Nancy Germond hosted this week’s Cavalcade of Risk, and there’s plenty of Turkey Talk for everyone – be sure to stop by and check it out. I found Jason Shafrin’s post about patient satisfaction to be particularly interesting. Medicare is going to start a financial reward/penalty system for hospitals beginning in 2014. The hospital value-based purchasing (HVBP) program will pay a bonus to hospitals that provide a high quality of care and financially penalize those with low HVBP scores. Jason weighs a few different angles of this, and particularly looks at the fact that patient satisfaction will be one of the aspects of HVBP.
Prior to working in the health insurance industry, Jay and I both worked at a company where customer satisfaction was a huge part of the business. The results were all or nothing – anything less than 100% satisfaction basically resulted in a zero for the store in question. Promotions and performance evaluations were heavily tied to the customer satisfaction ratings.
Our experience was that the customer satisfaction angle was a double-edged sword. It did drive everyone in the store to place a huge priority on customer satisfaction and go to great lengths to please the customers. But it also resulted in some undue stress for employees when faced with a customer whose expectations were simply unrealistic, and occasions when good business practices were marginalized in the name of customer service.
Put into practice in hospitals, I can see pros and cons to such a system. Obviously, we want patients to be satisfied with the care they receive, and an objective measure of their satisfaction plays an important role in judging how well a hospital is caring for its patients. But I think more importance should be placed on patient outcome and cost efficiency. This is a very over-simplified example, but what do we do if a patient is demanding antibiotics for a viral infection? The doctor can give in and write the prescription in order to satisfy the patient. Or she can say no, which is correct from a medical standpoint but does frustrate some patients who erroneously believe that antibiotics will cure what ails them. Which is more important here? In this particular scenario, pleasing the patient results in wasted healthcare dollars and contributes to the proliferation of super-bugs.
Particularly in the current era of spiraling healthcare costs, it’s a bit troubling to hear that hospitals are doing things like putting in extra elevators so that people don’t have to wait as long for an elevator… all for the sake of boosting their patient satisfaction rankings. Yes, it might increase patient satisfaction by a small margin, but somebody has to pay for it. Renovation projects like that add to the hospital’s overhead expenses, and that leads to increased charges for care at the hospital. Ultimately, health insurance carriers end up paying more for their insureds’ claims, and that translates directly to increased health insurance premiums. Perhaps patients truly are happier when they have to wait 20 seconds for an elevator instead of 80 seconds. But maybe we should ask another question on the survey: “How much of a premium increase are you willing to pay in order to have a shorter wait at the elevators next time you’re hospitalized?”
The HVBP system won’t be in place for another two years, and it sounds like it will be a multi-faceted program. In some regards, the focus on patient satisfaction will no doubt lead to better standards of care. But without a significant cross-check program that heavily weighs cost efficiency and patient outcome, a focus on patient satisfaction could end up being a runaway train in terms of healthcare expenses.