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Is Patient Satisfaction Bringing You Down?

With patient experience surveys driving provider ratings, healthcare facilities have increasingly become more customer-centric and focused on hospitality to ensure patients are happy. Sadly, many healthcare organizations have discovered that a happy patient doesn’t necessarily make a healthy patient. So, what do you do when patients ask for something you either don’t have or advise against?


Picture1At this point, I’m guessing you have a few good stories about patients who demand something totally unreasonable and give poor scores on a patient satisfaction survey when they don’t get their way. Consumerism prevails in modern society, and the notion that the “customer is always right” shouldn’t apply to healthcare, but it does.

In a national study published in JAMA Internal Medicine, patients who reported being most satisfied with their doctors had higher healthcare and prescription costs and were more likely to be hospitalized than patients who were not as satisfied. Because patient satisfaction does not directly correlate with better health, healthcare organizations find themselves in the paradoxical situation of wanting to please the patient, but also do what is medically right while reducing hospitalizations.

Fortunately, under the Medicare Access and CHIP Reauthorization Act (MACRA), the Centers for Medicare & Medicaid Services (CMS) will allow physicians the option to exclude patient satisfaction ratings from the CMS formula for determining rewards or penalties on their pay. Nevertheless, patient satisfaction surveys are valuable tools that can help identify your organization’s strengths and weaknesses, and they provide benchmarking data to aid you with continuous improvement. Before revising or implementing your surveys, consider the following three questions.


Screen Shot 2017-01-27 at 3.24.21 PMManaging your organization’s reputation is essential to its sustainability, and like it or not, ratings are a part of the equation. A 2016 survey revealed that over half of all patients polled used patient review sites sometimes or often, and 77 percent of those using the sites did so before selecting a doctor. Perhaps your online reputation is not as important to your current patients because you have already engaged them. However, for those patients who are comparison shopping before choosing a doctor, you’ll want to beat the competition. Look up your ratings on sites that patients are likely to view as reliable sources and make sure you are doing everything possible to address concerns and correct misinformation about your organization. Since patient reviews can be biased and not reflect the feelings of the majority, you may want to verify the reliability of those negative online responses by targeting them in your survey questions. Additionally, consider incorporating CMS survey questions into your surveys. This allows you to test your patient satisfaction and help decide if your organization should get into the CAHPS database and appear on patient-trusted CMS Compare sites.


TablesAnalyzing administration costs can help determine what you will include on, and how you will distribute, your surveys. Factors influencing your costs include survey length, how you collect patient survey data (e.g. mail, phone, Interactive voice response) and the number of patients surveyed.

The CMS uses Consumer Assessment of Healthcare Providers and Systems’ (CAHPS®) surveys and contracted Abt Associates Inc. to conduct a study on potential benefits and costs of using the CAHPS survey.

Abt’s study Table 4 reveals the average cost range to administer the current CAHPS survey as a stand-alone instrument averages between $11 and $15.25 per completed survey. Table 6 shows that hospitals could incur cost savings of around $3.26 per complete if they simply incorporated CAHPS survey questions into their current surveys. And Table 5 indicates that shorter surveys could save even more.

We included these tables to give you costs with which you can compare to your current survey expenses. The CAHPS survey is only one measure out of nearly 300 measures that could count in the Quality category under CMS’ Merit-based Incentive Payment System (MIPS) and may not be suitable to all healthcare organizations. For example, while excellent patient survey scores potentially increase merit-based pay, the percentage that your total merit-based pay can adjust for the 2017 performance year is plus or minus four percent. Depending on your Medicare volume, it may be more, or less cost-effective to exclusively use CAHPS surveys over your current method. The bottom line is that you want to examine all factors and decide what is best for your organization.


Using best practices will help you gain the most insight from your surveys. Small details can make a difference in your patient’s feedback and response rate. Consider the quick tips in the chart below to ensure your surveys give you the best possible results.

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Patient satisfaction scores are probably here to stay, so hold on to your sense of humor and don’t let them bring you down. Laughter is the best medicine, so share a funny patient satisfaction story. And feel free to share this blog post on your own social media to start a conversation with your peers.

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