The other day, a few physicians were discussing frequent fliers, patients who when discharged from the hospital find their way back to an inpatient status within days and sometimes within hours. Such patients are notorious for threatening to sign out of the hospital AMA (against medical advice) when refused pain medications for example, despite having serious life-threatening issues that they should stay in the hospital for. And when they do get signed out, they are smart enough to know that they are truly sick so down to the emergency room they go to get worked up all over again for an admission (and score some pain medications in the ED).
As frustrating as that is to the physician it doesn’t help that said physician is under immense pressure from administrative executives in the C-suite (CEO, CMO, CFO, CNO, etc) to do whatever possible to raise patient satisfaction scores. In this instance, the “do more” is to just give the patient the pain medication they request even though they fall asleep mid-sentence as they try to explain the “excruciating pain” for which they need more intravenous morphine dilaudid.
You please patients by going ahead and calling that cardiology consult “per family request” despite the patient’s chest pain being obviously heartburn, or is it? They do after all have a cardiac history. You as the cardiologist is just as incentivized or pressured to do an invasive cardiac catheterization “just to make sure”. Who wants to be graded low on physician satisfaction scores right? Google any physician and you will see physician grades. Who fills those out if not dissatisfied patients? If the patient wants an MRI because they bumped their head on the table after picking up a fork that fell to the ground, then by golly give that patient an MRI if you don’t want the C-suite to march down to your ER to ask why there’s a poor evaluation written about the hospital in the local papers. It’s not easy being firm with doing the right thing in spite of what the patient thinks they want.
Healthcare now is a business and many hospitals are struggling to compete. A satisfied patient is a return patient. A satisfied patient is a referral center. And now, Medicare has made it such that a satisfied patient equals a financial bonus. So wealthier hospitals change double rooms to single rooms and furnish all with plasma TVs. They provide catered food because that will certainly positively impact what the average patient thinks of their stay, and ka-ching, bonus payment from Medicare. The cycle continues with the building of more luxurious amenities to pander to a patient’s satisfaction. Excellent use of health care resources, don’t you think?
So it isn’t really with much surprise that I read the results of a recent study from the Archives of Internal Medicine that show that higher patient satisfaction was associated with “greater inpatient use, higher overall health care and prescription drug expenditures, and increased mortality”. It makes me sad that the state of the American healthcare system is to reward for excesses and to penalize for not doing enough when “more” is not necessarily better. “More” simply should not be incentivized. Clearly, a hospital with a high patient satisfaction score isn’t necessarily a good thing.
Sigh.
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