Healthcare News & Insights

Docs jockey for high HCAHPS scores by overtreating patients

178411299When it comes to keeping patients happy, the mandate for some doctors is simple: never deny a request for an antibiotic, an opioid pain medication, a scan or a hospital admission. 

Doctors and hospitals are jockeying for high Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores by overtreating and overprescribing to keep from getting their Medicare reimbursements slashed, said Dr. William Sonnenberg, Medscape reported.

Patients who are prescribed unnecessary medications or tests may be more satisfied with their level of care and give good ratings, yet be worse off, Dr. Sonnenberg said. Overtreatment, he warned, is a silent killer.

“We must have the ability to deny treatment for a patient’s own good, Dr. Sonnenberg said. “Patients aren’t the best judge of what is best for them.”

Take, for example, an elderly female patient who once asked Dr. Sonnenberg to write a prescription for tamsulosin — a drug used to treat the symptoms of an enlarged prostate — because she got a coupon in the mail.

“It didn’t matter that she lacked a prostate!” he said.

The cost of patient satisfaction is high, not just because of mounting costs for unnecessary drugs and tests, but  because satisfied patients are not necessarily healthy patients, Dr. Sonnenberg said.

Patient satisfaction

In a 2012 study at the University of California, Davis, researchers found that patients who said they were satisfied with their treatment spent more on healthcare  and prescription drugs. Researchers also discovered they were more likely to be admitted to the hospital and they were most likely to die.

It’s come down to the tail wagging the dog, with the pressure of patient satisfaction scores occasionally dictating types of treatment.

Dr. Sonnenberg cited examples of doctors “embracing the patient is always right” model to help spike their customer service ratings.

One physician said that he increased his patient satisfaction scores by 7% by prescribing an antibiotic to all patients who call with a complaint of a cough, sore throat or sinus headache.  One doctor told reporters that he had prescribed  Dilaudid for minor pain all because his patient satisfaction scores were in the basement.

One emergency room with with poor patient satisfaction scores started offering hydrocodone “goody bags” to discharged patients in order to improve their ratings.

Another physician said quality of care is measured in two ways:  The first is by getting the patient in and out the door in 45 minutes, and the second is tracking the results of patient satisfaction surveys to see if the patient was happy.

Pay-for-performance pressure

Pressure to hit pay-for-performance standards can also have doctors walking on eggshells when they have to confront a patient about behavioral issues such as smoking or obesity, Dr. Sonnenberg said.

“If you tell a patient their knee pain is related to their being overweight, that their smoking is worsening their child’s asthma, or that they can’t lose weight because of French fries and not because they have a glandular problem, their ratings and pay will take a hit,” Dr. Sonnenberg said.

Even without the added pressure of meeting pay-for-performance measures, three out of four physicians polled said their colleagues prescribe an unneccesary test or procedure at least once a week, according to results of a survey commissioned by the Choosing Wisely campaign,

Forty-seven percent of doctors surveyed said one patient each week requests an unnecessary test. Almost half the respondents said that when facing an insistent patient, they’d advise against the test but order it anyway; another 5% of respondents would just cave in and order it.

Reduce non-beneficial care

An article published in Hospitals and Health Networks, identified five areas that hospitals should look to reduce non-beneficial care:

  • blood management in inpatient services
  • antimicrobial stewardship
  • inpatient admissions for ambulatory-sensitive conditions (low back pain, asthma, uncomplicated pneumonia)
  • elective percutaneous coronary intervention, and
  • intensive care unit for imminently terminal illness (including encouraging early inter­vention and discussion about priorities for medical care in the context of progressive disease).

“We should try to be kind to our patients and take time to understand them, but we must resist these misguided pressures and do the right thing,” Dr. Sonnenberg said. “Sometimes patients have to be told ‘no’ and the leadership in healthcare must understand this.”

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