New rounds in the patient satisfaction debate
On July 8th Medscape presented a thought provoking discussion with three primary care physicians titled “The Good and Bad of Patient Satisfaction Measures.” This fuels the ongoing debate of the value and scores as part of physicians’ payment for their patient services -- a subject of keen interest to me. In March 2012 the Archives of Medicine published a study conducted by Joshua Fenton, MD, MPH, and colleagues at the University of California, Davis. The study analyzed data from more than 50,000 adult patients, indicating the most satisfied patients were 12% more likely to be admitted to the hospital and their healthcare and prescription drug costs were 9% higher. One of the most interesting findings to the study’s readers was that the report revealed more than 26% of these patients were more likely to die. What a startling fact! One of the strengths of this study was its nationally representative sampling. The findings were derived from the assessment of satisfaction based on 5 measures from the well-known CAHPS survey, emergency department visits and inpatient admissions. The tension between patient satisfaction and patient outcomes and cost savings continues two years after the study was released. There is discussion about whether physicians motivated by payment structures based on patient satisfaction are influenced in the ordering of diagnostic studies typical treatment standards in order to keep patients happy. An article in appearing in Forbes on July 21, 2013; “Why rating doctors is bad for your health” by Kai Falkenberg discusses this issue. "THE MATH IS NOW SIMPLE FOR DOCTORS: More tests and stronger drugs equal more satisfied patients, and more satisfied patients equal more pay. The biggest loser: the patient, who may not receive appropriate." When physicians are pressured and financially incentivized to keep patients happy an ethical dilemma occurs and some physicians succumb to appeasing patients by ordering tests they might not otherwise order. Forbes reported that the South Carolina Medical Association asked its members whether they’d ever ordered a test they felt was inappropriate because of such pressures, and 55% of 131 respondents said yes. Nearly half said they’d improperly prescribed
