By Rishi R. Khatri, Esq
Does your doctor or hospital have a good rating? A company called Press Ganey knows what those ratings are. Press Ganey is the nation’s leading provider of patient satisfaction surveys for the past several year, and the Affordable Care Act has made it a central metric to improve the quality of healthcare and reduce costs to the system. If a hospital has low Press Ganey scores, that hospital will lose reimbursement, with a total $880 million at stake in cuts nationwide. But how good are Press Ganey scores for patients, doctors, and the healthcare system?
How reliable are these scores?
Press Ganey scores are created from patient surveys after a provider visit. They rate a patient’s satisfaction. These scores are heavily reliant upon patient perception, which most statisticians would completely agree are subjective. That is, how a patient feels from one day to the next will affect that score. Moreover, the ratings can be created by a very small number of surveys, sometimes fewer than 10, thereby making these scores statistically unreliable. A doctor doesn’t even have to see a patient to be given a low rating. A bad review for a physician extender such as a nurse practitioner or physician assistant will affect the physician’s rating, despite the physician not even setting an eye on the patient. What is more, the company Press Ganey create their monthly and quarterly reports based on when surveys are received and are not based on visit dates. Therefore, the ups and downs of ratings in monthly and quarterly score reports are inaccurate, with the overall rating only accurate in annual reports. But that doesn’t stop hospital administrators and the Government from using them or to reduce reimbursement.
How do these scores hurt doctors?
One of the major problems that Press Ganey scores have is that they force physicians to perform extra procedures or prescribe extra drugs solely to keep the patient satisfied, and do not promote good medical practice. This is bad for doctors and certainly for patients.
Hospital administrators use these scores to allot a budget for their various hospital departments. Another problem that arises is that there is an inherent conflict of interest with some department directors in regards to these ratings and salary. Some director salaries are dependent on the Press Ganey scores of their staff or their own performance. If a hospital administrator arbitrarily singles out a few physicians in a particular department each month for having low scores, a director is forced to act to save his salary ($10-$15 thousand a month), even though the score is unreliable in regards to the physician and department effectiveness. The director then acts by coaching their staff to increase patient satisfaction, which as explained above, is not necessarily the same as improving patient wellbeing or quality of care.
How do these score hurt patients?
Paradoxically, a more satisfied patient has a higher mortality. According to a 2012 study, most-satisfied patients, when compared to the least-satisfied patients, ‘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.’ Also, despite the greater attention and the increased number of prescription drugs they received, 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.
Generally, a hospital system will have to understand the psychology of productivity and find what the best way to change the human behavior in their department. It needs to find other ways to improve the productivity of their doctors and bedside manners asides from cuts in salary or budget.
Short of that, active daily rounding by nurse managers, supervisors, administrators and asking patients in real time if there is anything the hospital could be doing better to make their stay the best possible.
There are other programs that also improve stays in real time, for instance one called "Care-Ensure" that communicates with the patient and assesses their satisfaction level on any topic while they are still in their hospital bed.
Understandably, hospitals and doctors want what’s best for their patients. The Affordable Care Act’s and health systems’ overall arguments are that these scores increase efficiency, drive down costs, increase hospital market share, and decrease hospital liability. But do they really?
 Fenton JJ, Jerant AF, Bertakis KD, Franks P. The Cost of Satisfaction: A National Study of Patient Satisfaction, Health Care Utilization, Expenditures, and Mortality. Arch Fenton JJ, Jerant AF, Bertakis KD, Franks P. The Cost of Satisfaction: A National Study of Patient Satisfaction, Health Care Utilization, Expenditures, and Mortality. Arch Intern Med. 2012;172(5):405-411. doi:10.1001/archinternmed.2011.1662