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Providing more low-value care doesn't lead to higher patient experience ratings

Press releases may be edited for formatting or style | June 01, 2021
As hospitals, insurance companies and policy makers seek to improve healthcare quality and reduce rising medical costs, one important metric used to assess clinicians hinges on how patients feel about their healthcare experience. Many healthcare providers and policy makers fear that increased pressure to please patients -- and ensure high satisfaction ratings as a result -- could lead to overuse of low-value care that doesn't provide any clinical benefit while unnecessarily ratcheting up medical bills.

But new research from the University of Chicago and Harvard Medical School may alleviate some of those concerns. The study, published May 28 in JAMA Internal Medicine, found no relationship between favorable patient ratings and exposure to more low-value care.

"Some believe that much low-value care is provided by doctors because they feel like they have to appease patients. This worry has become bigger as patient ratings are increasingly used in new payment models and public reporting of healthcare rankings," said lead author Prachi Sanghavi, PhD, Assistant Professor of Public Health Sciences at UChicago. "For example, if a patient asks for extra testing or screening when it's not medically indicated, should doctors worry they will be rated poorly if they don't comply? At the same time, physicians feel pressure to reduce unnecessary testing and procedures when possible, because they are wasteful and can lead to harm downstream."

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At least one often-cited study supports the concern that a focus on patient ratings will lead to more low-value care, finding patients with higher satisfaction ratings had higher odds of inpatient admission, higher healthcare and prescription drug costs and higher mortality. This study implied that catering to patient satisfaction may lead to worse outcomes. But, Sanghavi says, these results are likely a reflection of the methods used in the study.

"The past research didn't adequately adjust for certain key factors, like how sick a patient might be, which could be a confounding factor," said Sanghavi. "For example, people who are chronically or terminally ill may use more care and may develop closer relationships with their doctors, which could in turn lead to higher patient satisfaction ratings."

In their new study, Sanghavi and her team examined data from the federal Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, which uses patient-provided observations to measure things like communication with a physician, timeliness of scheduling an appointment and time spent in the waiting room. They also analyzed Medicare claims to measure the amount of low-value care received by a physician's patient panel. Unlike past studies, the researchers' approach relied on sampling independence and little overlap between the patients in the CAHPS and claims datasets. With this innovative methodology, the researchers were able to eliminate patient-level, unconnected factors that could influence the results and gain a less-biased look at the relationship between patient satisfaction and low-value care exposure.

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