As healthcare delivery continues to evolve in the US, we are seeing efforts by governmental agencies to use patient satisfaction scores to determine compensation. I think this will become a source of DISCRIMINATION AGAINST FUTURE PATIENTS.
Currently hospitals and physicians are being rated by patients for communication, caring, empathy, etc. Uniform government developed surveys are mailed to all patients during a certain time period, and all the comments and scores are tabulated. Bad scores may mean reduced compensation to the hospitals and physicians by the government. Various costly consulting groups are now being deployed by the most profitable Hospitals, to achieve better scores. Like many regulations, only the financially strong will be able to hire the best. The poorer hospitals, in the rural communities, or inner cities will not be able to compete. Of course, these are the hospitals that are caring for the most vulnerable, and sick
The consultants often re-package the obvious. The recommendations comes down to simple things like taking time to greet the patient. Wearing name badges and introducing yourselves. Sitting down when having important interactions. Other times, recommendations include refurbishing the hospital with private rooms. Each hospital is compared to other hospitals on a quarterly basis. Because it is a comparison and ranking system, it will be an ongoing process. Lower ranking facilities will be monetarily penalized by the payers. Many of those rural and inner city hospitals mentioned above will close as they cannot keep up with the constant costs associated with improving satisfaction scores.
Hospitals and doctors will evolve like all business entities, and will start to focus on the best customers, and not market to those that may cause extra costs to the business. As we discussed above, all patients are surveyed. In the ideal setting, all the patients that were admitted should be the ones that would be the most satisfied. Marketing experts can achieve that goal. Marketing will target healthier, wealthier patients, that tend to do better, and return good satisfaction surveys. Some might call that discriminatory.
In the July 1, 2015 issue of Spine, Bible et al wrote a paper titled “What Patient Characteristics Could Potentially Affect Patient Satisfaction Scores During Spine Clinic?”. In this paper, 200 patients of an outpatient spine clinic were contacted by phone to answer 25 survey questions. The questions were designed to score satisfaction with 1. the provider, 2. the overall visit and 3. quality of overall care.
The results of the demographic analysis indicated being younger, being a smoker, and having less formal education are associated with decreased satisfaction scores.
In addition, the abstract states:
“Marital status, working status, mental health history, travel distance, pain characteristics, previous treatments, and current narcotic use were not significant determinants of patient satisfaction.”
As hospitals and physicians start to understand the ramifications of taking care of the population that will be less satisfied, the business office of the hospital will decide that taking care of this population will be too costly to their reputation and revenue. This will lead to further healthcare access issues for this population. This is yet another example of the unintended consequences of a seemingly good goal of trying to improve patient satisfaction. In the end, it will cost more, and limit access to the population that needs healthcare the most.