Should Popular Doctors Be Paid More?
Starting in October 2012, Medicare will pay 3,000 acute care hospitals more based on higher client satisfaction survey results…
Client satisfaction surveys also affect many insurance company’s reimbursement rates for individual providers, are an accepted factor in many board-recertification processes, and are a planned future factor in doctor pay under Medicare, with implementation expected by 2015.
Whom do you think will get a higher patient satisfaction score and hence get paid more, the doctor who dashes off a Librium prescription after spending five minutes with [a patient], or the doctor who takes the time to try to explain the pitfalls, problems, and contraindications to him?
It’s hard to fathom how we got to the point where we actually pay popular people more for our healthcare.
No such system exists in any other professional or non-professional field. Not for lawyers, not architects, not nurses, not teachers. You can’t even pay your plumber less if she has a lower customer satisfaction score.
In client satisfaction surveys, 70 percent of practicing lawyers have very low satisfaction ratings. But we don’t pay less for our justice system, and I, for one, would argue strongly that we shouldn’t — at least not based on popularity.
There’s an even nastier, and more insidious, result from basing compensation on patient satisfaction. As Kevin Pho, writing as KevinMD, states, “Already, more than 80 percent of doctors, according to a survey from HealthLeaders Media earlier this year, said patient pressure influenced their medical decisions. And in primary care, linking bonus pay to patient satisfaction could cause physicians to be more selective in who they see, subtly keeping patients who they know will score them well, and referring disagreeable ones to other providers.”
Full post on paying popular physicians more for their services.
Whether or not you like your doctor should be a factor in whether you continue to see them. It could be due to personality; or it could be technical competence. But for Medicare to create a patient satisfaction score and then base compensation on it is a little worrisome.
In order to improve patient satisfaction, it sounds like hospitals should invest in “Care Bears” for every patient. The higher ratings from patients who had successful outcomes (and like bears) should outweigh the low ratings from those who have less successful outcomes.
What is unfortunate is that this sounds like higher pay for the winners of a popularity contest, and sound medical judgement is,unfortunately, very often unpopular with patients. This is sending the wrong message.
Sounds like higher ed teacher evaluations. Which has led to lousy teaching. Profs with easier courses get, surprise, better grades.
The medical equivalent will be physicians who have great bedside manners. Productivity and actual ability to deliver good medicine will not be evaluated.
Medicare may not be a good place to base payment on patient satisfaction.
Once again this illustrates the problem with third party payment. If I am paying my physician directly I might very well pay more to see someone I respect and appreciate than someone I distrust. This is how we make decisions in every other field. It rewards not just technical competence but a whole range of personal relationship issues. In no other field is this more important than in medicine where trust and personal compatibility are crucial to good outcomes. But sticking a bureaucratic report card in the middle of that transaction destroys the very relationship that is so important.
While it is important to measure doctors, “patient satisfaction” is the wrong approach. If there were a way to measure average/expected health outcomes of patients vs. their actual progress it might create a more meaningful barometer.
Let the free market figure this out. Phase out medicare. Good doctors will command higher payments. But we need not-so-good doctors too; doctors regular people can afford to visit. Ultimately, we need more doctors. That is the crux of the problem. More doctors, competing for patients, will drive down costs for the patient. Clear as day to me. I think there are almost 1 million doctors practicing in the states. We should aim to double that number to 2 million asap. It can be done with private for profit medical school start-ups, who will grow and aggressively compete for students. This will drive down the cost of tuition, lower the debt burden on doctors, and encourage innovation in the medical education field, further lowering costs and improving quality.