Kevin Pho knows how to craft a headline. He says on Kevin MD, that patient satisfaction is all the rage, and that it might actually kill.
Okay, that sounds dramatic. But not when you examine it from the red tape perspective. First, Medicare is now using patient satisfaction scores to determine hospital reimbursement. That means doctors nationwide are going to be pressured by their execs to raise them. Rich hospitals can still win in this situation: they have the money to invest in amenities that will make patients happier. However, the irony is that the hospitals desperate for funding might have to start making patients happier in a different way — by saying yes to patient demands.
The problem is that sometimes patients demand things like narcotics and barbiturates, what Kevin calls, “habit-forming pain medications that can feed an underlying, destructive drug addiction.”
Kevin wasn’t surprised and neither were we when we saw this study from Archives of Internal Medicine.
According to the study,
“Compared to the least-satisfied patients, those who were most satisfied with their healthcare were on more prescription medications, made more doctor’s office visits and were more likely to have had one or more hospital stays, despite the fact they were in better overall physical and mental health.”
Okay, that’s logical: healthcare feedback is going to come from people receiving healthcare. But this part defies intuition. The study goes on to say,
“Also, despite the greater attention and all those prescription drugs they got, the highly satisfied were more likely to die in the few years after taking the survey than were those who pronounced themselves least satisfied with their physicians’ medical care.”
Emergency physician WhiteCoat sums it up by saying, “High satisfaction with a health care facility means that you’re more likely to be admitted, you’re more likely to pay more for your care, and you’re more likely to be discharged in a body bag.”
Not only are satisfied patients more likely to die, they cost more, too. While examining the study, the Los Angeles Times reported, “Overall, the most satisfied patients incurred 8.8% more healthcare expenditures than did the least satisfied and spent some 9.1% more on prescription drugs than did the least satisfied.”
The authors of the paper — four family medicine doctors at UC Davis — suggest that in a healthcare marketplace where Americans choose their doctors the same way they choose a plumber or an electrician, physicians may be anxious about pleasing their “customers.” The problem is that by the study’s end, the most satisfied patients were 26% more likely to have died than the least satisfied. And this surprising finding was made stronger when researchers stripped out the unhealthy individuals from both groups.
We started Atlas MD to differentiate ourselves from a health system that’s all about DOING MORE but ACCOMPLISHING LESS. There are flaws in the design when doctors are rewarded for administering more tests. What is that? Ideally, doctors should be rewarded for being good doctors and ordering the RIGHT tests. Then there’s all this emphasis on patient satisfaction via red tape rigamarole and surveys. Putting the patient in charge of a practice’s income this way is absurd. Think of it like this — what if a patient hates getting shots? Wouldn’t their customer “satisfaction” increase if they received less injections? But what if they actually needed one?
“Only if we commit to overcoming the widespread misconception that more care is necessarily better care, and to realigning the incentives that help nurture this belief,” can physicians, healthcare companies and patients drive down rising healthcare costs and reverse a trend of overtreatment, wrote Dr. Sirovich.
So… direct care anyone? We’re in the business of making ourselves available and affordable. We’re not in the business of profiting from prescription dispensing and lab testing. Healthy patients who trust us with their longterm health is our success. We are the downward driver of cost, the reversal of overtreatment. We’re not just throwing pills at the problem.