An article in the Wall Street Journal (October 15,2012) describes a plan to hold back $1 billion in reimbursements that will be distributed based on patient satifaction survey scores. The scores measure whether patients were treated with courtesy, whether they were treated adequately for pain etc. But hospitals treating patients who come through the emergency room or hospitals with the greatest fraction of nonpaying patients, claim they are disadvantaged and will loose reimbursements just when they need them. Should patient satisfaction be given prominence or should reimbursements only focus on health outcomes ? Will the incentive to improve satisfaction create changes that might decrease health care costs ? Will it cause investments by hospitals in measures that are now justifiable – such as more frequent nurse visits and better communications ?
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Reimbursement should not be tied to patient satisfaction or outcomes. Satisfaction is subjective (housekeeping & food service drive expressed satisfaction scores). Outcomes are beyond control in many cases. Some events are not survivable.
If reimbursements are tied to any performance indicator it should be infection rate and re-admits for same diagnosis. Infection rates are almost always tied to human cause, ie, proper hand-washing. Re-admits for same diagnosis can hint at attempts reduce operating costs.
Most good hospitals are actively working on these points daily. If you find a low-infection rate provider, they probably have high satisfaction scores as well as good clinical outcomes.