Physicians Urged to Measure Patient Satisfaction 

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Quality Feature – May 2012   


Tex Med. 2012;108(5):43-45.  

By Ken Ortolon 
Senior Editor 

Do you know how satisfied your patients are with the care you provide, the ease with which they can make an appointment to see you, or how your front office staff treats them? If not, you might want to start asking them. 

Experts say every physician should measure patient satisfaction for many reasons. 

"From a very practical perspective, it's a good way to understand what's happening in your office without having to be on the front desk," said Joseph Gave, director of clinical advocacy for the Texas Medical Association. "And from a business perspective, it's good to understand your customers." 

In a December 2010 blog, Megan O'Donnell, health care division manager for Syracuse, N.Y.-based Research & Marketing Strategies, said conducting patient satisfaction surveys not only can help physicians find out what really matters to their patients, but also can attract new patients, build loyalty among existing patients, increase competitiveness in the marketplace, and improve staff morale. 

Customer satisfaction has been a key measure for companies in other industries for decades, but Ms. O'Donnell says only in the past several years has it become important in the health care industry. 

"It had long been the standard that the only measure of providing quality health care was found in the clinical outcome of the care provided," she said. "In today's consumer-driven health care environment, however, patient satisfaction is an important health outcome measure." 

While improving the performance of your practice is a major reason to begin conducting patient satisfaction surveys, Mr. Gave and others cite more reasons physicians need to measure satisfaction. 

Within the next few years, they say, Medicare will base physician payments at least in part on patient satisfaction data. And, medical specialty boards also have begun considering patient satisfaction as criteria for board recertification. 


The Business Perspective 

From a business perspective, it makes good sense to measure patient satisfaction, says Patty Riskind, senior vice president for medical services at Press Ganey Associates Inc., which measures patient satisfaction of hospitals and physician practices. 

From a business perspective, it makes good sense to measure patient satisfaction, says Patty Riskind, senior vice president for medical services at Press Ganey Associates Inc., which measures patient satisfaction of hospitals and physician practices. 

"You wouldn't diagnose a patient without doing an exam, so don't run your business without understanding your customers," she said, adding that measuring satisfaction can help on a number of fronts. 

"One, it will help you run your day-to-day business. If you have your finger on the pulse as to your customers' perception of communication, wait times, or the front desk staff, and a problem comes up, then you have the ability to address that and make it a better experience overall for your patients. That is good for business." 

Also, satisfied patients are lower liability lawsuit risks, thus measuring satisfaction can help reduce you medical liability exposure, Ms. Riskind says. In fact, some liability carriers give discounts on premiums to physicians who carry out patient satisfaction surveys, she adds.     

Plano family physician Christopher Crow, MD, says his practice's liability insurance premiums dropped significantly because it uses patient surveys. "Data clearly shows that practices that do customer satisfaction surveys have lower numbers of malpractice claims filed against them," he said. 

Both Dr. Crow and Ms. Riskind say the discounts are available simply for measuring patient satisfaction and do not depend on the scores the practice receives. 

There are several vendors, such as Press Ganey, that measure patient satisfaction. In the company blog, Ms. O'Donnell writes that using an outside vendor has several advantages, including that it allows a physician's staff to conduct its daily business uninterrupted. Patients also are more inclined to provide honest, constructive feedback if they are giving their responses to a third party, she added. 

But satisfaction survey programs from some of these outside vendors can be expensive, running as much as $10,000 to $20,000 annually.  

Mr. Gave says some physicians, particularly those in smaller practices, may want to develop and implement their own survey mechanism, which they can do without a lot of expense. 

The survey questionnaire does not have to be lengthy. A sample survey included in Policies and Procedures: A Guide for Medical Practices, offered by TMA Practice Consulting, has 15 questions. Those questions address overall quality of care received; respect, courtesy, and sensitivity of the physician, nurse, and receptionist; amount of time the doctor spent with the patient; the physician's explanation of what was done for the patient; time spent waiting in the office to see the doctor; and more.  


Differing Approaches

Scott & White Healthcare, which includes one of the largest multispecialty physician groups in the state, uses Press Ganey to conduct patient satisfaction surveys for its inpatient hospitals and outpatient clinics. Tiffany Berry, MD, Scott & White's medical director for quality and patient safety, says Press Ganey uses mail, telephone, and electronic surveys to collect data that is reported regularly to Scott & White. 

Scott & White Healthcare, which includes one of the largest multispecialty physician groups in the state, uses Press Ganey to conduct patient satisfaction surveys for its inpatient hospitals and outpatient clinics. Tiffany Berry, MD, Scott & White's medical director for quality and patient safety, says Press Ganey uses mail, telephone, and electronic surveys to collect data that is reported regularly to Scott & White. 

Pam Potter, practice administrator for the Bone & Joint Clinic of Houston, an orthopedic group practice with four offices throughout the Houston area, says it also uses an outside vendor, 9g Enterprises. Their surveys, however, are online. The patients can either sit down at a computer screen right by the checkout desk and take the survey or complete it on their computer at home. 

A large multispecialty group, Houston's Kelsey-Seybold Clinic, uses a survey it designed itself. Houston internist Spencer Berthelsen, MD, who chairs the Board of Managers for the Kelsey-Seybold Medical Group, says the practice gives the survey to a random sampling of patients on a card they can fill out when they're in the office.  

The survey includes questions about a patient's experience with the front desk, doctors, and nurses. It focuses on such things as wait times, the time actually spent with a physician, patient perceptions of how knowledgeable the physician was about the patient's illness or condition, and more. 

Dr. Crow, who chairs TMA's Council on Socioeconomics, says his practice, Village Health Partners, has surveyed patients for several years. The group, which includes 12 family physicians, started out with a short questionnaire distributed at checkout. They now do the surveys online, he says. 

The survey measures the patient's experience with setting an appointment and checking in at the front desk and with the nursing staff and doctors. Patients also are asked if they would recommend Village Health Partners to friends or family. 

Dr. Berry says Scott & White uses the data from its outpatient clinic surveys to provide individual feedback for each of its physicians, physician assistants, and nurse practitioners. 

"They get quarterly data including comments from patients with anonymity on those comments," she said. 

Some Scott & White departments use the data for innovative initiatives. For example, one department offers financial incentives to physicians and others with high satisfaction scores and recommends continuing medical education on improving patient satisfaction or mentoring programs for those with lower scores. 

Scott & White even began publishing the Press Ganey score on an electronic forum for the physicians. "That was a step forward for our organization" Dr. Berry said. "It was difficult for some to accept. It's hard to see something so personal become so transparent. With time, we've all become very accustomed to it. Just the act of making this data public, even internally, has improved scores. Scott & White has cut the number of providers in the lowest percentile by almost 50 percent." 

Dr. Crow also says his practice uses the satisfaction data in its bonus structure for staff. He says they can "slice and dice" the data they get back from the surveys by individual physician or nurse or specific area of the practice. 

"We are a larger clinic so we have three different areas where people check in and out," he said. "We can see if one is performing better than another from a customer service standpoint." 

Ms. Potter says she likes the online surveys they use because she can get instant feedback via e-mail if a patient gives the practice low scores. That allows her to take immediate action to remedy the problem 

9g also gives Houston Bone & Joint data on how it stacks up against other orthopedic practices they measure. 

Ms. Potter says one of the things they initially learned through the satisfaction surveys was that their physicians and staff needed to do a better job communicating to the patients, particularly about their medications.  


Defending the Bottom Line

While surveying can be expensive, Ms. Riskind says improvements in practice operations resulting from the data collected can help generate more revenue. 

While surveying can be expensive, Ms. Riskind says improvements in practice operations resulting from the data collected can help generate more revenue. 

"If you're able to reduce your wait times by 10 minutes and you're able to see an additional patient per day, five more a week, 20 more a month, it certainly pays for itself," she said. 

Also, physicians are soon going to need this data to get the maximum reimbursement possible under Medicare and to maintain their specialty board certification. 

The Affordable Care Act requires the U.S. Centers for Medicare & Medicaid Services (CMS) to implement by 2017 a value-based modifier that will adjust physician Medicare payments based in part on patient satisfaction scores. Mr. Gave says physicians must submit satisfaction data using the  Clinician and Group Consumer Assessment of Healthcare Providers Survey (CG-CAHPS) as early as 2014 and will begin receiving reports back from Medicare by 2015. CMS will base payments in 2017 on those 2015 reports, Mr. Gave says. The agency has not finalized its rules on the value-based modifier, so it is unknown what the consequences will be for failure to report satisfaction data. 

While CMS has not released details of how the value-based modifier will work, Ms. Riskind and others say the agency likely will start out paying bonuses to those with high satisfaction scores. And – much like adopting electronic medical records and participating in the Physician Quality Reporting System – those bonuses likely will turn into penalties for those with low scores in later years. 

The data also likely will be posted on the new Medicare Physician Compare website. 

Ms. Riskind says several states – including Oregon, California, and Minnesota – have launched initiatives using CG-CAHPS data. And, private health plans likely will follow suit. UnitedHealth recently announced it was launching a new payment system that would tie hospital payments to patient satisfaction and other criteria, including readmission rates, hospital-acquired infections, and more. 

The American Board of Medical Specialties also has begun assessing competencies that address communication and patient satisfaction in its maintenance of certification programs. 

 For more information about quality improvement issues and resources available from TMA, check out the Quality Improvement page on TMA's website.  

Ken Ortolon can be reached by telephone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email. 


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