Saturday, July 12, 2014

Patient Satisfaction....What is it ? What it is Not

3 Reasons Patient Satisfaction is More Important Than Ever

Social media, insurance coverage and patient experience are main drivers

How to balance patient satisfaction and quality care

"In essence, we want physicians to care about satisfaction, but not too much," Joshua J. Fenton, M.D., MPH, of the University of California, Davis, recently toldMedscape in an interview following up on his team's 2012 widely cited studyindicating that highly satisfied patients had higher hospital admissions, higher drug expenditures and were even 26 percent more likely to die.
The study has garnered both support and criticism during the two years since its publication in the Archives of Internal Medicine. With the opportunity to clear up misunderstandings in how the findings have been interpreted and offer current insights, Fenton made the following points:
  • In most settings, technical quality of healthcare is invisible to patients, and therefore has a weak relationship with patient satisfaction. "For example, in preventive healthcare, there might be an unadjusted relationship between patient satisfaction and receiving an appropriate cancer screening test," Fenton said, "but when you adjust for patient characteristics and other confounding factors, that relationship is no longer present."
  • Any incentive, if weighed too heavily, can become perverse, so "excellent" satisfaction at every encounter may not be an effective goal. "When difficult issues are raised, such as a patient's ability to drive, a possible substance abuse issue, or perhaps poor exercise habits, patients may have an affective response that leads to lower satisfaction," he said. "Yet compensation schemes that unduly award maximum satisfaction would discourage these important conversations."
  • Physicians in the bottom 20th percentile of satisfaction scores may need communication training. Physicians scoring well below their peers may likely be making "simple communication missteps" that can be easily corrected with the help of a trusted supervisor, colleague or consultant, Fenton said. "On the other hand, if a physician's satisfaction scores are in the middle of the bell curve for his or her peers and this physician is doing his or her best to communicate with respect, empathy, and care, then we have no compelling evidence to force that physician to change," he concluded.

In a surprising new study published in the Archives of Internal Medicine, patients who rated themselves as most satisfied with their doctors not only incurred 8.8 percent higher health expenses in a two-year period but were also 26 percent more likely to die shortly thereafter than those who rated themselves as less satisfied. In addition, the analysis of 51,946 patients' surveys revealed that although satisfied patients were less likely to visit emergency departments, they had more inpatient admissions.

More immediately, the takeaway for physicians may be that despite the benefits of patient satisfaction in keeping patients loyal and engaged, it's important that servicenot be confused with medical decision-making. In other words, there is probably no downside to offering convenient hours or streamlining a practice's phone systems, for example, but when it comes to deciding medical treatments, the "customer" is not always right.

"Practicing physicians have learned--from reimbursement systems, the medical liability environment, and clinical performance scorekeepers--that they will be rewarded for excess and penalized if they risk not doing enough," wrote Brenda Sirovich from the Department of Veterans Affairs Medical Center in White River Junction, Vt., in an accompanying invited commentary. "It is time that we, as a profession and as a society, take responsibility for controlling this unrestrained system, by working to overcome the widespread misconception that more care is necessarily better care and to realign the incentives that help nurture this belief."

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