Pay-for-performance programs almost always include some form of patient satisfaction score and the Center for Medicare and Medicaid Services has adopted standardized patient satisfaction surveys for almost every type of provider. While patient satisfaction is viewed as an outcome in itself and as indicative of patient-centeredness, it is also believed to be linked to better quality of care and quality outcomes. Research published in the Archives of Internal Medicine set out to test this link, also looking at the relationship of patient satisfaction, utilization and cost. (Archives Article) The researchers used the Medical Expenditure Panel Survey data from 2000 to 2007 to test for these relationships.
After looking at patient satisfaction for a particular individual in year one, the researchers looked at mortality, utilization and spending in subsequent years. Satisfaction was measured from the physician communication items on the Consumer Assessment of Health Plans surveys. Results were adjusted for various sociodemographic, health status and health behavior factors. The final set of respondents numbered more than 50,000 people. Patients in the highest quartile of satisfaction were less likely to have an emergency room visit than those in the least satisfied quartiles, but they were more likely to have an inpatient admission. These highly satisfied patients also had about 9% higher total health spending and prescription drug spending. They also had a 26% higher mortality risk.
So it appears that satisfied patients generally have more spent on their care, but don’t necessarily have better quality outcomes. The authors suggest that demanding patients may get discretionary care that they don’t really need and that doesn’t really benefit them, particularly when their doctors are measured by patient satisfaction and are concerned about their scores. It could be that patients who are sicker get more care and have more interactions and more opportunity to be satisfied, but the adjustments made by the authors suggest that this is not the case. In any event, it appears that putting too much emphasis on patient satisfaction may be costly to the system and to patients.