Patient satisfaction pressures may prompt unnecessary care

Providers choose when to say no to avoid bad ratings
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It's a daily struggle that providers are hyper-aware of these days--when to say no to patients and when to give in to reap high patient satisfaction scores.

Starting last month, Medicare's value-based purchasing program now weighs patient satisfaction for 30 percent of IPPS hospitals' performance scores. Bad scores mean hospitals will be docked up to 1 percent of reimbursements and even more in 2017 when the withholdings go up to 2 percent.

Medicare's changes, although well-intentioned, may have inadvertently pushed providers to write more scripts or provide unnecessary services to keep patients happy.

"This is my day-to-day conundrum," Aleksandra Zgierska, assistant professor in the Department of Family Medicine at the University of Wisconsin School of Medicine and Public Health in Madison, told American Medical News. "The challenge is how do we discuss this with the patient so the patient doesn't leave unhappy. … Saying yes is easy. I know from firsthand experience that it's very tempting."

Combined with Medicare payment adjustments, institutions' bonus packages based on patient satisfaction, such as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey scores, also incentivize providers to consider the patient experience.

According to a 2011 report from Philadelphia-based consultancy, the Hay Group, 59 percent of hospitals offered annual incentive plans for their physicians last year.

Such financial pressures mean providers must balance appropriate care with pain management--one of the HCAHPS questions--which might put physicians in a sticky situation when they consider, for instance, prescribing antibiotics for a cold or ordering imaging tests for uncomplicated low-back pain, amednews noted.

With heightened focus from the American Board of Internal Medicine's "Choosing Wisely" campaign, specialty societies have backed the notion that sometimes more care isn't better care, particularly on the question of pain management. But that doesn't mean patients recognize the cons of unnecessary care; it still puts opioid prescribing at odds for patient-satisfaction ratings.

Even though only 15 percent of physicians said they would not hold back in treating a patient's pain for fear the person would become addicted, according to a Medscape and WebMD survey last week, some providers are taking systemwide actions, including using database monitoring, implementing no-refill policies, asking patients to sign controlled-substance contracts, or even going as far as mandating urine testing from patients.

Still, patient advocates say satisfaction scores accurately reflect overall care--even if there are a few discontent patients.

"If the reason for doing patient experience is simply to get a better score on a test, you will fail," Jeremy Tucker, medical director of MedStar St. Mary's Hospital in Leonardtown, Md., previously told FieceHealthcare. Tucker encouraged an organizationwide culture change in thinking about the patient experience.

For more information:
- read the amednews article

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