Don’t hurt me. Heal me. Be nice to me.
This oft-cited patient credo captures what patients want. However, local hospitals are setting the bar far higher. With federal reimbursements on the line, after all, they can’t afford not to.
JPS Health Network recently hired an executive director of patient experience, a new department that includes three project coordinators. A patient experience curriculum is being created and will be rolled out during new employee orientation this month.
“We are in the process of evolving our culture,” said Dianna Prachyl, vice president of community health for JPS. “We’re not going to be serving our patients fancy coffees and giving them pedicures. We are going to deliver the care they need in a compassionate manner.”
Parkland is seeking to hire one as well.
Reigen Lox, Parkland’s project manager for value-based purchasing, said the system has created a patient satisfaction steering committee. She said the system is focusing on inpatient care first and will expand into outpatient clinics and the emergency department. Carlos Girod, an internal medicine physician and member of the Parkland steering committee, said efforts to improve patient satisfaction have met “no resistance” from physicians.
“Doctors went into medicine because they want to be excellent in customer service,” he said. “They have a sense of pride and want to improve their [satisfaction] scores.”
Girod pointed out the physician’s ability to communicate more effectively will be enhanced at Parkland when it opens its new patient tower in 2015. Most of its current hospital rooms are double occupancy, and the new facility will have all private rooms with adjoining family areas.
Baylor Healthcare System has had an Office of Patient-Centeredness for years. Texas Health Resources has had a vice president of service excellence since 2010.
In June, more than 100 Methodist Health System managers and employers participated in a daylong customer service training program, designed by hotelier Ritz-Carlton, on how to achieve exemplary customer service.
“You can’t overestimate the value of having an organization like the Ritz-Carlton share its success formula,” said Methodist Health’s vice president of revenue cycle Leslie Pierce. “It was inspiring, motivating, and at the end of the day, you couldn’t help but walk away with a renewed sense of commitment to providing an exceptional patient experience.”
Like Methodist, many U.S. hospitals are borrowing customer-service best practices from the retail, marketing and hospitality industries. Many are including executives known as chief experience officers—or CXOs—in the C-suite.
However, the responsibility for patient satisfaction rises to the top in some organizations. At Methodist, the chief operating officer leads the effort. At UT Southwestern, senior leaders and boards of trustees closely monitor patient experience through ongoing reports.
The foundation of measuring hospital patient satisfaction is the 27-item HCAHPS—the acronym for Hospital Consumer Assessment of Healthcare Providers and Systems—survey. Since 2008, HCAHPS has allowed comparisons to be made among U.S. hospitals. The publicly reported survey, along with Medicare’s value-based purchasing program, has added extra juice to patient-satisfaction efforts.
In October, the Centers for Medicare and Medicaid Services began withholding 1 percent of hospital reimbursement to be redistributed as incentives to those with the highest performance-measure scores. Patient-satisfaction metrics account for 30 percent of the score. The percentage of reimbursement withheld will rise to 2 percent in 2017.
In the proposed 2013 Medicare physician fee schedule, CMS outlined plans to include patient-satisfaction survey results for group practices participating in the Physician Quality Reporting System on the Physician Compare website by 2014 or later. Starting in 2013, physicians who do not report enough quality metrics to CMS would absorb a Medicare pay cut of 1.5 percent in 2015, which would rise to 2 percent in 2016.
Patients themselves are demanding more. According to PriceWaterhouseCooper, there are five trends driving the transformation from patient to “customer experience:”
- Increased cost sharing: Higher deductibles and tiered pricing have forced patients to take a more active role in their healthcare decisions.
- The push for value by payers and the government: There is a greater focus on cost containment, quality and transparency.
- “On-demand” healthcare: Nearly 1 out of 4 patients said they sought treatment at a retail clinic in 2011.
- Information access: There is a greater democracy in seeking healthcare information on the internet.
- Health reform: Millions of newly insured Americans will begin seeking care, and standardized insurance means providers will have to differentiate themselves on customer service.
The Institute of Medicine described patient-centered care as taking into account patient preferences, needs and values. It is easy to conflate that with patient satisfaction, which has its roots in consumer marketing. Patient satisfaction, say physicians Joel Kupfer and Edward Bond, means the customer’s expectations were met or exceeded. If not, the service is deemed low quality. Patient satisfaction is important, they say, because it means physicians are providing comfort, support and education. However, patient satisfaction and patient-centeredness differ because physicians are not obligated to satisfy all the patients’ demands in the latter. After all, urging patients to change health behaviors can run counter to patient satisfaction.
In an online survey of 6,000 consumers, PriceWaterhouseCooper found only 8 percent ranked price as the top factor in choosing a physician—despite the fact that it was the No. 1 response for more than half the respondents in shopping for travel, health insurance, or retail stores. Personal recommendations were more than twice as likely to influence the purchase of healthcare services as any other consumer purchase. Nine out of 10 said they would be willing to recommend a physician or hospital after a positive experience.
Consumers are not particularly adept at figuring out what excellent care is. In a study of 374 breast-cancer patients, 55 percent said they received “excellent” care—even though 88 percent got treatment that was consistent with the best treatment guidelines.
Respondents seemed to be more focused on the treatment process—such as how well providers communicated and the ease of obtaining service.
Evidence indicates physicians—especially those employed by hospital systems—have been altering the way they practice to please the patient.
Consider these results from an Emergency Physicians Monthly survey:
- More than 16 percent of medical professionals had their employment threatened by low patient-satisfaction scores.
- 41 percent decreased the amount of testing performed, while 59 percent increased the amount of testing they performed because of the effect of patient-satisfaction surveys.
- 48 percent of providers said they altered medical treatment because of the potential for a negative report on a patient-satisfaction survey, with 10 percent of those admitting they provided medically unnecessary care.
- In a South Carolina Medical Association survey, more than half of physicians said they had ordered tests they considered inappropriate, and nearly half said they improperly prescribed antibiotics and narcotic pain medication, because of patient-satisfaction surveys.
Nearly 2 out of 3 hospitals, health systems and large physician groups have annual incentive plans for doctors. Nearly 2 out of 3 of those use patient-satisfaction metrics as a factor, up from 43 percent in 2010.
A team of UC Davis researchers found that people who are the most satisfied with their doctors are more likely to be hospitalized, accumulate more healthcare and drug expenditures, and have higher death rates than patients who are less satisfied with their care.
“Patient satisfaction is a widely emphasized indicator of healthcare quality, but our study calls into question whether increased patient satisfaction, as currently measured and used, is a wise goal in and of itself,” Joshua Fenton, assistant professor in the UC Davis Department of Family and Community Medicine and lead author of the study, said in a statement.
Prior studies have shown that patient satisfaction strongly correlates with the extent to which physicians fulfill patient expectations, according to Fenton.
“Doctors may order requested tests or treatments to satisfy patients rather than out of medical necessity, which may expose patients to risks without benefits,” he said. “A better approach is to explain carefully why a test or treatment isn’t needed, but that takes time, which is in short supply during primary-care visits.”
In an editorial accompanying the UC-Davis study, Brenda Sirovich, MD, wrote, “The direct relationship between customer satisfaction and subsequent consumption is doctrine in commerce and business. ‘The customer is always right,’ a phrase likely coined by Marshall Field, the department store magnate, in the late 19th century, is a credo that we, as consumers, may wish we encountered more often. Is healthcare any different? Apparently not.”
Steve Jacob is editor-at-large of D Healthcare Daily and author of the book Health Care in 2020: Where Uncertain Reform, Bad Habits, Too Few Doctors and Skyrocketing Costs Are Taking Us. He can be reached at firstname.lastname@example.org.