Michael Scott, main character from "The Office," once said, “Wikipedia is the best thing ever. Anyone in the world can write anything they want about any subject. So you know you are getting the best possible information.” Sadly, there is truth in this.
The Internet has made experts of us all. Our online opinions impact revenue at everything from restaurants to cabinet makers.
Should customer satisfaction surveys also be connected to how our doctors and healthcare providers are paid? According to Obamacare, it should.
Beginning in October 2012, a provision of the Patient Protection and Affordable Care Act started linking hospital payments and ratings to patient satisfaction surveys. The Centers for Medicare and Medicaid Services states, “Delivery of high-quality, patient-centered care requires us to carefully consider the patient’s experience in the hospital inpatient setting.” This sounds extraordinarily reasonable, but like many facets of Obamacare, doesn’t hold up.
The ACA’s policy is to withhold one percent of total Medicare reimbursements from hospitals approximately $850 million, to incentivize high patient satisfaction scores. That number is expected to double in 2017, when the percentage increases. Staying out of the healthcare alphabet soup, a material portion of hospitals’ revenue is literally determined by the equivalent of a customer or employee online survey. “The pressure to get good ratings can lead to bad medicine,” says a report by the Hastings Center.
Knowing that their employer’s rating and revenue are connected to patient satisfaction, doctors may find themselves writing prescriptions out of patient desire, not medical necessity. Dr. Tommy McElroy, CEO of Echelon-Health, an innovative concierge practice, provides a physician perspective becoming more universal. “We’ve moved from ‘evidenced-based medicine' to ‘review-based medicine.’ The physician has become a glorified maître d’, ordering tests and prescribing medications to satisfy the patient and avoid getting a bad ‘score.’”
Michelle Katz, a nurse, published author, and nationally recognized patient advocate shares that sentiment. "As a nurse and patient advocate, my concern of tying doctors' and hospitals' compensation to patient satisfaction surveys is it may get in the way of needed candor and optimal care . . . If I'm worried about a survey, am I going to be as open as my patient needs me to be?”
This issue captured national attention last month in relation to the opioid crisis and abuse of painkillers. Standard of care for pain management stresses that these highly addictive pills should be prescribed on a limited basis in smaller doses, and only when other more conservative modalities are unsuccessful. Remarkably, prior to last month, the Obamacare promoted satisfaction survey asked patients how doctors managed their pain. So when patients who were looking specifically for a pain pill didn’t receive one, the doctors felt the hit.
Last month, in response to significant pressure from both the healthcare industry and patient advocate groups; Health and Human Services (HHS) directed this pain management question be dropped from the survey.
While this may lessen the pressure to “overprescribe opioid pain medication to boost their hospital’s scores,” indirect influences may linger. The happy patient-happy revenues culture, fostered and promoted by the federal government, is already affecting hospital standings.
One thing is for certain, several highly prominent hospitals are not happy. Last Wednesday, the government released its first overall hospital quality rating, with many of the nation’s best-known hospitals for treatment and care receiving average or below average scores. Out of 3,617 hospitals rated, only 102 received full five stars. Many of these hospitals are relatively obscure, and many still specialize in just a few types of surgery.
The problem here is that the hospitals that face the toughest, sickest, and most complicated patients were often given the lowest star ratings, while hospitals that mainly do, say knee replacements, received top scores. “Hospitals cannot be rated like movies,” Dr. Darrell Kirch, president of the Association of American Medical Colleges, said in a statement.
“We are extremely concerned about the potential consequences for patients that could result from portraying an overly simplistic picture of hospital quality with a star rating system that combines many complex factors and ignores [many others].”
When a patient tries to “help out,” by controlling a doctor’s actions, only trouble can arise.
As Jarod Kintz, author of "Emails from a Madman," put it, “I don’t like customer service, because I don’t believe the customer should have to pay and help out too.”
Treating patients like customers is a good thing. Having patients treat doctors and hospitals like an online Yelp review isn’t good for anyone. Unless we all want to abide by Michael Scott’s rules, and use the internet to treat ourselves.
Bryan Rotella’s first legal job was with a California firm made famous by the movie “Erin Brokovich." In 2014 he founded the Rotella Legal Group. He regularly serves as personal counsel to several national industry business leaders on the Affordable Care Act. To read more of his reports, Click Here Now.
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