Downside of Satisfaction Surveys

The Downside of Patient Satisfaction Surveys


In a previous post, we talked about how patient satisfaction surveys can help health care providers improve. As we discussed, certain factors are well within doctors’ control—such as whether they listen and show respect to patients, and if they explain things in a way that’s easy for patients to understand.

We also noted, however, that measuring patient satisfaction is not an exact science. In some cases, this feedback can have a negative impact. Some even blame patient satisfaction surveys for driving up health care costs for everyone. Find out why, and what are the primary reasons that providers are concerned.

Driving up costs with unnecessary services?

Are “frivolous” hospital amenities like uniformed valets and in-room massages driving up the cost of health care for all of us? That’s the concern Physicians Practice recently expressed in response to an article in The New York Times about how hospitals are attracting patients by offering high-end conveniences.

While the services are paid for out-of-pocket by patients and through donors, some are questioning whether this model could do more harm than good. “We’re in a period of epically high health care costs, primarily at the hospital outpatient level, and the cost of health spending seems to be irreversible. Meanwhile, we’ve got some hospitals acting as if they are the Ritz Carlton,” writes Gabriel Perna, managing editor of Physicians Practice.

According to the Times, though, it’s paying off in hospitals’ patient satisfaction survey scores. Customer satisfaction ratings have improved and patients are more likely to recommend the hospital to others. Length of stay and readmission rates have also decreased, which allows more beds to open up and the hospital to treat more patients. It also boosts hospitals’ bottom lines—the article cites a study by Deloitte that found hospitals with higher patient experience ratings were generally more profitable than those with lower scores.

But are we putting too much stock on patient satisfaction scores? asks Perna. “Are the Consumer Assessment of Healthcare Providers & Systems (CAHPS) surveys leading us to a dangerous place where inconsequential amenities are being prioritized over important services?”

The downside of patient satisfaction surveys

In fact, the more common fear is that these surveys will lead to unnecessary and even potentially harmful care. For instance, doctors who treat Medicare patients may be feeling pressure to prescribe narcotics, reports Kaiser Health News (KHN). That’s because those patients typically complete patient satisfaction surveys that ask how doctors managed their pain. Because these surveys are linked to hospital reimbursements, their results can also affect doctors’ compensation. So providers are caught in the middle.

Doctors “feel like they’re getting mixed signals,” said Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association, to KHN. On one hand, “they’re getting this signal [from the CDC] to not prescribe opioids. And on the other, they’re getting this signal to manage patient pain so it’s zero.”

“Though the intention of patient satisfaction surveys may be altruistic, the focus on patient satisfaction and the surveys designed to measure it could actually lead to a decrease in care quality and an increase in costs,” states Becker’s Hospital Review, citing a recent report from The Hastings Center. The report cites the following unintended negative results of patient satisfaction surveys:

  • Doctors giving unnecessary or inappropriate care – such as overprescribing medications and ordering tests that aren’t medically necessary.
  • Telling patients what they want to hear – because patients tend to rate doctors more poorly if they deliver bad news.
  • “Teaching to the test” – when hospitals put processes in place to “manipulate” patient responses to CAHPS and HCAHPS surveys.
  • A decrease in health care quality and increase in costs – the report cites a 2012 journal study that directly ties high satisfaction scores to higher overall health care costs.


Handling negative online feedback

Of course, CAHPS and HCAHPS aren’t the only ways patients can give feedback. A fact of life in the Internet age is that people can and do freely share their experiences online—even more so if they’ve had a bad one.

Doctors should monitor their online reviews and ratings and consider whether they require responses, or should be ignored or reported to the site administrator to be removed (in the instance of inflammatory language, for instance). Be careful when responding to online reviews not to expose patients’ privacy or violate HIPAA laws like these doctors, reported The Washington Post.

While the number of people reading online reviews has increased, rest assured that word-of-mouth recommendations still beat online reviews. The best way to get prospective patients to overlook a negative comment or two is to ensure that there are more good reviews alongside them. Ask your longtime or highly satisfied patients to post reviews—most will be happy to.

For more tips on this topic, check out our post, Managing Negative Feedback Online: 5 Tips. And for more information on patient satisfaction in your practice, check out our blog archives and subscribe to our newsletter.

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