Engagement and Alignment: The Key to Improved HCAHPS is with Both Physician and Patient Education

A few years ago, a friend was describing her visit to an outpatient oncology site.  The facility was located in a run-down urban area, the office needed a coat of paint, the furniture needed to be refreshed and the other patients were a bit dowdy.  Her impression was less than stellar and led her to choose a different facility for her treatment. What she did not talk about was the expertise of the physician or the outcomes of treatments at this center, both of which were excellent.  Clearly in this instance, her satisfaction had nothing to do with the quality of care being provided.

In a study conducted at UC Davis in 2012 (Fenton et. al, 2012), researchers found that the most satisfied patients were also those that spent the most on health care and prescription drugs, were 12% more likely to be readmitted and accounted for 9% more in health care costs.  What the study cannot tell us is whether the quality of care provided was appropriate or not.

Patient satisfaction is being closely monitored.  The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) provides feedback on patient satisfaction with inpatient care and penalties are assessed for low ratings, up to 1.25% penalty in 2014.  Similar programs will be initiated in physician offices (Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CGCAHPS)) as well as Long Term Care and Dialysis Centers.

While we have the feedback on satisfaction, the issue may be that we are not necessarily educating patients on the important aspects of health care.  We are moving towards a patient centric health care system, where we must manage the care of individuals through collaboration and communication.  It is vital that we explain their treatment plan to patients and their families.  But it may be equally important that we explain what should be important to them – their disease, the outcome of treatments and the rationale of tests and procedures.  Education about how to judge their care must be incorporated into the plan.  Getting anything you want to eat anytime of the day or night is nice but cannot (and should not) compare with receiving evidence based care that actually manages your disease.

Some hospitals are using patient satisfaction as a proxy for the effectiveness of care provided by physicians.  In certain instances, incentive payments are being conditioned (i.e. decreased payments for lower scores) using the satisfaction scores.  This may be a mistake.  Dr. William Sonnenberg wrote in Keystone Physician (2013) about a talk he gave on antibiotic use for RSV bronchiolitis in children.  While standard protocols do not include antibiotics for viral infections, several physicians in the audience explained that if they did not prescribe the antibiotics, parents were unhappy.  This translated into lower patient satisfaction scores and potentially decreased their salaries.  One physician described how he raised his satisfaction scores 7% by writing an antibiotic for anyone that complained of a sore throat, cough or sinus headache.   While these patients may have been mollified, the care provided deviates from standard practice and should not be rewarded.  Instead, hospitals would be better served by recompensing physicians for providing high quality, efficient care.

The first step must be to educate physicians on what this means and providing direction to them on how to achieve it.  Outcomes rather than process should be stressed and cost considered but cannot be the only driving factor.  Incentive conditions should be based on ensuring that your physicians are actively involved in the provision of care and smooth running of the facility.  Examples that make more sense for conditioning include compliance with discharge dictation summary guidelines (since this affects revenue), participation in hospital or departmental committees (since this keeps them involved) and attendance at training (since this ensures they are informed).

By educating both the patient and the physician on key aspects of care, overall satisfaction should get better, patient care ought to become more efficient and effective, and everyone’s perspective of the facility improve – and isn’t that what we should care about.

References

Sonnenberg, W. (2013, Fall). Patient Satisfaction is Overrated. KeystonePhysician, 4-5. Retrieved July 24, 2014, from http://www.nxtbook.com/nxtbooks/pafp/keystonephysician_2013fall/index.php?startid=4

Fenton, J. J., Jerant, A. F., Bertakis, K. D., & Franks, P. (2012, February 13). The cost of satisfaction: A national study of patient satisfaction, health care utilization, expenditures, and mortality. Archives Internal Medicine, 172(5):405-411. doi:10.1001/archinternmed.2011.1662.