Why Higher HCAHPS Scores Don’t Always Mean Improved Quality of Care

Filling in questionnaire.
Man filling in a medical questionnaire.

The most satisfied patients aren’t always the ones receiving the highest quality of care. It may seem counterintuitive, but recent studies and news articles suggest that a patient’s level of satisfaction doesn’t strictly correlate with the quality of care they receive.  

Since the inception of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), which measures patient satisfaction and influences Medicare reimbursements to hospitals, healthcare providers have placed extra emphasis on their patients’ happiness. Some hospitals have gone as far as implementing valet service, hiring door greeters and even adopting loyalty programs, all in an effort to please their patients. While a nice touch, these added “amenities” offer little when it comes to actual quality of care. 

Hospitals will soon begin to measure satisfaction among patients within their emergency department with the Emergency Department Patient Experiences with Care (EDPEC) Survey. And just as with their inpatient population, hospitals will face financial repercussions if their ED patients are left unsatisfied. 

When it comes to this new survey, emergency departments will find the greatest cause for concern in regards to their patients’ perception of pain management. Specifically, these three questions:

• During this emergency room visit, did the doctors and nurses try to help reduce your pain?
• During this emergency room visit, did you get medicine for pain?
• Before giving you pain medicine, did the doctors and nurses describe possible side effects in a way you could understand?

If the inpatient experience is any indicator, patients suffering from acute and chronic pain may be disappointed to find that the pain medication they believe they urgently need will be prescribed sparingly or withheld altogether. 

With the growing opioid crisis in the country, many EDs are instituting strict guidelines when it comes to prescribing these narcotic pain medications. They’re turning to alternative therapies, such as acupuncture and even laughing gas, which have proven effective and have less dangerous side effects—think addiction, overdose and death. 

Even with alternatives some patients are set on receiving pain medication, regardless of the consequences. And if they don’t receive them, or are prescribed a limited quantity, the likelihood they’ll express their dissatisfaction in the EDPEC survey will be great. 

In many cases related to the management of pain, quality of care will come at the expense of patient satisfaction. When it comes down to it, the patient’s perception of the quality of care they receive isn’t as important as the reality of the care they receive. However, Medicare reimbursements may be in jeopardy as a result. 

I believe this short quote from The Atlantic sums up the dilemma hospital and ED leaders face:

"Patients can be very satisfied and be dead an hour later."

What do you think? What strategies have you implemented to increase patient satisfaction? Are you confident these strategies aren’t undermining the quality of care your ED provides? I’d love to hear your experience. Feel free to comment, send a message or email me directly at cmd@constancedonovan.com.

The Atlantic: “The Problem With Satisfied Patients.”

AMA Journal of Ethics: “Patient Satisfaction Reporting and Its Implications for Patient Care.”