PLEASE NOTE: THIS RESOLUTION WILL BE DEBATED AT THE 2013 COUNCIL MEETING. RESOLUTIONS ARE NOT
OFFICIAL UNTIL ADOPTED BY THE COUNCIL AND THE BOARD OF DIRECTORS (AS APPLICABLE).
RESOLUTION:
43(13)
SUBMITTED BY:
Pennsylvania Chapter
SUBJECT:
Patient Satisfaction Scores
PURPOSE: Take a clear public stance to reject the continued use of non-valid patient satisfaction scoring tools in
emergency medicine and that current patient satisfaction surveys should not be used to determine ED physician
compensation and reimbursement.
FISCAL IMPACT: Staff time for public relations and advocacy initiatives.
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WHEREAS, Patient satisfaction scores do not accurately reflect the level of expertise or competence of
emergency medicine physicians. Patient rating scores do not reflect technical quality of care1,2; and
WHEREAS, Patient satisfaction scores do not accurately reflect the volume of patients or degree of work
accomplished by emergency physicians3,4; and
WHEREAS, The methodology of determining patient satisfaction scores, via retrospective patient surveys
of discharged patients, skews and biases the data to disproportionately represent dissatisfaction and negative
opinions5,6,7,8; and
WHEREAS, There is very little correlation between patient satisfaction scores and patient complaints9; and
WHEREAS, Many factors influence the satisfaction of a particular patient and many of those factors are
outside the control of the emergency physician; e.g. radiology and laboratory waiting times, equipment failures,
transfer delays, ambient temperature in the ED, presence or absence of televisions or food, unrealistic patient
expectations, etc.10, 11; and
WHEREAS, Patient satisfaction scores are increasingly being used to financially penalize and incentivize
emergency physicians with salaries and bonuses tied to individual and departmental patient satisfaction scores.
(Sullivan 9/2010, Falkenberg 2013); and
WHEREAS, There is evidence to suggest that in efforts to avoid negative impact on their individual patient
satisfaction scores, emergency physicians are increasingly performing unnecessary tests, admitting patients to the
hospital unnecessarily and prescribing antibiotics and narcotics with less attention to evidence based guidelines 3,8;
and
WHEREAS, Hospitals with higher patient satisfaction scores are demonstrated to spend more per capita
than hospitals with lower scores and patients in high patient satisfaction hospitals are exposed to higher doses of
iatrogenic radiation and have higher patient mortality statistics12; and
WHEREAS, Hospitals have paid hundreds of thousands of dollars to consultants and advisors in efforts to
beat the local competition for fractions of percentage points of patient satisfaction scores, largely for purposes of
advertising and promotion. This money is better spent for preventive and patient care3,8; therefore be it
RESOLVED, That ACEP take a clear public stance that rejects the continued use of non-valid patient
satisfaction scoring tools in emergency medicine; and be it further
Resolution 43(13) Patient Satisfaction Scores
Page 2
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RESOLVED, That ACEP affirm that current patient satisfaction surveys should not be used to determine
ED physician compensation and reimbursement; and be it further
RESOLVED, That ACEP stands ready to help CMS and other agencies in the creation of scientific and
valid survey tools for use in the measurement of emergency medicine patient satisfaction.
References
1
Chang JT, Hays RD, Shekelle PG, MacLean CH, Solomon DH, Reuben DB, Roth CP, Kamberg CJ, Adams J, Young RT,
Wenger NS. Patients' global ratings of their health care are not associated with the technical quality of their care. Ann Intern
Med. 2006 May 2;144(9):665-72.
2
Lee DS, Tu JV, Chong A, Alter DA. Patient satisfaction and its relationship with quality and outcomes of care after acute
myocardial infarction. Circulation. 2008 Nov 4;118(19):1938-45. doi: 10.1161/CIRCULATIONAHA.108.792713. Epub
2008 Oct 20.
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Sullivan W, DeLucia J. 2+2=7? Seven Things You May Not Know About Press-Ganey Statistics. Emergency Physicians
Monthly. September 2010.
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Sullivan W, DeLucia J. Are Press-Ganey Statistics Reliable? Emergency Physicians Monthly. October 2010.
5
Gallagher J. Invalid Patient Surveys: Not A Bargain At Any Price. Journal of Health Care Marketing, March 1989;9(1):6971.
6
Powers TL, Valentine DB. Under the Influence: How Does Patient Satisfaction Affect Survey Response and Completion
Rates? MH Spring 2006. Pages 20-5.
7
Jensen HI, Ammentorp J, Kofoed PE. User satisfaction is influenced by the interval between a health care service and the
assessment of the service. Soc Sci Med. 2010 Jun;70(12):1882-7. doi: 10.1016/j.socscimed.2010.02.035. Epub 2010 Mar 18.
8
Falkenberg Kai. Why Rating Your Doctor is Bad For Your Health. Forbes January 21, 2013.
9
Garbutt J, Bose D, McCawley BA, Burroughs T, Medoff G. Soliciting patient complaints to improve performance. Jt Comm
J Qual Saf. 2003 Mar;29(3):103-12.
10
Bleich SN, Ozaltin E, Murray C. How does satisfaction with the health-care system relate to patient experience? Bull
World Health Organ 2009;87:271–278 | doi:10.2471/BLT.07.050401
11
Lloyd J. Billing Process Affects Patient Satisfaction. The Receivables Report for America’s Health Care Financial
Managers. May 2011;vol.26(5)
12
Fenton JJ, Jerant AF, Bertakis KD, Franks P. The cost of satisfaction: a national study of patient satisfaction, health care
utilization, expenditures, and mortality. Arch Intern Med 2012;172:405-411.
Background
This resolution calls for ACEP to take a clear public stance to reject the continued use of non-valid patient
satisfaction scoring tools in emergency medicine and that current patient satisfaction surveys should not be used
to determine emergency physician compensation and reimbursement. In addition, this resolution calls for the
College to work with the Center for Medicare & Medicaid Services (CMS) and other agencies in the creation of
valid survey tools for the ED.
Since July 2007, hospitals subject to the Inpatient Prospective Payment System (IPPS) annual payment update
provisions must collect and submit Hospital Consumer Assessment of Healthcare Providers and Systems
(HCAHPS) data in order to receive their full annual payment update. Hospitals under the IPPS that fail to report
the required measures, including HCAHPS survey data, risk a two percent reduction in annual payment updates.
Under the Affordable Care Act (ACA) of 2010, results from IPPS patient satisfaction surveys will be a key
component of hospital performance measures and will influence pay-for-performance in the outpatient setting.
ACEP has been actively communicating with CMS about how the ED is a unique setting and should require a
discrete survey tool in addition to raising concerns about valid sampling.
In September 2010, the ACEP Board approved the “Patient Satisfaction Surveys” policy statement that outlines
specific elements that should be incorporated into patient satisfaction survey tools.
Resolution 43(13) Patient Satisfaction Scores
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During the 2010- 2011 committee year, the Emergency Medicine Practice Committee (EMPC) was assigned an
objective to develop an information paper, “Emergency Department Patient Satisfaction Surveys.” The ACEP
Board reviewed the paper in June 2011 and it was posted on the ACEP website.
In August 2012, ACEP’s comment letter “Physician Fee Schedule Proposed Rule for CY 2013 Letter to CMS”
expressed appreciation that CMS contracted with the RAND Corporation to develop and validate a patient
experience of care survey for ED patients that could more accurately and meaningfully capture experiences of
care.
Also in August 2012, ACEP responded to a request from RAND to provide input on domains for ED survey
questions and the requested that surveys from admitted patients be included in ED survey sample.
In January 2013, ACEP provided comments on ED patient satisfaction survey development to CMS in response to
its request for information to aid the design and development of a survey regarding patient experiences with ED
care. The comment letter addresses concerns about weighing the value of patient satisfaction surveys, including
surveys completed by patients admitted from the ED, impact of wait times, questions related to pain control,
sample size and survey mechanism.
In the spring of 2013, ACEP staff and members met with the CMS project officer for ED-HCAHPS and were
informed that CMS has developed three separate instruments to be used for:
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Patients discharged from the ED
Patients admitted to the hospital, stand-alone survey administered separate from HCAHPS
Patients admitted to the hospital, survey conjoined with HCAHPS
CMS plans to test the three instruments at 12 sites with a seven-month trial. As of August 2013, the Office of
Management and Budget (OMB) approval for the pilot is pending. It is anticipated that it will be two months
before approval is received.
The EMPC completed a second information paper on Patient Satisfaction Surveys that was reviewed by the Board
in June 2013. This information paper is embargoed while it is being considered for publication in Annals of
Emergency Medicine.
ACEP Strategic Plan Reference
Pursue strategies for ensuring fair payment and practice sustainability.
Fiscal Impact
Staff time for public relations and advocacy initiatives.
Prior Council Action
Resolution 26(12) Patient Satisfaction Scores and Pain Management not adopted. Called for the College to work
with appropriate agencies and organizations to exclude complaints from ED patients with chronic non-cancer pain
from patient satisfaction surveys; to oppose new core measures that relate to chronic pain management in the ED;
to continue to promote timely, effective treatment of acute pain while supporting treating physicians’ rights to
determine individualized care plans for patients with pain; and to bring the subject of patient satisfaction scores
and pain management to the American Medical Association for national action.
Substitute Resolution 22(09) Patient Satisfaction Surveys adopted. Directed ACEP to disseminate information to
educate members about patient satisfaction surveys, including how emergency physicians armed with more
knowledge can assist hospital leaders with appropriate interpretation of the scores and encourage hospital and
emergency physician partnership to create an environment conducive to patient satisfaction.
Resolution 43(13) Patient Satisfaction Scores
Page 4
Substitute Resolution 12(98) Benchmarking adopted. Directed ACEP to study and develop appropriate criteria for
methodology and implementation of statistically valid patient satisfaction surveys in the ED.
Resolution 51(95) Criteria for Assessment of EPs adopted. States that ACEP believes that multiple criteria can be
used to assess the professional competency and quality of care provided by an individual emergency physician.
Prior Board Action
June 2013, reviewed the information paper, “Patient Satisfaction Surveys.”
February 2013, approved “Crowding” policy statement. Originally approved January 2006.
June 2011, reviewed the information paper, “Emergency Department Patient Satisfaction Surveys.”
September 2010, approved “Patient Satisfaction Surveys” policy statement.
Substitute Resolution 22(09) Patient Satisfaction Surveys adopted.
Substitute Resolution 12(98) Benchmarking adopted.
Resolution 51(95) Criteria for Assessment of EPs adopted.
Background Information Prepared By: Margaret Montgomery, RN
Emergency Medicine Practice Manager
Reviewed By: Marco Coppola, DO, FACEP, Speaker
Kevin Klauer, DO, EJD, FACEP, Vice Speaker
Dean Wilkerson, JD, MBA, CAE, Council Secretary and Executive Director