In today’s booming healthcare industry and rise of corporate healthcare, the competition amongst large healthcare conglomerates has become even more ferocious. The pool of reimbursement or reward compensation from government programs can make or break a system. The Centers for Medicare and Medicaid Services have implemented ways to help rank facilities based on different criteria for these reimbursement or reward situations. One of the implementations have been the use of Patient Satisfaction Surveys to help determine quality of care. This is also known as HCAHPS (Hospital Consumer Assessment of Healthcare Providers). Many studies in the past have linked quality of care to correlate with patient satisfaction on a long-term care basis. Unfortunately, acute care hasn’t fared as well in terms of correlation with quality of care and patient satisfaction surveys.
So, what’s the big deal with these surveys? Long story short, they serve as a ranking system that will allow participating institutions to either get reimbursed at the normal fee rate or make a bonus for doing well at the expense of lower performing facilities (which are penalized). This creates a competition among institutions and other providers to have the best patient satisfaction scores.
Are these surveys accurate? That is the million-dollar question that has contributed to years of research into trying to prove that they are. This is especially the case with long term care. Patient satisfaction surveys tend to correlate with quality of care when utilized in a long-term care environment. It has not been well established that the surveys correlate well with short-term or acute care provided. Of course, these answers are based on which research you go off of (which may or may not be biased).
Now that brings us to the question we asked initially, “Friend or Foe?” After years of research on trying to prove the “Friend” argument (why they may be good for determining quality of care), I am going to discuss the “Foe” part (why they may not be good for determining quality of care). It seems like a main part of the survey which is important is the provider survey. I will use the provider survey as an example. The following are my main arguments involving the “Provider Satisfaction” part of the survey (which is just one part):
- Not all patients are honest
- The score may be biased based on the mood of the patient the day of the survey
- Bias towards the hospital or provider (the random ideals of the patient aren’t met)
One can make the argument that the surveys are better at determining quality of care when used for long-term care because a patient usually picks the provider they like to go to. This usually results in the patient being satisfied with them long term. If they don’t like the provider, they find a different one. The insured clientele that are responsible enough to see their PCP for non-urgent primary care cases are more likely to be more responsible and accurate when filling out the surveys. In acute care or urgent care settings, the provider is unknown in many cases and the patient’s ideals of a provider aren’t always met. The surveys are supposed to be based on sample size and randomness but when taking into account the Emergency Department it seems that many times the patients that are having the worse day of their life are the ones that fill out the surveys. This situation may create a bias toward a fair or subpar score. This is one reason any particular month the scores might be really good and the next month they may be really bad with no change in how the provider practices. Also, it is well known that quite a few of these patients don’t carry insurance but are the ones helping determine the facilities reimbursement through these surveys. Thus, an example of why long-term care satisfaction surveys may correlate more with quality of care compared to short-term or acute care environments.
If all else fails and these surveys end up not proving quality of care in the long run (which I don’t think they can be completely relied upon), they still provide valuable information to the hospital and corporate administrators on the mood of the public and how they’re facilities are being portrayed by the community. This information will allow them to make goals they can work towards in the future. Finally, as you can see there is both a “Friend” and a “Foe” part to these patient satisfaction surveys.
Administrator
