Late last month, I flew nine airline segments to seven cities, arriving on time in three of the nine legs, with two flight cancellations along the way. I ended up buying two new tickets to get to meetings I would have otherwise missed and was assessed $400 in change fees. I ended the week tired, frustrated with air travel, and feeling a bit helpless as I anticipated the week ahead. And the airlines pocketed my $$$ in spite of their performance.
Like the airlines, hospitals interact with people in need. Like airlines, ours is a high-profile sector in the economy. And like airlines, our "product" carries a high price. But unlike the airlines, hospitals are penalized if the patient experience is bad.
Since 2005, hospitals have used a standardized 32-question survey, HCAHPS, to measure patient perspectives in nine key areas: communication with doctors, communication with nurses, responsiveness of hospital staff, pain management, communication about medicines, discharge information, cleanliness of the hospital environment, quietness of the hospital environment and transition of care. The survey instrument, designed by AHRQ with input from a wide variety of industry stakeholders, including patients themselves, uses a set of screening questions to categorize respondents into discrete groupings important to analyzing the data.
Patient satisfaction scores for every hospital in the United States are readily available. The government publishes the HCAHPS scores and health insurers augment these with their own, using them to structure their contracting networks and in contract negotiations with hospitals.
In the scholarly literature, high patient satisfaction is associated with better outcomes, increased adherence to treatment recommendations and improved reputation for the hospital. To date, the correlation to lower costs has not been proven, though it's reasonable to assume it might exist to a greater or lesser degree depending on the nature of the medical problem.
What's striking is that patient satisfaction with hospitals is not strongly associated with accuracy in diagnosing a medical problem or appropriateness in the treatment recommendation that follows. In the vast majority of cases, patients are oblivious to the distinction between a wrong diagnosis and a medical problem whose signs, symptoms, risk factors and comorbidities lend to an uncertain diagnosis. And most patients are clueless as to medical necessity for the majority of diagnostic tests and a significant portion of surgical cases.
Will it change? Will patient satisfaction matter more in the future? Absolutely. But perhaps not because of the penalties from CMS and efforts of health plans to report patient satisfaction in their plan design. The momentum driving the growing importance of patient satisfaction is driven by three factors:
- Increased importance of digital health and social media: The millennial and Gen Y generations are "digi-holics." Online tools to shop and compare for goods and services are integral to their lifestyles. Hospitals lacking a social media strategy, interactive websites that allow personalization and quick access, and connectivity between electronic health records and personal health records remains uncertain.
- Changes in insurance coverage: Even if employers maintain a dominant role in health coverage, they'll shift purchasing accountability to employees to encourage smart shopping. Narrow networks, reference pricing, price transparency and high-deductible plans will be their fundamental offering, forcing employees and their dependents to seek the highest value for their purchases. Data formally captured and reported by plans and hospitals and informally connected through social media will have a profound impact on how individuals access their providers and select their coverage.
- Analytics that correlate patient experiences with outcomes and cost: The analytic skill to dissect large databases wherein correlations between various methods of optimizing patient satisfaction are analyzed in hospital settings that vary by patient severity, or staffing model, ownership status and other criteria is now available. Thus, for most medical conditions, consumers will know what the specific treatment options are that correlate to optimal outcomes, and their experience will become more about diagnostic accuracy and treatment optimization than access to parking, tolerable food choices, and physicians and nurses who answer questions.
A hospital serious about patient satisfaction can ill afford to be content if it scores well on standardized surveys like HCAHPS. Leveraging the full range of patient satisfaction measurement tools to improve outcomes, increase adherence to evidence-based treatments, identify inappropriate physicians and nurse performance, avoid penalties for avoidable complications and admissions, and evaluate the efficiency of the hospital's operations is an imperative.
If hospitals were judged as airlines, they'd be paid full price if the patient survived after a wrong-site surgery or hospital-acquired infection. Thankfully, hospitals are held to a higher standard of performance, and, for us, a higher level of importance for satisfaction.
Paul H. Keckley, Ph.D., a health economist and leading expert on U.S. health reform, is managing director at the Navigant Center for Healthcare Research and Policy Analysis. His H&HN Daily column appears the first Monday of every month. He is a member of Health Forum's Speakers Express. For speaking opportunities, contact David Parlin.