For those of you who believe that patient satisfaction ratings are a detriment to health care and to our patients, a study published yesterday in the Archives of Internal Medicine titled “The Cost of Satisfaction” is a must-read.
Not only does “satisfaction [have] little or no correlation with Health Plan Employer Data and Information Set quality metrics,” but, according to the results of this study, hospitals that push to have the highest satisfaction scores may be harming or even killing their patients.
Noting the “tenuous link between patient satisfaction and health care quality and outcomes” the authors found that patients who had the highest satisfaction were more likely to be admitted to the hospital, spent more on health care, spent more on prescription drugs, and were 26% more likely to die than those who had the lowest satisfaction. When study authors excluded data for patients who rated their health as “poor” or who had a “substantial chronic disease burden,” they found that with “healthier” patients, the association between high patient satisfaction and increased patient deaths became even higher.
Next time you see a hospital brag about its high patient satisfaction scores, remember what this study shows: High satisfaction with a health care facility means that you’re more likely to be admitted, you’re more likely to pay more for your care, and you’re more likely to be discharged in a body bag.
Still think “satisfaction” and “quality” are synonymous?
Someone needs to “follow the money”. Just like there was documented corruption between Big Pharm and the AHA/ASA, there HAS to be some collusion between CMS and the patient satisfaction survey companies (e.g. Press Ganey). According to a Press Ganey representative that spoke at our Grand Rounds this morning, CMS is in charge of the survey questions, the questions used, the fact that they only count a “5″ score, and will only above pay HCAHPS moneys above the 50%ile.
I would like to see an investigation of the circumstances and payoffs survey companies have with CMS. The whole affair smacks of corruption. Also, does CMS require statistical verification for their survey rankings? We complain frequently about the low number of returned surveys used to calculate our percentiles.
When is an investigative reporter going to get to the bottom of this debacle? The legal, social, and medical ramifications are huge!
Very well said. I am an RN in a suburban hospital and it is becoming worse every day. You are right and I so wish a “60 Minutes” or some big media giant would expose this farce that is absolutely ruining healthcare.
I’m not surprised by the conclusions of this study. Our hospital is rapidly moving towards a “the patient is always right” model (which of course means that the staff member is always wrong), even when what the patient wants is potentially or actually detrimental to the patient’s well-being. Thank you Press Ganey for pushing for such great outcomes!
As a patient, I have grave misgivings about Press Ganey. The common wisdom is to get recommendations from friends for a good doctor. This is hogwash if your friends are not medically trained. Lay people recommend doctors who have have great bedside manners, are prompt, and are sympathetic. Some of the best doctors don’t have any of those qualities. Press Ganey produces similar results as the recommendations of friends.
I only get recommendations for doctors from my doctors. I actually do not care whether my doctor has a great bedside manner. I need someone who knows what he is doing and doesn’t overlook things. My personal friends can give me all the sympathy I need.
I have to rely more on instinct than knowledge when sizing up a doctor, but the best evaluation comes from another fine doctor.
I think we should remember that it is the US government that required HCAHPS and designed the study and that companies like Press Ganey originally tried to prevent HCAHPS from being put into place. We should also remember that there are many other companies out there that provide the patient satisfaction data to the government and this isn’t Press Ganey’s “fault.” and last you should consider that where there is correlation, there isn’t always causation – just because higher patient satisfaction (with their doctor, by the way, read the study in detail) is correlated to high mortality and cost, that doesn’t mean that hospitals who strive to provide great service to their patients are killing them or spending more. First, note that the study measured patient satisfaction with their doctor and the overall experience of health care for the last year. Second, maybe these patients are sicker to begin with, and therefore get lower nurse-to-patient ratios while in the hospital. Or maybe those sicker patients have more frequent interactions with their doctor (remember that study from the university of michigan years ago about the frequency and style of physician communication leading to higher patient satisfaction?)
those of you who blame companies like Press Ganey for CMS rewarding hospitals for great service to their patients are clearly proving your ignorance to the entire concept of HCAHPS and likely provide horrible experiences for your patients and simply need a scapegoat for your own performance. Shame on you. In any industry, healthcare included, the customer is always right. And in healthcare, the customer at the end of the day is THE PATIENT. Press Ganey, and other companies, simply give patients the voice to speak to ignorants like yourselves. I’m embarrassed to be associated with people like yourselves.
Thank you, Mrs. Ganey. Say hello to Dr. Press for me, will you?
P.S. The study controlled for “sicker” patients and when that patient population was removed, the association between higher satisfaction and death nearly doubled.
Great….either someone with a medical degree from Google University, or, even worse…..
A CLIPBOARD NURSE!
ps….To all you nurses who have sold your soul for a suit and a 403(b)? The rest of us loathe you!
Well said, Pattie.
I am sorry, but the patient is not a customer. The patient is a patient. We take care of the patients. Customer satisfaction scores mean nothing to me as an ER doctor. If I save their life, that is what means the most to me. It has come down to giving patients the strongest pain meds, running blood tests and doing everything on patients so that way they are happy and give you good Press-Ganey scores. This is ridiculous. I don’t need to give someone with sciatica Dilaudid. I don’t need to run blood tests or do xrays on these people. They are my patients and I do what is best for their medical condition. If you dont give the patients narcotics to go home with, they will write a bad review. All the people who criticize the ER need to work or shadow me or other ER docs to see what it is really like. To see the way we are abused by patients mentally and physically.
IF THEY WERE A CUSTOMER, I WOULD GET PAID FOR MY SERVICES. CUSTOMERS OF GROCERY STORES, AUTOMECHANICS, ETC PAY FOR THE SERVICES UPFRONT. ONE HALF OF THE PATIENTS I SEE ACTUALLY PAY THEIR BILL. WHAT THE GOVERNMENT NEEDS TO LET US DO IS RUN MEDICALLY SCREENING EXAMS ON PATIENTS AND IF THEY AREN’T EMERGENT OR CAN FOLLOW UP WITH THEIR DENTIST FOR THEIR DENTAL PAIN THAT THEY COME TO THE ER WITH, THEY NEED TO PAY A SET FEE (EVEN 30 DOLLARS) TO GET THEIR PRESCRIPTIONS FOR ANTIBIOTICS OR PAIN MEDS. OTHERWISE, I AM PROVIDING FREE HEALTH CARE, AND YOU AS A TAX PAYING CITIZEN, ARE PAYING FOR THEIR ER VISIT FOR SOMETHING THAT DOESN’T HAVE TO COME TO THE ER.
I don’t get the big deal about patient satisfaction survey. Every profession deals with this. If my clients aren’t satisfied with me, regardless of how much or little they understand what I’m doing and how much it benefits them, they can go elsewhere. And yeah, it costs me money.
I have a friend who actually beat me in a real estate case on summary judgment, and his idiot client was mad at him that he didn’t get to have his day in court. So he hired a different attorney for the remainder of the case. It happens.
I’m not sure why you guys thought you’d be exempt from it and it would never affect your bottom line. If anything, it maybe should wake you up to the perils of continuing on the path you’re on. This kind of stuff will take over your lives as Obamacare progresses.
Why the world’s wealthiest profession remains so poorly represented when it comes to the takeover of its industry is beyond me.
Imagine working for a law firm in which your job depended upon little more than making clients happy. If clients wanted you to file a frivolous lawsuit, you had to do it, even though it was wrong to do so. If clients wanted you to perform potentially illegal acts, you had to do so or risk losing your job.
A couple of incidents where you did lose your job and then you have trouble finding another job.
That is the atmosphere under which many providers practice due to patient satisfaction.
You’ll probably say something to the effect that if docs don’t like it, they should get out of the situation. More and more of the good docs are doing so. People are going to be so satisfied with fewer docs that the death rates will just continue going up because they can’t find a doctor to treat them or the lines in the emergency departments are so long that they can’t get timely care.
As for a takeover of the industry, we’ll see what happens. Whatever does happen, I’m glad I’m a doctor.
Your situation is not as unique as you believe it to be. What illegal acts are you asked to perform that will get you fired if you don’t? Other than that you’re describing every profession. There are architects who have clients that want them to cut corners or they will fire them. There are engineers under pressure to falsify reports or they’ll lose a large client. And I’ve been fired for refusing to do everything my client wanted when I felt it was simply wasting te court’s time. Welcome to being a professional service provider.
The fact that you’re still questioning the changes is mind boggling. Particularly in light of the recent contraception “compromise”. I can only assume you are being willfully blind because I know you’re smart enough to see it.
Matt, you are, and continue to be, an ignorant slut. (with apologies to SNL)
Pattie, the depth and intelligence of your response speaks well of your knowledge of the issues. Well done.
Matt,
Last I checked, real estate agents, architects,and lawyers were not responsible for people’s lives.
You may lose a client because they are not satisfied with you. Big deal. You are just out of money.
But when physicians are pressured to give a treatment that causes physical harm to a patient- and they refuse which results in a poor PG score, then you will know what I am talking about.
I remember the days when physicians were pressured into giving antibiotics by their patients. They succumbed- and now we have drug resistant bacteria.
That is just one example.
Medicine is so different from other fields. A complaint is a loss of money to you.
Keeping a patient happy can result in a bad outcome.
why don’t we rise up together with a class action lawsuit. stating unreliable data with punitive consequences. make the hospitals and pres ganey liable. obviously their statistics are inaccurate. I suspect if all physicians join the suit that the hospitals will have to buckle to the pressure. This in effect will bankrupt pres ganey
I like your thinking, Gerges.
Any of you that have never seen a Press Ganey Survey should get one and read it. There are no questions about actual medical outcomes only about PERCEPTIONS of quality. I have received several of them and always return them uncompleted with a note explaining what total BS the survey is.
As a 30 year veteran of the ER I know that many patients come with unreasonable expectations and it would be malpractice for me to acquiesce to them, even though it would improve our P-G scores.
Of course there is a high correlation between patient satisfaction and high mortality rate. I already see how it could happen on my floor. I have my manager called me into her office basically telling me indirectly that if a self care patient ask you to clean there a**.. You must do so because of patient’s satisfaction. In my head, I’m thinking what the hell happen to self-promotion and early mobilizations to prevent physical decline and PNA.
Our healthcare system has turned into a hell hole, being reimbursed depending on patient satisfaction and not their health outcome….is total BS. Sometimes I feel more like a maid instead of an RN.
This whole healthcare reform is getting out of hand.
Sometimes I wonder if patients who can perform self care and wants a nurse to do it for them is in some way getting off on it.
It is like sexual harrassment.
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