The fatal bias of patient satisfaction scores
Let me close by condemning MACRA's reliance on patient satisfaction surveys as a factor in physician compensation. The fact that a clinician retains a patient who is free to choose a different clinician tells you everything you need to know about patient satisfaction. Patients vote with their feet, and they do not hesitate to vote themselves a new doctor if their needs are not being satisfied. Traditional Medicare allows patients to switch doctors freely, a freedom which may exact some cost in continuity of care, but which increases satisfaction for patients and doctors alike.
Surveys are fatally biased by the fact that angry patients are much more motivated to fill out a survey than are satisfied patients. Read the handwritten comments by the patients and ignore the standardized rating numbers they circled. The comments tell the true story:
• The patient had to wait for over an hour (because their stingy HMO forces the doctor to overbook to pay the overhead).
• The doctor's medical assistant was nasty to the patient (because most doctors today have no control over the hiring and firing of ancillary staff).
• The billing department turned their account over to collections (because the front desk staff failed to contact the patient when their bills were "returned to sender" by the post office).
• The doctor refused to refer the patient for acupuncture or to prescribe medical marijuana (for a condition lacking evidence of benefit of either treatment).
Doctors prefer to satisfy their patients as much as possible, but there must be limits.
David L. Keller, MD is a retired internist who resides in Lomita, California.