Blog | Friday, October 7, 2011

Should patients join the pay-for-performance circus?

There was an extremely popular game show where several times each episode the emcee would shout out, "Survey said!" Of course, this was just a game, not real life.

Circus: kamelen by doenietzomoeilijk via Flickr and a Creative Commons licenseNow, several times each week I am asked to respond to surveys. They pop up uninvited on the Internet and are often veiled advertisements for products and services. They are on the back of receipts from coffee houses and doughnut shops. Is it worth 10 minutes of my time clicking through the doughnut survey for either a free chocolate frosted doughnut or the chance to be entered into the grand prize drawing months later?

Hotels I stay at routinely follow-up with e-mail surveys for my feedback. I suspect most folks delete these instantly, which skews the customer base to those who do respond. (Remember, dissatisfied folks are often more motivated to give feedback than the rest of us are.) How often do we call a restaurant, a retail store, a bank or even a doctor's office to offer hosannas about great service?

Medicare recently released fascinating patient-survey data that raises interesting issues. In over 120 hospitals, patients rated the hospitals very highly, despite high death rates for heart disease and pneumonia. So, who do we believe here, the patients or the death rates? I wonder if the patients' survey results were more optimistic, since only the live ones were available to complete them.

Surveys are now serious bu$ine$$. Reimbursement for hospitals and physicians will be influenced in either direction by patient satisfaction results. But, are patients equipped to measure medical quality? The discrepancy between the Medicare patient survey results and actual medical outcomes suggest that they are not the right tools for this task. How can we expect ordinary folks to understand and rate medical quality when experts are confounded by the same mission?

Surely, there are important aspects of the medical experience that patients can evaluate.
--on-time performance
--cleanliness of the facilities
--courtesy of the staff
--compassion and bedside manners
--responsiveness to billing issues
--ease of making appointments
--timely communications
--ease of reaching a living, breathing human being for a question or concern

But, while the above items are significant, are they true measurements of medical quality in the conventional sense? Is the definition of medical quality being broadened simply to encompass measurable events?

Patients are being recruited under the Big Top, aka as the Pay-for-Performance Circus. But, should patient surveys really count? Or, do they count simply because their results are so easy to count?

Despite the dissenting arguments against P4P advanced on the Whistleblower, a must-read blog for health care thought leaders across the country, patient surveys will be folded into the expanding hydra of P4P programs. These programs won't measure true medical quality, at least in their current forms. But, what a performance they will be. The curtain will rise as the Secretary of Health and Human Services approaches the podium and shouts out, Survey Said! What a Family Feud this will be.

This post by Michael Kirsch, FACP, appeared at MD Whistleblower. Dr. Kirsch is a full time practicing physician and writer who addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.