O-Pinion

Patients like but don’t love Charlotte’s hospitals. That’s OK.

Novant Health Presbyterian Medical Center received three stars out of five in a patient satisfaction survey released by the federal government this month.
Novant Health Presbyterian Medical Center received three stars out of five in a patient satisfaction survey released by the federal government this month. rlahser@charlotteobserver.com

Charlotte’s biggest hospitals did kind of so-so this month in a Medicare survey of patient satisfaction. Carolinas Medical Center got four stars out of five in the survey posted last week, as did eight others owned by Carolinas HealthCare System. Novant’s three Mecklenburg County hospitals got three stars.

That’s not at all awful, but it’s not the excellence CMC and Novant expect out of themselves. “We’re performing at an average level right now,” Novant’s Sean Keyser, vice president for patient experience, told the Observer. “This is not OK with us.”

Maybe it should be OK with us. How much do we want our hospitals worrying about the happiness of their patients?

In The Atlantic magazine last week, author Alexandra Robbins explores a potential problem: Beginning in 2012, the Affordable Care Act mandated the withholding of 1 percent of total Medicare reimbursements from hospitals, a total of about $850 million. Hospitals that earn high patient-satisfaction scores and meet some basic care standards get that money back. Really high scorers get bonus money.

Beginning in 2017, the amount that’s withheld doubles. That’s high stakes.

Is it necessarily bad? After all, hospitals should strive to deliver high-quality, patient-centered care that will leave their customers happy. That’s what the Department of Health and Human Services said when it began basing Medicare reimbursement on patient satisfaction survey scores.

But turning patient happiness from a customer service issue into a government funding issue could mean placing too much emphasis and resources on the wrong thing – frills and perks – while threatening what patients need: critical and sometimes-difficult health care counsel.

The problem lies partly in the 32-question Hospital Consumer Assessment of Healthcare Providers and Systems survey. As Robbins notes, the survey’s questions can be too comfort-oriented – “How often did you get help as soon as you wanted it?” asked one – with too little context, such as was that help medically necessary?

The result is that annoyances such as noisy hospital roommates take on outsized significance. One hospital got dinged on the survey because it didn’t have Splenda, Robbins writes.

A bigger danger is that doctors may be reluctant to talk patients out of unnecessary treatments or tests they want, or they may be less inclined to bring up uncomfortable but important behavioral concerns like smoking or obesity.

A 2012 University of California-Davis study showed that patients who were most satisfied with their doctor had greater chances of subsequently being admitted to a hospital and had about 9 percent higher total health-care costs. They also had a bigger chance of dying: For every 100 people who died over an average period of nearly four years in the least satisfied group, about 126 people died in the most satisfied group.

“Patients should be satisfied with their physicians, but ideally it’s because their physicians guide them toward the best care,” said the study’s author, Joshua Fenton.

None of which means that hospitals shouldn’t care about making their patients comfortable and happy. The lengths some will go (including live music and higher-end meals) sound silly and costly but aren’t necessarily dangerous in themselves. Perks and good health care can co-exist, but when care is threatened by financial incentive to please, that’s not healthy for anyone.

Peter St. Onge

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