Wednesday, May 28, 2014

Life Imitates The Onion On Physician Satisfaction Surveys

The Daily Beast just published an interesting article on, "You Can't Yelp Your Doctor" (5/21/2014).

One of their take-home points is that some of the country’s best doctors have the worst patient satisfaction scores (and vice versa).

From the article:
Armed with the idea that “patient is always right,” Washington figured that more customer satisfaction data “will improve quality of care and reduce costs.”

That turns out to have been a bad bet.

In fact, the most satisfied patients are 12 percent more likely to be hospitalized and 26 percent more likely to die, according to researchers at UC Davis. “Overtreatment is a silent killer,” wrote Dr. William Sonnenberg in his recent Medscape article, Patient Satisfaction is Overrated. “We can over-treat and over-prescribe. The patients will be happy, give us good ratings, yet be worse off.”

It’s Economics 101. If we ask drug-addicted patients to grade their physicians on how satisfied they are with the “service,” then a high score will likely indicate they got the opposite of good medical care. It doesn’t take a genius to figure out how putting addicts in charge of the patient encounter contributes to the $24 billion in excess medical costs caused by prescription opiate abuse.
[U]nnecessary antibiotic prescriptions are also on the rise, adding to the deadly menace of drug-resistant bacteria. A patient demanding unnecessary antibiotics is one of the things that doctors hate most, yet nearly half of physicians surveyed said they’ve had to “improperly [prescribe] antibiotics and narcotic pain medication in direct response to patient satisfaction surveys”...

“The mandate is simple,” wrote Dr. Sonnenberg. “Never deny a request for an antibiotic, an opioid pain medication, a scan, or an admission.” So instead of better care and cheaper care, satisfaction scoring is making patients sicker and driving up costs...

But when physicians don’t acquiesce, they pay a price. Last year, The Atlantic profiled a physician who quit due to the pressure to prescribe narcotics. In many cases, doctors can’t keep their jobs or make partner if their scores aren’t—not just good—but stellar. And many physicians claim that hospital administrators explicitly tell them to do whatever it takes to raise scores even if it means compromising their professional standards...
Of course, The Onion was able to make a very similar point more succinctly in their satirical piece, "Physician Shoots Off A Few Adderall Prescriptions To Improve Yelp Rating" (4/17/2014):
Noting that his practice’s rating on the business review website had dipped to just 3.5 stars, local primary care provider Dr. Frank Hawley reportedly dashed off several Adderall prescriptions Monday to give his Yelp average a needed boost.

“I keep a pretty close eye on my reviews, and whenever I see my number fall below four stars I just write out a few extra Adderall or Dexedrine scripts and it’s back up in no time,” said Hawley, adding that he usually ups the dosage to 30 milligrams and makes sure to prescribe two refills to ensure he stays near the top of the local general practice rankings. “Patients are always happy when I sign that prescription slip and hand it to them—it’s pretty much a guaranteed five-star rating. In a business that survives by word of mouth, good reviews are absolutely essential.”

In addition, Hawley confirmed he hasn’t advised a single patient to exercise regularly or maintain a healthy diet since 2011, saying he learned his lesson after receiving a devastating one-star review.