Most physicians have long been critical of patient satisfaction surveys. They question whether the surveys truly measure quality and whether it's fair to use them to determine physician bonuses.
They will finally get their wish under the new physician payment system under the Medicare Access & CHIP Reauthorization Act. The 90% of physicians expected to use the standard incentive program (dubbed MIPS for Merit-based Incentive Payment System) will have the option of excluding patient satisfaction ratings from the formula for determining rewards or penalties to their pay.
The CMS escape clause came in response to the general hostility most physicians have toward the surveys. In a survey for Modern Healthcare conducted by New York City-based SERMO, an online physicians' social networking website with over 600,000 members around the world, only 9% of 2,100 respondents thought patient satisfaction surveys accurately reflect the quality of care.
“There's no clarity at present on the issue of how strongly clinical measures of quality and patient satisfaction are related,” said Timothy Hoff, a medical sociologist and professor of management at Northeastern University in Boston. The healthcare industry generally oversimplifies patient experience, he said, making it difficult to link it clearly to other health outcomes.
Yet a number of healthcare systems that have experimented with public posting of patient satisfaction survey results and comments have seen their physicians strive to improve their relationships with patients, which can mean anything from improving their bedside manner to being more attentive to basic needs.
In December 2012, the University of Utah Hospitals & Clinics in Salt Lake City became the first hospital to post patient survey results online. “It actually resulted in a big turnaround for our institution,” said Dr. Thomas Miller, chief medical officer at the system.
But even Miller is opposed to linking physician compensation to survey results, which the CMS' new proposed policy will give his system and its employed physicians the option of doing. “I would advise against it,” he said. “Our success is an indication that you don't need to because people tend to look out for their own self-interest and self-image.
“Once your reputation is out there, it's yours to manage,” he said. “You don't know that you need to compensate people for that.”
Critics of patient satisfaction ratings have focused most of their ire on the Consumer Assessment of Healthcare Providers and System (CAHPS) measurement tool, which is used by the CMS for both physicians and hospitals and is considered state of the art in measuring patient satisfaction. They say the questions in the patient experience sections are crude proxies for deeper or more complex aspects of care.
Hoff pointed to the example of a provider giving a patient an unnecessary antibiotic simply because it will earn him or her a better rating because the patient came away from the encounter with a prescription. “Is that necessarily the right clinical thing to do in that situation? Maybe not,” Hoff said. “High levels of patient satisfaction don't always mean that good quality is being delivered and also it means sometimes that there's overutilization being committed.”