Patient Satisfaction Surveys: Doing More Harm than Good?

August 5, 2016

With the cost of healthcare rising, is it really wise for hospitals to spend money on services that you'd find at the Ritz Carlton?

Welcome to Editor's Corner. Here, the editors of Physicians Practice will share their thoughts on the happenings in healthcare and look at the industry from a broader viewpoint.


A number of items on the web caught my eye recently.

Item number one: Health spending continues to grow and according to researchers from the Office of the Actuary at CMS, it will "represent 20.1 percent of the total economy by 2025." The growth in spending, which represents an increase from previous estimates, is mainly due to the aging of the population and faster growth in medical prices.

Item number two: Analytics firm Avalere examined why Affordable Care Act premiums were increasing in nine states (including the one I live in) and found that the main reason is the high cost of hospital outpatient services. In fact, outpatient services accounted nearly 30 percent of rate increase justifications in 2017.

Item number three: An article in The New York Times about how hospitals are catering to well-to-do patients with private insurance by offering high-end amenities. The amenities? In-room massages, on-demand meals, professional greeters and uniformed valets, are a few mentioned.

The article states that a portion of the amenities are paid for out of pocket and from donors, so it's not like this is serving the poor at the expense of the rich. Yet, something about that NYT article doesn’t sit right with me, especially when I look at items one and two. We're in a period of epically high healthcare costs, primarily at the hospital outpatient level, and the cost of health spending seems to be irreversible. Meanwhile, we've got some hospitals acting as if they are the Ritz Carlton.

They're not the Ritz and this seems like a good way to keep those health costs at a high level. I agree with this guy:

 

Here’s a great way to drive up health care costs for all by catering to fee-for-service care for rich peoplehttps://t.co/VZeJRSlu3h

- Tim Lahey (@TimLaheyMD) August 2, 2016

Do these swanky hospital services have a medical purpose? I'm not talking about a soft value "feeling better" ideal that isn't really measurable, but something that tells me they're worth the money. Couldn't the donors contribute to something that would actually improve care and lower its cost? Maybe instead of using donations to hire greeters and valets they could hire a care manager, someone who could help patients with multiple chronic diseases avoid unnecessary and costly trips to the emergency room. Maybe they could start a program to collaborative effort with local practices to help them reduce these hospitalizations and improve the care of patients.

I have no doubt the hospitals see the upside in the form of improved patient satisfaction survey scores. Henry Ford West Bloomfield, the hospital in Detroit interviewed for the article, admits as much.

If that's the case, maybe we are putting too much stock into patient satisfaction scores? Are the Consumer Assessment of Healthcare Providers & Systems (CAHPS) surveys leading us to a dangerous place where inconsequential amenities are being prioritized over important services?

There is no doubt a number of benefits to surveying patients, whether you're a small practice or a large health system. I am an ardent believer in that care should be patient-centered, which often means ensuring the patient is engaged and satisfied with their care. However, this seems to be a slippery slope and there are a lot of potential negatives to relying on patient satisfaction surveys.

It's not just about spending money on frivolous expenses, like a spa service. According to The Detroit News, a study in 2014 from the nonprofit group Choosing Wisely Campaign, which aims to reduce unnecessary health expenses, revealed that in any given week 72 percent of physicians order an unnecessary test for a procedure, usually to appease patients. Another survey, highlighted in this week's Practice Rounds, shows that many physicians feel pressured to prescribe narcotics for the sake of patient satisfaction surveys.

Can't we find a middle ground here, where we keep patients satisfied while ensuring health spending is kept to a minimum?  I certainly hope so.

Follow Gabriel Perna on Twitter at @GabrielSPerna