Enhancing patient experience is part of the quadruple aim for value-based care. CMS uses the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey to measure patients’ perceptions of their hospital experiences and compare them across hospitals, locally, regionally and nationally. Those scores have played a role in hospital payment through the Hospital Value-Based Purchasing program since 2012. Now, under MACRA, physicians’ and hospitals’ patient satisfaction scores beginning in 2017 will affect their Medicare reimbursements beginning in 2019. Sheridan is rolling out patient satisfaction scoring for all its physicians and Gerald A. Maccioli, MD, MBA, FCCM, Chief Quality Officer, was recently interviewed by Medical Economics about the challenges and opportunities.
Patient satisfaction scores are especially challenging in the current environment, he said, not only because those scores affect reimbursements, but also because patients often come in with self-diagnoses and expect doctors to prescribe whatever tests or medicines they read about on “Dr. Google.” When physicians explain that those tests or medicines are not appropriate or indicated, patients who receive best practice care may be dissatisfied because it did not meet their expectations. Physicians may feel pressured to accede to patient demands for unnecessary tests or to overprescribe opioid pain medications to avoid being dinged on patient satisfaction surveys – a situation that has contributed significantly to this country’s opioid epidemic. (Sheridan is exploring reduced- and non-narcotic alternatives for effective pain control.)
Gerald A. Maccioli, MD, MBA, FCCM
Chief Quality Officer, Sheridan Healthcare
He said patient satisfaction scores are part of the new normal under value-based care and physicians need to embrace it. Read more of Dr. Maccioli’s interview in the new Medical Economics article, “Top 10 Challenges of 2017.”
Dr. Maccioli also believes it’s up to healthcare organizations’ leaders to help their physicians embrace this change by focusing on why patient satisfaction scoring is important and, in many ways, a good thing for doctors as well as patients. He advises leaders to emphasize that giving patients the best experience is “first and foremost a clinical imperative,” not just a business imperative because HCAHPS scores affect payment. Patient satisfaction and effective physician communication have been shown to affect patient adherence to treatment plans and, therefore, outcomes. Thus, monitoring patient satisfaction scores is a way of helping doctors improve their relationships with their patients to improve their care and outcomes. The key, Dr. Maccioli says, is to use the scores as a positive tool for improvement and not in a punitive way.
Allowing physicians to view and monitor their own scores gives them insight into which aspects of their patient interactions they need to work on to give their patients most positive experiences – and potentially better outcomes – and improve their satisfaction scores. In monitoring physicians’ scores and activity within Envison’s system, Dr. Maccioli says he and other leaders have noticed some interesting trends. Physicians’ tendency to be competitive seems to be having a positive effect on patient satisfaction scores. Some physicians whose patient satisfaction scores are good but not at the top of their peer groups have been logging in to look at their scores multiple times a day. And if they are not scoring well in a particular area, such as communication or empathy, they are going into one of the relevant education modules to help themselves improve.
The move toward value-based care is accelerating the development and widespread use of clinical best practice, and Dr. Maccioli believes patient satisfaction scores will become an increasingly important differentiator. He says organizations that embrace and commit now to patient satisfaction as well as high quality care will be the future leaders in healthcare.