Correlating Patient Satisfaction and Surgical Quality




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The perceived link between quality of care and patient satisfaction scores has been strengthened by two recent studies. Because patient satisfaction is a significant factor in payment policy, it’s worth examining the reality of that link further.

In the first of the two studies, published in the January 2015 issue of Annals of Surgery and reported by the ECRI Institute, included 2,953 U.S. hospitals that performed at least one of six common surgical procedures, used national Medicare data to calculate surgical efficiency and quality, and analyzed the relationship between those measurements and each hospital’s patient satisfaction scores.

The study concluded that those hospitals scoring in the highest quartile (of patient satisfaction) had higher process of care performance (96.5% vs. 95.5%), lower readmission rates (12.3% vs. 13.6%), and lower mortality (3.1% vs. 3.6%). Length of stay was also shorter in the top quartile hospitals as compared to the bottom quartile (7.1 days vs. 7.7 days). Researchers concluded that incentives to improve surgical quality and patient satisfaction were truly aligned and that there should be no conflict between delivering high-quality care and providing a positive patient experience.

Another study published online in June 2015 in JAMA Surgery analyzed mortality, complication and readmission rates of more than 100,000 older patients in 180 hospitals across the U.S. Researcher reached corresponding conclusions – lower risk of death, minor complications, and reduced readmission rates.

Under the CMS Hospital Inpatient Value-Based Purchasing (HIVBP) program, 30% of hospital’s weighted payment is based on patient satisfaction scores, and the data presented in these studies does indicate a correlation between surgical quality and patient satisfaction. It also seems obvious that patients are likely to be more satisfied with successful surgical outcomes, regardless of the quality of care received.

Are there other factors driving high patient satisfaction, and might they be unrelated to the quality of care received?

A 2012 J.D. Power and Associates study linked satisfaction to additional aspects of the patient experience, including the personality and attentiveness of hospital staff. Rick Millard, senior director of the healthcare practice at J.D. Power and Associates, said, "Having an appealing hospital facility matters, but an experienced and socially skilled staff has a greater impact on patient satisfaction."

In a June 2014 Medscape interview with Joshua J. Fenton, MD, MPH, Dr. Fenton said, “…we found a strong association between total medical expenditures and satisfaction, and between prescription drug expenditures and satisfaction.” The March 2012 study, conducted by Dr. Fenton and fellow researchers at the University of California and published in Archives of Internal Medicine, referred to the potential contribution of utilization and expenditures in driving satisfaction among an ambulatory population.

The results of their analysis of data from more than 50,000 adult patients indicated that the most satisfied patients (highest patient satisfaction quartile) were 12% more likely to be admitted to the hospital and had total healthcare expenditures and total prescription drug expenditures that were 9% higher. Most surprising, these patients were also 26% more likely to die. These findings were derived from assessments of patient satisfaction based on five items from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey and healthcare utilization (any emergency department visits and any inpatient admissions) one year later. The data came from respondents to the 2000-2007 National Medical Expenditure Panel Survey.

Dr. Fenton's findings have been commented on many times as evidence that patient satisfaction is not associated with quality-of-care outcomes, including this article by William Sonnenberg, MD, (which appeared in the Fall 2013 issue of Keystone Physician and was reprinted by Medscape) that attracted many comments in agreement. The study also continues to garner criticism from supporters of the opposite view.

Medscape interviewed Dr. Fenton two years after the study was published. In his interview, Dr. Fenton said, “We observed an association between higher patient satisfaction and higher healthcare utilization, and yet there was also an association between higher satisfaction and patient mortality.” Dr. Fenton
“It was an observational study, so is it impossible to determine whether the associations were causal. It does raise some concern that the high utilization among the more satisfied patients may not have been for high-value care.”

“Most primary care providers are concerned about the perverse incentives that satisfaction metrics could introduce into the clinical encounter. I'm particularly wary about the push to maximize satisfaction, as if the goals should be to get every patient to rate every encounter as excellent.”

Dr. Sonnenberg concluded his article with the following observations: “Satisfied patients are not healthy patients…Patients aren't the best judge of what is best for them…We should try to be kind to our patients and take time to understand them, but we must resist these misguided pressures and do the right thing. Sometimes patients have to be told "no," and the leadership in healthcare must understand this.”

At Somnia, we have a long-standing policy of linking our outcomes to patient satisfaction. We ask each patient meaningful questions, including whether or not they feel they experienced an anesthetic complication, to further link outcomes and satisfaction. However, satisfaction cannot be allowed to drive the decision-making process with regard to a patient’s care. Quality care is that which will produce the most desirable outcome possible. That in turn should drive higher patient satisfaction.

Once again, under the CMS Hospital Inpatient Value-Based Purchasing (HIVBP) program, 30% of hospital’s weighted payment is based on patient satisfaction scores. Will this have an undue effect on physicians’ decisions? In his 2014 interview, Dr. Fenton said, “In essence, we want physicians to care about satisfaction, but not too much.”

Let us know how patient satisfaction measurement affects the care your patients receive. Join the conversation by leaving a comment below…

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