Tying Patient Satisfaction to Medicare Reimbursement is Problematic

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    Patient satisfaction surveys are important in helping the healthcare facility to harvest data, discover perceptions of the care being rendered, and gather suggestions on how to improve. Since patient satisfaction surveys consist of subjective data instead of objective metrics, the responses should not be tied to Medicare reimbursement rates.

    Patient satisfaction surveys have been receiving an amplified amount of attention at hospitals and other types of healthcare facilities, especially since the results of these reviews now have a significant effect on Medicare reimbursement.

    Valuable information can be gleaned from the comments and feedback that patients provide when they fill out and return the surveys to the facilities where they previously received care. In addition, patient feedback is a remarkably important tool that helps the healthcare facility to harvest data, discover perceptions of the care being rendered, and gather suggestions on how to improve.

    Still, patient satisfaction surveys are not exactly free from problems. In fact, patient satisfaction surveys are problematic for several reasons.

    First of all, the results of these patient satisfaction surveys are entirely subjective and do not always reflect the quality of the care that clinicians are delivering. For instance, many of the most poorly rated facilities have some of the best patient outcomes, including lower than average death rates, low readmission rates, and a minimal number of hospital-acquired infections. Good facilities and skilled healthcare workers are two of the main ingredients that make favorable patient outcomes possible, but a handful of nitpicky patients can destroy one hospital's overall patient satisfaction rating by returning surveys where they've responded to every single question with 'one.' A survey score of 'one' translates to 'very poor' care, even though the patient who returned these dismal responses actually might have had an excellent outcome that was free of complications.

    On the other hand, many of the most favorably rated facilities have some of the worst patient outcomes, including higher than average patient death rates. A USA TODAY analysis of more than 4,600 U.S. hospitals has found that 120 of those most highly rated by patients have higher than average death rates for heart attack, heart failure or pneumonia (USA TODAY, 2011). However, a patient's perception is his reality, so he will return a survey with appreciative responses to every single question if the care was perceived as being good, even if the inpatient stay is taking place at a hospital with a high percentage of poor outcomes.

    Secondly, the corporations that formulate patient satisfaction surveys are exploiting hospital administrators' hopes of using the ratings to market their facilities. One national chain of cancer treatment hospitals regularly uses expensive airtime to broadcast television commercials. The narrator of their TV commercials never fails to mention that "our facilities have an overall 95 percent patient satisfaction rating!" Countless hospitals across the US have resorted to providing customer service measures that sometimes detract from effective patient care as an attempt to alter perceptions and raise patient satisfaction survey scores. Many overworked nurses are spending increasing amounts of time on activities such as the recital of phony scripted phrases and the constant fetching of snacks, sodas, chairs and cots to keep clients happy.

    Finally, patient satisfaction surveys can unfairly generate positive ratings for mediocre doctors and bring about poor ratings for highly competent physicians. The physician who coddles the most demanding patients, submits to their unrealistic requests, gives them everything they desire and never says "no" will receive high ratings. In contrast, the doctor who sets realistic limits with patients and says "no" to improper medical care or unnecessary prescriptions will be rated unfavorably. A growing number of patients will be unhappy if they do not get what they want out of their clinicians, even if they do not need the things they are requesting.

    Patient satisfaction surveys have their place in the realm of healthcare because the opinions of the people to whom we provide care are essential. However, the surveys are based on subjective perceptions instead of objective metrics such as infection rates and patient outcomes. In view of the fact that patient satisfaction surveys consist of subjective data, the responses should not be tied to Medicare reimbursement rates.

    USA TODAY Publishes Analysis of Death Rates at More Than 4,600 U.S. Hospitals. (August 2011). usatoday.com. Retrieved March 7, 2013, from http://usatoday30.usatoday.com/marke...hospitals.html
    Last edit by Joe V on Mar 8, '13
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  3. by   MECO28
    Astute as always, Commuter. I had a patient just the other day who had one of the most experienced nurses on out unit but wasn't happy with her. Why? Because this nurse does not coddle and is very matter-of-fact. She is the first to notice a change in condition and to meet that change with the appropriate intervention but this patient felt she wasn't empathetic enough.

    It's a sad day when experience and excellent care mean less than remembering no ice in the water and extra snacks. I could go on...
  4. by   sistasoul
    These patient satisfaction scores are just a way so Medicare does not have to pay out. This among other things is driving me out of the hospital.
  5. by   sistasoul
    It is also a way to get good nurses fired due to "opinions" that are uneducated on what good care consists of.
  6. by   Aurora77
    Brilliant commentary, Commuter. I do believe patient satisfaction should be considered by medical staff, since customer service is important, especially in terms of adherence to treatment regimens. However, to have such a substantial portion of reimbursement tied to arbitrary scores is ludicrous. This system can only have been designed by someone with no actual knowledge of health care.
  7. by   azhiker96
    My wife once had a complaint called into the office after she did a home visit. The complaint was that "the nurse didn't hoover the carpets". Seriously, the patient's spouse expected the hospice nurse to clean up the house as part of a visit.
  8. by   MECO28
    Furthermore, it's also human nature to comment and dwell on bad things rather than good things. That's why there are so few comments like "My awesome nurse kept me alive and comfortable her entire shift!" and so many like "My nurse didn't smile enough and forgot my warm blanket."
  9. by   Donoharm
    I have heard many nurse voice this very statement. Seems nursing adm is telling the staff that if "their patient satisfaction scores don't improve nurses and techs will need to look for another job". You know nurses aren't selling shoes!!! It isn't about sales or is it?
  10. by   Marisette
    This sounds worse than the hotel and hospitality industry.
  11. by   TheCommuter
    Quote from MECO28
    Furthermore, it's also human nature to comment and dwell on bad things rather than good things.
    There's actually a term for this phenomenon: negativity bias.

    Negativity bias is peoples' psychological tendency to focus more of their attention on negative events and experiences rather than positive or neutral occurrences. So the healthcare workers can do 1,000 things correctly during a patient's stay, but the patient will be focused on the one negative occurrence ("My breakfast plate had cold, watery eggs.").
  12. by   KnitWitch
    This pretty much articulates every objection I have to these stupid patient satisfaction surveys in a clear, concise nutshell.

    Essentially I won't get a raise for providing quick, competent, lifesaving care to a critical patient, but if I facilitate the delivery of snacks and dilaudid to every patient that asks for it I get better ratings and a raise.

    Priorities? Standards? What are those?
  13. by   uRNmyway
    I have a question about this...If you receive a questionnaire and don't submit it, does that affect anything? Is 'No comment' seen as 'bad comment'?
  14. by   turnforthenurse
    Quote from Jeweles26
    I have a question about this...If you receive a questionnaire and don't submit it, does that affect anything? Is 'No comment' seen as 'bad comment'?
    I think it only counts if a patient submits a survey.

    And I agree, KnitWitch. Forget my professional nursing judgement. Give the somnolent patient their dilaudid, klonopin and benadryl all at the same time because "it's good for satisfaction scores." Let the patient go downstairs and smoke even though we're a non-smoking facility. You're on a 1500cc fluid restriction but it's okay to have all those soda cans and juices at your bedside because it makes you happy. You're diabetic? Go ahead and eat all of those sugar-laden snacks at your bedside, it won't mess with your blood sugar!