Interest in the Consumer Assessment of Healthcare Providers and Systems among providers has never been greater — in part, because later this year, the Centers for Medicare & Medicaid Services will begin using data from the hospital component of the survey, HCAHPS, to help calculate Medicare payments. But "The Cost of Satisfaction," a March 12 article in the Archives of Internal Medicine, has created an uproar in patient satisfaction circles, concluding that "in a nationally representative sample, higher patient satisfaction was associated with less emergency department use but with greater inpatient use, higher overall health care and prescription drug expenditures, and increased mortality."

During a roundtable discussion of the findings at May's Patient Safety Congress, several speakers took aim at the findings, including Carolyn Clancy, director of the Agency on Healthcare Research and Quality. Clancy, M.D., who jokingly referred to the study as "the article that said happier patients cost more," said it relied too heavily on data from an AHRQ household survey that was not tied to specific provider encounters. Clancy added that tools like HCAHPS and AHRQ's patient safety culture survey continue to have real value for providers.

"Are these perfect tools? No. Are they giving us very clear signals that patient experiences are highly correlative with efforts to make health care safer? Yes," she said.

Elizabeth Goldstein, director of the division of consumer assessment and plan performance with CMS, agreed, adding that the agency works closely with patients when developing the HCAHPS survey.

"The types of things CAHPS measures are things that come top of mind with patients," Goldstein said. "The CAHPS information is often the information they understand as opposed to detailed clinical" information.

Marc Elliott, a senior statistician for RAND Corp., Santa Monica, Calif., said that, in general, high patient satisfaction scores have been linked to better technical quality, better quality outcomes and lower 30-day readmission rates for patients.

"Sometimes there's a belief there must be a trade-off between improving patient experience and high technical quality with better outcomes," Elliott said. "The preponderance of evidence suggests the opposite is true."

Also at the Patient Safety Congress, clinicians from California-based Kaiser Permanente unveiled a nascent checklist for use by patients and their families. The list includes instructions to discuss symptoms and medical history with doctors, assess their condition, review the diagnosis with their doctor and understand what next steps are needed. The so-called SMART list (Symptoms, Medical/medication history, Assessment, Review and To do) is designed to help patients and their families better navigate confusing, harried interactions with providers, said Doug Bonacum, vice president of quality, safety and resource management at Kaiser Permanente.

"The intent is to communicate to patients and families that their voices are important," Bonacum said.

In an informal, quick poll of the audience, 95 percent of attendees said that one of the scenarios Kaiser Permanente showed in its presentation — involving a misdiagnosis due to communication failure — could occur in their institutions, while 58 percent of attendees said their organizations were working on a strategy for better patient/provider communication.