Editor's note: H&HN Senior Online Editor Haydn Bush is blogging this week from the Patient Safety Congress.


NATIONAL HARBOR, M.D. — Interest in the Consumer Assessment of Healthcare Providers and Systems, or CAHPS, among providers has never been greater — in part because later this year, data from the hospital version of that survey will start influencing Medicare payments. But are patient satisfaction surveys truly a good measure of care?

That was the question under debate Friday morning during the final day of Patient Safety Congress, as several speakers took issue with a recent article in the Archives of Internal Medicine that questioned the linkage between patient satisfaction scores and clinical outcomes and costs. Carolyn Clancy, director of the Agency on Health Care Research and Quality, jokingly referred to the study as "the article that said happier patients cost more," adding that it relied on data from an AHRQ household survey which was not tied to specific provider encounters.

"This study was really hypothesis generating," Clancy said, adding that there are strong correlations between HCAHPS and AHRQ's surveys on patient safety culture, especially around communication with doctors and nurses.

"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."

Marc Elliott, a senior statistician for RAND, pointed to data that suggests hospitals that initially scored poorly on HCAHPS several years ago are showing the most overall improvement on the survey. Elliott added that, in general, a better patient experience has been linked to better technical quality, better outcomes and lower 30-day readmission rates.

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

Elizabeth Goldstein, director of the division of consumer assessment and plan performance with the Centers for Medicare & Medicaid Services, says the patients CMS consults with on CAHPS bring up concerns that generally mesh with the survey questions.

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

Neeraj Arora, a research scientist with the National Cancer Institute, made a similar point as he detailed his personal, two-decade care journey through a successful battle with Non-Hodgkins lymphoma and subsequent heart problems related to his chemotherapy treatment. During that time, Arora was treated in five hospitals and 12 outpatient practices, saying of his experiences, "most have been good, some have been okay and some have bordered on the ugly."

Beyond clinical expertise, Arora said patients are desperately looking for human connection during their time of crisis, pointing to surveys that suggest patients depend on more on clinicians for emotional support than their families.

"The health care system would not exist without the patient," Arora said. "It's high time we gave the voice of the patient its due."