By Thomas H. Dahlborg, M.S.M., chief financial officer and vice president of strategy for the National Initiative for Children's Healthcare Quality (NICHQ)
If a portion of my compensation is based on patient satisfaction then to maximize my reimbursement I must provide to my patients everything they want. And if that means services they don't actually need, be it an antibiotic or x-ray, so be it. If I say no they are mad (unsatisfied) and it will cost me money. These are the rules of engagement the system has created and thus these are the engagement rules I will follow."
This is an example of many conversations I have had with physicians working within our broken healthcare system, and this is an example of an unintended consequence associated with protocols implemented by well-meaning individuals who are trying to improve the system but without understanding the complexity of that system.
When a physician is triple booked every 15 minutes and required to generate 30 relative value units (RVUs) per day, and on top of that is being assessed on patient satisfaction and other measures, they find it easier to simply provide the answers the patient wants to hear and move on to the next patient.
But at what cost?
At the cost of patient's lives, patient safety, increased healthcare costs, decreased access for those who truly need care ... all while the system is incentivizing and striving for improved patient satisfaction.