Higher Patient Satisfaction Scores Associated With Higher Mortality.

The Medicare National Bank is on a rampage to make sure their beneficiaries are happy with the care they receive. So much so, in fact,  that patient satisfaction scores administered through the  HCAHPS programs will determine whether hospitals lose millions of dollars a year in funding if they can't meet defined thresholds of patient satisfaction.  This is a radical change in hospital payment methodology.   It means education for sex after joint replacement is the number one priority in hospital care.  It means the Slow Code Commission recommendations rule the day. It means in hospital fires, administrators are required to abandon all patients in favor of  saving their manual on  How to Win The HCAHPS Game.    In today's payment environment, if hospitals can't make their patients satisfied, they can't get paid.  And a hospital that doesn't get paid becomes irrelevant.

What is a hospital to do?  Of course, they do what all hospitals must do in this situation.  They hire nice experts to teach their doctors and nurses how to make their patients happy.  For some hospitals, that means a healthy dose of AIDET.  But why?  We aren't experts in happiness.  We treat disease all day long.  For many patients, happiness is achieved with awesome chiropractic marketing at trade shows and State Fairs, not at hospitals undergoing chemo for their metastatic colon cancer.

When did making patients happy become the number one priority for physicians and nurses?   When did it become a hospital's mission to be more concerned about being nice than being good?  It became this way when it became an issue of money.  Should we be nice to patients?  Of course we should be.  Being nice is to be human.    But I fear that creating an environment were being nice to get paid will cause our patients to suffer needlessly at the hands of over utilization of resources. 

You see, many patients believe that more care is better care.  They see the magic of technology and believe, foolishly, that every disease has a quick cure or every question has an answer that lies in a magic pill or magic intervention.   We know that the risk of dying decreases during a recession.  Fascinating.  When Israeli doctors went on strike several years ago, the nation's mortality rate actually decreased.  Even more fascinating! Perhaps people do better because they fail to realize just how dangerous being in the hospital really is.  Whether we're talking about dangerous hospital food trays, falling wall mounted IV poles,  doctors using cell phones contaminated with poop,  or living amongst the highly contaminated hospital privacy curtains, many patients fail to appreciate the dangers lurking all around them in the hospital setting.

And a recent study published in JAMA Internal Medicine suggests just that.  What was their conclusion? In a sample of over 50,000 patients, higher patient satisfaction scores was associated with a higher mortality, higher rate of hospitalization and higher overall resource utilization.  Wow.  The Medicare National Bank, through the HCAHPS program, plans to punish hospitals that don't get the best patient satisfaction scores, when in fact, these patients experience the highest resource utilization and are dying at a higher rate than less satisfied patients.  

This is concerning. As a physician, I have a hard time trying to provide care I know works and avoiding care I know  doesn't when my expectations and the patient's expectations don't always coincide.  While fully explaining why every pill or every intervention may or may not be indicated might help strengthen patient satisfaction scores, providing such an intensity of communication takes more time than CMS is willing to pay for, especially in the woefully inadequate evaluation and management payment model.    Many physicians will simply bend to patient's wishes to hope for high satisfaction scores than to go through  the time consuming process of informed consent.  The authors agree.

This research suggests that CMS  will punish hospitals that provide the best mortality outcomes, an unintended consequence of good intentions.  As a physician, I have great concerns about being graded on my patient satisfaction scores if we have compelling data that suggests the nicer I am, the worse off my patients' outcomes.  If we want our patients to give us good satisfaction scores, perhaps hospitals should provide a free parting gift of sorts as a thank you for their business.  Everyone likes FREE.  Let the physicians and nurses stand strong to provide the right care, not the care that makes people give good happiness scores.  

Go read the article in full (linked above):  The Cost of Satisfaction.  A National Study of Patient Satisfaction, Health Care Utilization, Expenditures, and Mortality   It offers fascinating insight into how your care is being graded and how your satisfaction with those around is going to affect your own outcomes.  The Skeptical Scalpel agrees.  This original Happy Hospitalist hospital ecard helps to explain. 

"I can't understand why we treat hospital patients like royalty and then can't understand whey they keep coming back for more.  Hello?  Ever heard of Pavlov?

I can't understand why we treat hospital patients like royalty and then can't understand why they keep coming back for more.  Hello?  Ever heard of Pavlov nurse ecard humor photo.

Some of this post is for entertainment purposes only and likely contains humor only understood by those in a healthcare profession. Read at your own risk.

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