Plastic surgeons question impact of patient satisfaction ratings

A topic article in the Journal of the American Society of Plastic Surgeons (ASPS) examines changing regulations on physicians and healthcare facilities. The move to a system of evaluation and ratings leaves the article's authors afraid that some might fear a one-star review as much as treating a patient incorrectly.

Physician ratings and related reimbursement can be major sources of stress. The rankings can also determine how a facility allocates resources. Hospitals are installing the latest in amenities in the race to a five-star review. But these new features could impact medical judgment in an attempt to keep patients happy. The article—titled "The Importance of Patient Satisfaction: A Blessing, a Curse, or Simply Irrelevant?"—brings up important questions regarding the value of these patient satisfaction ratings.

"Increasingly used as a measure of physician performance, patient satisfaction data can be flawed and not broadly applicable," said Terence Myckatyn, MD, of Washington University School of Medicine in St. Louis. "While patient satisfaction is important, we think that better rating tools are needed to measure it."

The authors cite many circumstances in which patient satisfaction ratings have come before what is actually the best for the patient’s interests. Hospitals are competing with one another both to improve patient care and better facilities to attract patients.

Myckatyn et al. writes, “one could argue that these costly expenses have more to do with the perception of healthcare quality rather than actual outcomes.”

Physicians are also to blame in the attempt to improve ratings by making patients more comfortable and prescribing pain medication to move them in and out of care. This idea that “a comfortable patient is a healthy patient," according to the authors. "Behavior motivated by patient satisfaction becomes especially dangerous when ratings are directly tied to compensation," the authors wrote.

“Unfortunately, there is little high-level evidence to support that patient satisfaction will improve medical outcomes, and there are plenty of contradictory data in smaller studies,” wrote Myckatyn and colleagues. “Part of the difficulty of these studies may lie in the diversity of patient expectations, which are dependent on the disease process and the inherently subjective and labile nature of people’s responses. Reliable tools are needed that will take into account what constitutes a superior quality of patient care in a more systematic, meaningful, and validated way.”

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