Patient Satisfaction (the CMS view)

The chart above is extracted from CMS data.  All US hospitals are now required to collect data on patient satisfaction.  This data is used by Medicare to adjust hospital payments upward for good satisfaction scores or downward for poor satisfaction scores.  This new payment adjustment certainly has the attention of hospitals since the adjustment amounts to a significant amount of money.

If one looks at the actual questions they really are pointed toward the quality of communication.   The questions are not about whether the treatment was satisfactory but whether there was good communication between the patient and the doctors, nurses and other staff.  The focus on communication tends to get around the criticism that sick people are never satisfied because they have some disease.   Even a sick patient can be quite satisfied (or not) with the communication received during a hospitalization.

The above table is the summary for the entire US.  The data is subject to a selection bias because the patient selects the hospital with some intent to select a good one.  But given that bias the results are not all that great — about 20% of patients did not feel they always had good communication with nurses and doctors.

Satisfaction is not the same thing as quality health care.  You might have been given the wrong medication or had unnecessary surgery but you went away happy (and ignorant of the problems).  Doing the right thing and getting a good outcome is what hospitals need to focus on.  Patient satisfaction is a small step in the right direction.

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  1. #1 by RxforAmerica on October 30, 2012 - 8:29 PM

    Clearly patient satisfaction is an important aspect of medical care that in the past may not have received enough dedicated effort. It will be interesting to see the effects HCAHPS and whether it actually contributes to higher quality or more cost effective care. There may be substantial risk associated with the intense focus on patient satisfaction to the point of altering reimbursement. As stated above, patient satisfaction is not the same as quality, and the effects of changing reimbursement based on patient satisfaction may actually include an increase in adverse outcomes and/or health care costs. At least based on one study, “The Cost of Satisfaction” in the March 2012 Archives of Internal Medicine, the highest levels of patient satisfaction correlated with increased mortality rates, overall costs, prescription drug use, and inpatient utilization. HCAHPS is a different scenario and focusing on better provider communication may work to improve compliance and overall care quality. Still it seems that this is an area to proceed with caution.

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