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September 09, 2014
HCAHPS: The True Impact of Patient Satisfaction

Patient satisfaction scores such as HCAHPS have become an integral part of a patient’s visit to the hospital. This scoring consists of questions pertaining to factors such as the level of noise on the floor throughout the night, the doctor’s bedside manner, and whether the patient would be willing to recommend the hospital to friends and family. This last question could hold the key to a hospital’s future.

The reason is not that this question weighs disproportionately more in the survey’s scoring as much as the fact that patient satisfaction is the new marketing tool for hospitals, especially considering the fact patients are increasingly involved in choosing a hospital. Moreover, because of Medicare’s tying of patient satisfaction scores to hospital reimbursements, physicians are under immense pressure to keep their patients satisfied. But is HCAHPS helping or hurting the patients?

HCAHPS does have its usefulness. For example, patients are now able to provide feedback on how well they believe their physicians communicated with them. Such feedback is helpful not only for physicians but also for hospitals as they work on improving their communication tools and tactics. Generally speaking, HCAHPS helps hospitals improve shortcomings in these areas, and studies have shown an inverse correlation between patient satisfaction and medical malpractice risk. But do satisfaction scores really measure quality of care?

Currently, the mantra some doctors use in keeping their patients satisfied is to never deny a request for pain medication, antibiotics, scans, or even hospital admission. Unfortunately, to keep Medicare reimbursements from being slashed, doctors and hospitals are vying for high HCAHPS scores by over-treating and over-prescribing!

Sadly, this not only translates into mounting costs on an already very heavily burdened healthcare system, but also suggests patients might not necessarily be getting what is best for their health. According to a survey, 47% of physicians reported having at least one patient per week request an unnecessary test. More than half of the physicians polled also admitted to ordering an unnecessary test when faced with a relentless, demanding patient — even though they would otherwise have advised the patient to not take the test. Furthermore, physicians who are bearers of bad news (for example, telling a parent that his/her child’s asthma is exacerbated by his/her smoking) are most probably not going to score very high on patient satisfaction scores. After all, good healthcare is not necessarily synonymous with popularity.

To further improve patient satisfaction scores, some hospitals have resorted to providing hotel-like accommodations and amenities for their patients. However, this too results in adding unnecessary costs to the nation’s healthcare bill! A growing number of studies have indicated that patient assessments of quality care might not necessarily correlate with clinical measures of quality. Simply put, a hospital with high patient satisfaction scores might not be the best when it comes to quality healthcare. There are factors in these patient assessments that unfairly penalizes hospitals that are busy — busy because of high caseloads. Studies have shown that hospitals with high caseloads are more likely to have better medical outcomes.

Besides patient satisfaction scores, what other information can patients use to select a hospital? Unfortunately, patients are frequently bombarded with mass amounts of information that may not mean much to the layperson.Dr. Lieberthal, using an existing statistical methodology known as the Pridit, developed a method that could help patients who are choosing between 2–3 hospitals narrow down their choice to the one, highest-quality hospital.

Patients need to look beyond “room service” and look at other factors that more strongly affect clinical outcomes. The lack of a flat-screen television in the room or the fact the physician advised the patient to quit smoking for the sake of a child’s health does not warrant the hospital’s or physician’s receiving low patient satisfaction scores. Bottom-line: take the results of these patient satisfaction scores with a pinch of salt!