A recent New York Times article calls to light a natural paradox in the medical field, in that patients who understand more about disease processes and medical information actually feel less, rather than more, informed. In other words, those who are actually the most well-informed may rate communication the lowest. The article also calls to light the natural paradox between providers being honest and providers being likable, especially considering they routinely have to deliver messages that patients do not want to hear:
- You need to quit smoking;
- Your weight is affecting your health; and
- Your disease is not curable.
Given these natural paradoxes, the article argues that it is difficult to reconcile why hospitals and providers should be held financially accountable for their patients’ perception of care, when that perception may not equate to “real” care quality.2
However, there is some evidence that patient satisfaction surveys may actually be good proxies for care quality. A large study found that hospitals with the highest quartile HCAHPS ratings also have about 2%-3% higher quality scores for acute MI, CHF, pneumonia, and surgery, compared to those in the lowest quartile. The highest scoring hospitals also have about 2%-3% lower readmission rates for acute MI, CHF, and pneumonia.3,4 And, similar to other quality metrics, there is evidence that the longer a hospital has been administering HCAHPS, the better are their scores. So maybe hospital systems and providers can improve not only the perception a patient has of the quality of the care they received, but improve the quality, as measured by the patient’s perception.
Although there are legitimate arguments on both sides as to whether a patient’s perception of care reflects “real” care quality, in the end these CAHPS surveys are, and have been publicly reported, and will be tightly coupled to reimbursement for hospitals and (likely) providers for the foreseeable future. So in the meantime, we should continue to focus on patient-centered care, take seriously any voiced concerns, and have a relentless pursuit of perfection for how patients perceive their care. Because in the end, you would do it for your family so we should do it for our patients.
References
- Centers for Medicare & Medicaid Services. Spring 2013 HCAHPS Executive Insight Letter. Available at: www.hcahpsonline.org/Executive_Insight. Accessed Aug. 15, 2013.
- Rosenbaum L. When doctors tell patients what they don’t want to hear. The New Yorker website. Available at: www.newyorker.com/online/blogs/elements/2013/07/when-doctors-tell-patients-what-they-dont-want-to-hear.html. Published July 23, 2013. Accessed Aug. 15, 2013.
- Jha AK, Orav EJ, Zheng J, Epstein AM. Patients’ perception of hospital care in the US. New Eng J Med. 2008;359(18):1921-1931.
- Boulding W, Glickman SW, Manary MP, Schulman KA, Staelin R. Relationship between patient satisfaction with inpatient care and hospital readmission within 30 days. Am J Manag Care. 2011;17(1):41-48.
Dr. Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at [email protected].