The High Cost of Dissatisfaction

By Adam DiPaula

As a researcher who conducts patient satisfaction surveys, I read Janet Adamy’s October 14 Wall Street Journal article on hospital payments and patient satisfaction scores with keen interest. The article left me ambivalent regarding how patient satisfaction surveys are being used to reward–and punish–hospitals.

As a patient survey research practitioner I was first I thrilled to learn that the U.S. government is taking the results of patient satisfaction results seriously, and using them to make decisions that will impact the future of hospitals. Hospitals now receive payments based on a combination of a) hospital performance across a dozen procedural metrics, and b) hospital scores on a U.S. government 27-item patient satisfaction survey. Each hospital receives a score–weighted 70% based on the procedural metrics and 30% based on the patient satisfaction scores. There’s about $1 billion at stake here for U.S. hospitals.

This seems like a great example of the triumph and continued relevance of the survey. In research circles, the survey has been getting beaten up pretty bad these days. Many argue that basing decisions on answers to surveys is misguided and lacks strategic vision. However, here is a case where survey respondents’ check marks have implications for who which hospitals will get more funding and which will get less.

Predictably, many healthcare professionals working in hospitals are not exactly thrilled about the new ‘payment based on survey score’ regime. They note, quite rightly, that there are many things that reduce patient satisfaction that hospitals can’t control. And some feel that they will be unfairly punished based on the types of patients that they end up treating. For example, some hospitals with chronically busy emergency departments will no doubt get the short end of the stick even though they really don’t have much control over the cases coming in the door.

Also, and again predictably, some hospitals are looking for quick ways to earn higher patient scores. As much as I like to see survey research used for decision-making, some of the consequences of this scheme are leading to patient ‘improvements’ that likely have little to do with patient outcomes that really matter.

For example, after getting docked funding based on low patient satisfaction scores, one hospital upgraded patient rooms with flat-panel televisions; another installed mini waterfalls in patient rooms; and another introduced daily newspaper delivery. Some hospitals are expanding their menus to include upscale cuisine and expanding their cable TV channel line-up and sports network choices. (Note that the latter has a side benefit for hospital staff workload. Evidently, patient pain complaints and requests go down during the period in which NFL games are broadcast on Sunday).

I’m all for concrete illustrations of how what we do as survey research practitioners makes a real difference. I’m not sure, in this instance at least, that the difference will actually lead to outcomes that really matter to patients.