A journal of healing

Posts tagged ‘health care reform’

I can’t get no satisfaction


My thoughts today are a reflection in respond to a friend’s blog who is going to be about the overkill of patient satisfaction and the impact on the cost of medical practice. I was going to use the link to an article that she used to explain where this discussion is coming from. However, the article is not substantiated and does not use cited resources or even verified statistics. It is claptrap.

Patient satisfaction in health care has become the elephant in the room. The problem is now the government has stepped in and will (and in some cases is) attaching a numerical reimbursement rate based on a scoring. The scores are based on patient’s answers from a survey. Statically, it is proven, more people will respond to a survey if they have an emotion attachment to the outcome. In other words, if you’re pissed, you are more like to answer the survey. To that, the opposite is should be true and it is to some extent. I get the survey results and tabulate them for our agency. I would say that most patients are satisfied with our services. But in order for the survey to be counted towards reaching the mark, the patient has to give a 9 or 10. I personally very rarely give a 10 for anything. But if the patient is pissed, we have to do cartwheels to resolve the issue. And that negative score is going to cost us revenue someday in a climate where the government is already trying to take back as much money as they can for reimbursement.

It does not matter to the government that the patient had dementia or was giving a diagnosis which has caused them to be pissed at the world. Some surveys come in with all the answers with terrible negative responses until the last two where they answer we are the best and would recommend us. Clearly, they do not understand the survey. Also, we teach that a score of ten on a pain scale if horrible, the worse pain ever. BUT the government in its stupidity makes a ten the best answer on the survey. No problem there. We are not allowed to teach using the survey to the patient so we have used a discharge checklist with similar language to remind them of what happened with our service. The survey can come at any time, but often after the patient is discharged and has forgotten how bad they were when we started working with them. The whole process is stacked against the agency, hospital or provider.

The survey does not measure things like the environment of care, the caliber of the care…or in other words was the patient a complex visit which is much more involved, or even the overall health of the patient to begin with. It does not measure the attitude of the patient in general. If the patient is not one who is taking care of themselves to begin with, medical care is just another intrusion.

Having said all that, patient satisfaction is critical to the wellness or the ability of the patient to get well. Health Care is reforming and the responsibility of care will be more on the patient. If the patient views health care systems and all the clinicians as something to fear, or they come away from a service angry or upset, be it a hospital stay or a visit to a practitioner, it impacts their wellness. It keeps people away from the care they need. Bottom line, most people will not subject themselves to something not pleasant until it is a desperate situation. And then the cost for the care is more expensive. They are not going to keep appointments, which costs the practice lost revenue. They are not going to listen to what the prescribed recovery entails and they will be non-adherent. And often that ends up in a hospital readmission which then costs the hospital more as they get dinged for those by the government. And that all drives up medical costs more so then having some person in-charge of patient satisfaction.

Locally, our Patient and Family Centered Care practices came about when the Chief Medical Officer of the largest hospital in the area had a bad fall from his bicycle. He ended up losing all senses from his neck down. He said the one thing that made his initial situation tolerable was when a nurse offered to wash his hair for him when he was in ICU. He said because it was the only place he had feelings, so her touch was critical to his healing. The power of simply touch and caring had such an impact on him that once better (he recovered much of his abilities) he made it a major initiative for the whole URMC system. The fervor died down over the years, but there still is a PFCC unit and all employees of URMC and the affiliates still train on the principals and work hard at giving the best service possible to our patients.

My point is that until you experience a personal situation of being the patient, it is very difficult to understand how necessary it is to continue to have patient satisfaction an important part of health care. I feel there are way too many caustic and omnipotent clinicians out there that do more harm than good with their arrogance and judgments. The cold impersonal care of clinicians with too much on their caseloads drives up the cost of health care. Unfortunately, it is hard to statistically prove that because they produce high volume revenue. It’s hard to find the losses if their numbers look great.

And that is the problem with health care in general. It is all numbers. It is the flaw with patient satisfaction scores. “I did not like my doctor telling me something I do not want to face so I am going to give him/her a lousy score.” This in no way measures the clinician’s ability to do good work. And yes, there is a cost for providing good customer satisfaction as the article explains, but there can be overkill on anything. I do not think that it is the general case and that we actually have a long way to go to improve the patient experience.

This is the link to the good doctor’s blog. https://doctorly.wordpress.com/2015/04/25/closed-door/