Health care inflation consistently outpaces economic growth, and threatens to 'crowd out' other important societal priorities. This blog addresses efforts to control health care costs. The blog began as an outgrowth of a class at the Harvard School of Public Health, and is open to all. Please join us.
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Thursday, January 3, 2013
Is Patient Satisfaction Dangerous?
Today’s Managing Health Care Costs Indicator is 6.4
issue of Forbes magazine has an article “Why Rating your Doctor is Bad for
Your Health.” Writer Kai Falkenberg points
out that physicians hate to be judged by their patients, and tells a
story of an ED physician who prescribes a inappropriately strong narcotic for
minor pain because “my [patient satisfaction] scores last month were low.
doctors, in order to get high ratings (and a higher salary), overprescribe and
overtest, just to “satisfy” patients, who probably aren’t qualified to judge
She points out that the Affordable Care Act offers higher or
lower hospital reimbursement based on patient satisfaction scores, and notes
that hospitals across the country are seeking to improve patient experience,
and often put physician bonuses at risk for patient satisfaction.
Adjusting for sociodemographics, insurance status, availability
of a usual source of care, chronic disease burden, health status, and year 1
utilization and expenditures, respondents in the highest patient satisfaction
quartile (relative to the lowest patient satisfaction quartile) had lower odds
of any emergency department visit (adjusted odds ratio [aOR], 0.92; 95% CI,
0.84-1.00), higher odds of any inpatient admission (aOR, 1.12; 95% CI,
1.02-1.23), 8.8% (95% CI, 1.6%-16.6%) greater total expenditures, 9.1% (95% CI,
2.3%-16.4%) greater prescription drug expenditures, and higher mortality
(adjusted hazard ratio, 1.26; 95% CI, 1.05-1.53).
That’s right. Higher patient satisfaction is associated with
9.1% higher costs and a 26% increase in mortality.
The average age in that more expensive and
higher mortality but very satisfied quartile was 6.4 years older than in the youngest
and least satisfied quartile. The study did adjust for age - but is it possible that the adjustment was suboptimal.
Note that the previous paragraph is corrected. I initially said there was no age adjustment, but there clearly is. I'm grateful to anonymous for pointing out my error.
Patient experience matters. Doctors who think that patients will be more
satisfied when they order unnecessary MRIs and harmful antibiotic prescriptions
for viral infections are misleading themselves. Even this Archives article has references
for articles demonstrating that patients could be highly satisfied by getting
patient-centered care, as opposed to unnecessary procedures that run up the
bills, and increase patient inconvenience and risk.
Patients deeply want to be listened to, and want their real
needs ascertained and addressed. We
should measure patient satisfaction, and seek to improve it. I’m confident that improving patient experiene doesn’t simply mean
ordering unnecessary diagnostic tests and prescriptions!