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!

Michael Murphy, MD
Dr. Michael Murphy is co-founder and Chief Executive Officer of ScribeAmerica, LLC. He co-founded ScribeAmerica in 2004, and it is now the country’s largest and most successful medical scribe company with a staff exceeding 7200 employees operating in over 46 states nationwide. Today, ScribeAmerica is the recognized leader of the medical scribe industry and remains at the forefront of professional scribe education, training, and program management nationally. Dr. Murphy served as an Army Ranger for the 1st Ranger Battalion in Savannah, Georgia, which allowed him to gain various leadership skills along with the ability to develop standard operating procedures. He applies this to his daily duties for ScribeAmerica. Dr. Murphy has been a leader on multiple issues including scribe policy, hospital throughput, electronic medical record implementation and optimization of provider to patient ratios. His goals are to continue making all medical practice locations an environment built for an exceptional patient experience that allows providers to focus solely on patient care. Dr. Murphy received his Doctor of Medicine from St. George's University and completed his residency training in Emergency Medicine at the University of Medicine and Dentistry of New Jersey in Newark. He has co-authored one textbook and is involved in 3 peer review articles.
Posted In: General, Quality, Efficiency, Utilization On: Tuesday, 9 September, 2014


  • K W - November 5, 2014

    Is there any research that shows what percentage of patient satisfaction is the physician interaction versus the front desk, the nurses/CAs, the environment of the clinic etc.?

  • Eileen Sailer - May 2, 2015

    How do I find the patient satisfaction scores for our local hospital?

  • George Walruff, RN, BSN (CPT, USAR, Ret.) - July 24, 2016

    The BOTTOM LINE is correct, patient satisfaction scores MUST BE taken with a grain of salt. Actually, a cupful would be more like it. HCAHPS is, IMHO, a farce. A Corporate Hospital that I worked for, that kept the religious affiliation of the founding group as its name, taught staff to utilize certain words of the English language regarding ‘quality and satisfaction’ of care when speaking with the patients (clients). Of particular note, these words and terms could be found in HCAHPS survey forms. Of special interest is, if I’m not mistaken in my reading of regulations pertaining to this marvelous tool of the federal idiocracy, it is illegal to prompt patients in this manner.
    For the Federal Government to pay reimbursements, the patients are Medicare or Medicaid, and thus one must consider the source of the responses. More specifically, my experience has been that the entitlement mentality that often permeates the Medicaid cultural group is virtually never satisfied. (Perhaps a dose of work therapy would help.) And one more comment, a customer pays for services and goods, a consumer just consumes them. Play with that thought for a while and think about how you as a customer have to pay for services and goods that you receive and not on what you perceive them to be.
    Getting on to the subject of eHRs/eMRs (electronic Medical/Health Records), one must remember that the same Government brain trust that brought you HCAHPS, brings you eHRs/eMRs. Where records must be made to be electronically retrievable. Ok, so we had three eMR systems in that hospital – one for ER, one for L&D, and the main one for inpatients. One problem, they did not talk to one another, so again everything needed to be printed up for transferring a patient from one of those care settings into another. I work in a small rural hospital and yet again, we are making paper copies of eMRs for transferring patients to other facilities. When you pass a law that is supposed aid in communicating HC data, shouldn’t you have set a standard that would require electronic capability for all eHRs/eMRs to be read on any system in the country.
    Fortunately, some of us learned in the era of SOAPIER notes, paper, pen, and/or pencil, so when the time comes we can still take care of people and let others know what we have done. Most of us that have this skill also were blessed to have had teachers that taught us how to write legibly, use correct grammar, and how to spell correctly without spell-check or your friend and mine, auto-correct.
    So, you can leave your trust in Government to guide and regulate you in charting your work, or next time you’re buying reams of printer paper and ink cartridges to ‘transcribe’ your patients’ eMR to send to another provider for inclusion in their “chart”, buy a pad of paper and a pencil and write a note on how you provided care in a SOAPIER format. Now, which one describes what happened best and how long did it take you to write vs your scribe to type. (Extra credit for correct grammar and spelling.)

    • Bunmi - February 4, 2017

      “More specifically, my experience has been that the entitlement mentality that often permeates the Medicaid cultural group is virtually never satisfied. (Perhaps a dose of work therapy would help.)”

      This is soo true— and many people don’t realize that to get healthcare for free is a priviledge, but then these group with the entitlement mentality gets the upper hand to decide level of reimbursement with their rating … laughable but then it gets me thinking to research if this is how it really is on a large scale or if it’s only on a small scale

  • FairPriceRx - March 25, 2019

    Hey. It is very interesting. I like this reform. Now doctors began to more closely monitor their work. The level of satisfaction with medical care in recent years has become an important structural component of a comprehensive assessment of health care activities. Appeal to public opinion allows to identify problems that are not available to reflect the dry figures of official statistics, and most importantly – to establish cause-effect relationships. Now many say that it interferes with the work of the doctor. On the one hand it is. But if you look on the other hand, the level of service in hospitals has dropped significantly.


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