Can You Satisfy Patients, Hospitals, and Doctors All At Once?

I can’t get no satisfaction.

Keith Richards (born 1943),  musician, songwriter, and original member of Rolling Stones, Satisfaction (1965)

You get the satisfaction from being heard.

John Jay Chapman (1862-1933), Learning and Other Essays

October 15, 2012 -  Today two articles in the Wall Street Journal caught my eye.

·         The first, by reporter Janet Adamy was “U.S. Ties Hospital Payments to Making Patients Happy.” Adamy describes how the Obama administration is tying hospital payment to results of a 27-question government patient satisfaction survey. The questions are subjective and asks questions about how well doctors and patients communicate well, are courtesy, are responsive,  and whether the hospital food is good.   If scores are bad, non-performing hospitals get docked nearly $1 billion.  The $1 billion goes to hospitals are perform well.  This is part of the Obama administration  financial carrot-and-stick campaign.  In 2012,  the bad hospitals will be penalized 1% of their Medicare revenues; next year it will be 2%.  Hospitals complain that the  subjective results may have little to do with quality of care and outcomes.  Dr. Michael Frankel, MD,  chief of neurology,  says doctors are frustrated because there is little doctors can do to improve scores. He adds, “We’re expected to work miracles on patients, and sometimes that doesn’t happen.”  Nevertheless, the Obama people cling to the notion that punishing or rewarding physicians or hospitals for installing EHRs, prescribing electronically,  or reducing  hospital 30 day readmissions is the path to lower costs, higher quality, and greater satisfaction.

·         The second piece, “Let Doctors Cure Health-Care Costs, “on the Op-Ed page, is by Mitchell Rabkin, MD, a Harvard professor of medicine, and John Cook, an independent consultant on health are payment.   The two say that more satisfaction could be achieved by replacing the ailing fee-for-service model with salaried-physician groups working within a fixed budget.   That way doctors would be held accountable.  They say the current Medicare Accountable Care Organization model may not work because primary care physicians are not on salary.   But they point to Kaiser Permanente as a model that works  and where salaried  physicians tend to be more satisfied than doctors elsewhere according to 2012 White Paper from the Physicians Foundation. The key word here may be “elsewhere,” for in the other parts of the country – Ohio, Texas, and Connecticut – to name but a few, the Kaiser model has not worked because of patient and physician dissatisfaction. They conclude”  When these three goals are met – living within a reasonable budget, maintaining high quality of care, and patient satisfaction- the money not spent in the annual budget would be distributed  in three ways:  to the physician group, to the insurer (Medicare), and to the patients in the form of reduced premiums over the next year.

So far in Massachusetts, where Romneycare is supposedly the model for Obamacare and  where salaried physician groups are the norm. premiums are higher, waiting times are longer,  and ERs are more crowded than ever.  And in the Physician Foundation Survey of 630,000 physicians, released on September 24, 2012,  62% of physicians said, in their opinion, accountable care  organizations would be unlikely to decrease cost,  enhance quality,  or improve satisfaction.

To paraphrase Abraham Lincoln, “You can satisfy all of the people some of the time, you can even satisfy some of the people all the time, but you can’t satisfy all of the people all of the time.”

Tweet:  The Obama administration has adopted a policy of rewarding or punishing hospitals financially based on a 27-question patient satisfaction survey