The patient satisfaction surveys used by CMS to assess hospitals are not valid, according to a new report by the Hastings Center, the nonpartisan research center on bioethics.
It is increasingly common for patient-satisfaction surveys to be used as indicators of healthcare quality, as well as to influence the reimbursement paid to providers. But the Hastings Center authors argued that the surveys could eventually compromise the quality of care and raise healthcare costs.
“The pursuit of high patient-satisfaction scores may actually lead health professionals and institutions to practice bad medicine by honoring patient requests for unnecessary and even harmful treatments,” they wrote. “Patient satisfaction is important, especially when it is a response to being treated with dignity and respect, and patient-satisfaction surveys have a valuable place in evaluating healthcare. Nonetheless, some uses and consequences of these surveys may actively mislead healthcare.”
The authors of the report, Patient-Satisfaction Survey on a Scale of 0 to 10, are a resident physician in the Department of Psychiatry at the New York University School of Medicine, and a professor of bioethics and psychiatry in the Department of Bioethics at Case Western Reserve University School of Medicine in Cleveland. (The Hastings Center report is available online at http://tinyurl.com/ohaudwj.)
“Good ratings depend more on manipulable patient perceptions than on good medicine,” the report states. “In fact, the pressure to get good ratings can lead to bad medicine.”
The healthcare community should reconsider whether the focus on patient satisfaction is actually generating improvements or leading the industry astray, the authors said. Though patients should have the opportunity to share feedback about their experience, the concept of “patient satisfaction” remains poorly defined, they said. Surveys often blend healthcare quality and patient satisfaction, resulting in patients requesting, and ultimately receiving, treatments that are not medically necessary.
“Certainly, eliciting the patient’s perspective is essential to shared decision-making and important to healthcare quality,” they wrote. “Yet placing such an emphasis on the patient perspective risks giving patient-satisfaction surveys the power to pressure providers to “satisfy” their patients at all costs.”.