Friday, May 27, 2011

Patients Satisfaction Surveys: Valid Test, Or Make-Work for Money?

Doc Gurley's Urban Health Beat, Reporting on Health, patient satisfaction, doctor reimbursementPerhaps you remember Sam, the chronic inebriate whose story I shared to discuss the pitfalls of basing doctor pay on patient satisfaction surveys.

Looking at his discharge papers, I wondered who helped Sam fill his survey out, and how much their "help" affected the results.

After all, millions upon millions of dollars are already now at stake for hospitals. And individual doctors' Medicare payments are expected to be based on their satisfaction scores, as early as the year 2015.

Surely these surveys are validated and standardized, right? Surely there is policing to prevent "helping" people fill them out? You might be surprised by the answers to those questions.

For instance, when you're talking about something like "satisfaction," there are some regions where patients are less forthcoming with praise (check out the difference between, say, a quiet night hospital score in California versus Alabama).

These scores also lack variability. Westby Fisher, a clinical associate professor at University of Chicago's Pritzker School of Medicine, calculated, with the Kaiser Foundation, the mean, median and standard deviation of hospital patient satisfaction data. Nationwide, there is just a two to six percent variation. In other words, the results vary arbitrarily, but very little. By statistical standards, it’s not a very good test.

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Disclaimer: Identifiable patients mentioned in this post were not served by R. Jan Gurley in her capacity as a physician at the San Francisco Department of Public Health, nor were they encountered through her position there. The views and opinions expressed by R. Jan Gurley are her own and do not necessarily reflect the official policies of the City and County of San Francisco; nor does mention of the San Francisco Department of Public Health imply its endorsement.

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