Making Patients Happy and What About the Discouraged Patients?

This past week, the New York Times discussed the role of patient satisfaction scores in changing Medicare reimbursement.  The timing is linked to the October 1st introduction of the new Medicare payment rate partly  based on hospital survey patient experience  data collected beginning in July of 2011.  

Never mind that 70 percent of the payment rate differential is based on procedural metrics unrelated to the satisfaction surveys, most of the ink I have seen spilled has been over the satisfaction surveys. This is because the survey questions try to get at the subjective experience of and observation of the quality of care.

I have written about this elsewhere. You can read my "'How's My Doctoring?' Patient Feedback's Role in Physician Assessment" paper here: http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2078684. I am heartened, as well,  to see this topic  discussed in the 2012 Health Care Reform Supplement to the Furrow, Greaney, et al Health Law casebook.  

Janet Adamy did a good job in her New York Times article of highlighting how survey questions like "How often did doctors treat you with courtesy and respect?" are about provider-patient communication and, ultimately, patient treatment plan adherence. But there were two topics that, though mentioned briefly, deserved far more attention.

First, when a patient notes and reports that an examination room is not completely clean it is not just an aesthetic observation, deeply relevant to "what we would want as a patient."  These same patient survey observations on hospital cleanliness standards should be deeply relevant to what we should  all want of our hospitals, objectively lower rates of hospital acquired infections.

Second, when urban hospitals note that patients who enter acute care stays through the emergency rooms, with their concommitmant lengthy waits, are significantly more displeased with their hospital experience, we should all take note.  Put aside important questions about why urban acute care hospitals tend to treat the sickest of the sick and the challenges this can pose for weighting patient satisfaction data against middle class commercially insured patients commenting on the amenities provided during suburban hospital  elective procedures. This matters. But we should also focus on the issue of patient wait times and discouraged patients abandoning the quest for care, something we don't track.  The latter are the wait times of failed encounters, after all.

But these failed encounters are tracked elsewhere, particularly in the U.K. The goal of tracking is to find out if the discouraged health care seekers enter the system later at  more expensive health care venues to seek services they could not obtain earlier. 

Thinking about discouraged patients is a little like thinking about discouraged job seekers in the labor and employment statistics.  In the latter, though we know the discouraged job seekers exist, we choose not to count them.

I wonder if something very similar isn't going on with emergency room data collection. What would we learn if we tracked everyone who arrived and not just those whose work and family commitments allowed them to wait hours to be seen? Do discouraged patients in the U.S. disproportionately abandon the quest for care or simply delay it or transfer it?