Dr. Ken’s Corner: The Disconnect Between Patient Satisfaction and Quality Care

Since 2012, the Centers for Medicare and Medicaid Services (CMS) has been using a carrot-and-stick approach intended to encourage hospitals to improve the quality of their care. If you rate high on our patient satisfaction survey, says CMS, we’ll pay you a bonus. Rate low, and we’ll penalize you with a pay cut.With hundreds of thousands of dollars at stake, hospitals are finding new and creative ways to make sure their patients are happy customers: chef-inspired food services, premium movie channels, valet parking, and well-coached, smiling nurses.

The hospital’s primary objective is to get the highest score possible on the 32-question survey known as HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems). Because of their frequent contact with patients, most of the questions are about nurses. For example: During this hospital stay, after you pressed the call button, how often did you get help as soon as you wanted it? This question is misleading, because it doesn’t specify whether the help was medically necessary (The Atlantic, April 17, 2015). An Oregon critical-care nurse had to argue with a patient who believed he was being mistreated because he didn’t get enough pastrami on his sandwich (he had recently had quadruple-bypass surgery). Many patients have unrealistic expectations for their care and their outcomes,’ the nurse said. One patient complained, My roommate was dying all night and his breathing was very noisy.Another complained, The hospital doesn’t have Splenda.”

According to Alexandra Robbins (author of the above-referenced article), the focus on patient satisfaction has spawned an entirely new industry, encouraging hospitals to waste precious dollars on expensive consultants claiming to provide scripts and other resources that boost patient satisfaction. Unfortunately, patients can be very satisfied and be dead an hour later.”

With luxury hotels as their role model, hospitals can provide poor quality care and still get high patient satisfaction ratings. Robbins reviewed Medicare data on every hospital that makes such data publicly available and found that when one looks at patient outcomes, two-thirds of those poorly performing hospitals scored higher than the national average on the key HCAHPS question; their patients reported that YES, [they] would definitely recommend the hospital. Robbins suggests that it’s time for hospitals to stop focusing on smile over substance, hiring actors instead of nurses, and catering to patients’ wishes rather than their needs.”

If consumers can’t rely on patient satisfaction surveys as a measure of quality care, how do they go about rating their own community’s hospitals? The first results of a new rating system were just released on July 21st. Also implemented by CMS, this new assessment tool is based on 62 quality measurements, such as post-surgical infection rates, emergency room waiting times, complication rates after hip replacement, and treatment outcomes for heart attacks and pneumonia. The system mirrors star ratings the CMS has been assigning to nursing homes, Medicare Advantage health plans, dialysis centers, and home health services (www.cnbc.com).

Out of nearly 4600 hospitals only 102 (about 2 percent) received a 5-star rating. Nearly three percent got just one star, the lowest possible score. CMS said it intends to post the overall hospital star ratings for individual hospitals shortly (at its website Hospital Compare). This method appears to provide objective, reliable data that will help consumers choose the hospital best for their needs, instead of selecting a hospital simply because it has a high patient satisfaction rating.