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Is 'Quality' Quelling Physician Job Satisfaction?


Physicians are experiencing frustration with federal quality care programs that tie patient satisfaction to physician compensation.

For those medical groups that participate in the Physician Quality Reporting System (PQRS) program, CMS requires group practices of 100 or more eligible professionals to administer and report the Clinician & Group-Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) survey to solicit patient input on their satisfaction with caregivers.

Meryl Luallin, a San-Diego-based consultant, says that even though small-group practices are not yet required by CMS to administer and report patient satisfaction surveys, many practices are using these surveys internally and tying some part of physician compensation to patient satisfaction scores.

On the surface this may sound like a good thing, as it can be an opportunity to hear feedback from patients and make improvements to clinic operations. However, as Luallin says, that is not always the case. Many physicians are frustrated because they are being held accountable for subjective patient experiences that may be based on a variety of hard-to-control factors, such as a long wait time or limited parking.

"It is frustrating to physicians to think that patients are being asked to rate something on an experiential level from a visit they may have had six months ago," she says. Physicians are also complaining about the scoring method, says Luallin, because it ranks them according to percentiles, and not raw scores. "Because the rankings on the surveys are pitting you against others … if you have 95 percent of patients rating you 'always,' [in terms of frequency of a positive event] and so does everyone else, you now have a ranking at the 50th percentile."

To combat poor physician scores which could drag down revenue, Luallin says many practices are hiring her firm to conduct "shadow coaching" to improve their customer service. "The bottom line is more physicians are taking pains to learn how to interact effectively with their patients, so [they] will rate them highly on the patient surveys."

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