iProtean—New Study Disputes Correlation between Quality and Patient Satisfaction

Patient satisfaction assessments represent 30 percent of the bonuses and penalties given to hospitals during the first year of Medicare’s value-based purchasing, a component of the health reform law.


But a new study from Johns Hopkins University suggests that patient satisfaction is not necessarily a good indicator of quality care. The study analyzed patient satisfaction and surgical quality measures in select urban hospitals in 10 states. Study results indicate that little relationship exists between a hospital’s patient satisfaction scores and most quality ratings.


Patient satisfaction was measured through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, Medicare’s standardized survey instrument and data collection methodology that has been in use since 2006 to measure patients’ perspectives of hospital care. Quality was judged by how consistently surgeons and nurses followed recommended standards of care such as giving antibiotics at the right time and taking precautionary steps to avert blood clots.  Researchers also examined how hospital employees evaluated safety attributes at their hospital.  (“Patient Satisfaction May Not Be A Good Indicator Of Surgical Quality, Study Finds,” Kaiser Health News, April 17, 2013)


One of the researchers noted that while patient satisfaction scores are a valuable component of evaluating a hospital, they are getting excessive attention because they are among the few quality measures available to the public. But this study, as well as previous studies of the relationship between patient views and the quality of care, indicates that the two are not necessarily correlated. “Opinions are not barometers of whether your hospital’s surgical care is any good,” wrote Jordon Rau in a recent Kaiser Health News article.


Nevertheless, Medicare views patient satisfaction scores as useful. In addition to the 30 percent bonus/penalties tied to patient satisfaction under value-based reimbursement, Mr. Rau noted that some of the surgical measures are also included in the calculations that make up the other 70 percent of the bonus/penalties this year. Hospitals currently can gain or lose one percent of their regular Medicare payments under the value-based purchasing program; this increases to two percent in October 2013. As of December 2012, 1,557 hospitals were rewarded and 1,427 others saw a reduction in payment. (See Deloitte Center for Health Solutions “Health Care Reform Memo,” April 22, 2013 and iProtean blog, “Two Pay-for-Performance Programs Now in Effect,” October 2, 2012.)


The study does reveal some relationship between how patients rated their experiences and whether hospital workers considered themselves part of a team approach to caring for patients.  However, there was no relationship between patient scores and hospital workers’ overall assessment of the hospital’s safety culture. (“Patient Satisfaction May Not Be A Good Indicator Of Surgical Quality, Study Finds,” Kaiser Health News, April 17, 2013)


In the iProtean advanced course Value-based Purchasing and Accountable Care Organizations, Dan Grauman and Nate Kaufman describe the value-based purchasing program under the Affordable Care Act, how it works, its positive and negative effects for hospitals, implementation and involving physicians.



For a complete list of iProtean courses, click here.



iProtean Symposium & Workshop

Mark the Date!! October 2 – 4, 2013 at The Lodge at Torrey Pines, La Jolla, CA. Faculty: Michael Irwin (Citigroup), Todd Sagin, M.D., J.D. (Sagin Healthcare Consulting), Dan Grauman (DGA Partners), Pam Knecht (ACCORD LIMITED), Barry Bader (Bader & Associates), Ed Kazemek (ACCORD LIMITED).  For more information, click here.


For more information about iProtean, click here.