satisfaction is actually generating improvements or leading the industry astray, said Dr. Stuart Youngner, a professor of bioethics and psychiatry at the Case Western Reserve University and Alexandra Junewicz, a resident in psychiatry at the NYU School of Medicine, in the Hastings Center report.
Patients should indeed have the opportunity to share feedback and inform healthcare leaders, but the concept of “patient satisfaction” remains poorly defined, making it difficult to measure, they state. Furthermore, surveys often blend healthcare quality and patient satisfaction under one umbrella, a conflation that could result in patients requesting and ultimately receiving treatments that are not medically necessary.
“Certainly, eliciting the patient's perspective is essential to shared decision-making and important to health care quality,” Youngner and Junewicz write. “Yet placing such an emphasis on the patient perspective risks giving patient-satisfaction surveys the power to pressure providers to “satisfy” their patients at all costs.”
The bioethicists also worry that focusing on patient satisfaction as an independent goal has made it “ripe for commercialization” and resulted in a boom of profit-making businesses.
According to a Modern Healthcare list of the nation's 15 largest patient-satisfaction measurement firms, Press Ganey, a private group based in South Bend, Ind., had the highest total number of clients at 130,685. They were followed by the Lincoln, Neb.-based National Research Corp. with 24,252 clients.
The companies “tend to appeal to hospitals' financial interests,” Youngner and Junewicz, promising increased profits through improved patient-satisfaction scores. A request for comment from Press Ganey was not immediately returned.
The current metrics used to rate, rank and evaluate hospital quality continue to undergo scrutiny as the field of quality measurement advances in healthcare. Improvements are more frequently gained on easily tracked process measures, like using checklists and giving discharge instructions. But many have questioned whether focusing on those priorities will lead to improvements in patient outcomes such as lower mortality and lower readmission rates or result in unintended consequences.
That could likely be the case for patient satisfaction, the Hastings researchers suggest.
“Pressure to tell patients what they want to hear and accede to unreasonable requests may increase the provision of unnecessary care,” and ultimately “lead healthcare astray, undermining the provision of optimum care for all.”