Patient Satisfaction & P4P-Three Things Doctors Need to Know

In these early days of Pay for Performance (P4P) reimbursement, as the size of your paycheck begins to reflect your patient satisfaction scores, let's have a frank discussion about 3 important topics all health care providers and organizations must understand going forward:

1. How your performance will be measured
2. How to get the highest patient satisfaction scores and be a happier doctor at the same time
3. The first step to improving performance (in a healthy way) for you and your organization

1.  How your performance will be measured = “Percentage of Top”

A large component of your performance ratings will be based on patient satisfaction surveys very much like the HCAHPS inpatient or Press Ganey outpatient satisfaction surveys currently in use. Here is a link to the HCAHPS patient satisfaction questions where you can see the 3 doctor-specific patient satisfaction measures that are already publically reported on the Medicare Hospital Compare Web site.

It is important that we get granular here so that you understand exactly how your own personal patient satisfaction is both scored and reported.

The satisfaction surveys ask several questions the patient answers on a 4- or 5-point Lickert scale where the top score represents the word/phrase "always," "strongly agree," or “outstanding.”

You may naturally assume that your personal physician rating is an average of the scores from individual patients. You would be completely wrong in that assumption.

Here’s how your satisfaction rating is actually scored-it is NOT an average.

Your scores are reported as a “percentage of top.” This means the percentage of patients who gave you the top score. In other words, only the top scores count. Anything less than 5 out of 5 is thrown out. “Good” or “Above Average” is meaningless to these scoring systems.

Now that you understand how your performance will be rated and reported in the near future, I invite you to take just a moment to recall your last personal experience with a customer satisfaction survey of any kind:

• Are you a person who gives a 5 out of 5 under any circumstances? (Most doctors are not!)
• When did you last give a retail transaction or online customer service top marks?
• What did they have to do to earn that rating from you?

Imagine the experience your patients will expect and that you will have to consistently provide to receive the all important “5.” This is exactly how you will be rated by your patients more and more frequently in the years ahead. Soon these patient ratings will determine a portion of your pay as well.

2. How to get the highest patient satisfaction score AND be a happier, healthier doctor at the same time

First you must understand what most health care administrators do not. Physician satisfaction is the only lasting foundation for patient satisfaction. It takes happy doctors and staff to have happy patients-in that order.

To understand this fundamental fact, let me ask you the following question . . .

How can we reasonably expect a patient to give a doctor a 5 out of 5 score on satisfaction when . . . if we asked that doctor to rank their personal satisfaction with their workplace on that same day, they would score it a 3 out of 5?

Your administration might be able to goose patient satisfaction numbers temporarily by cracking the whip and teaching some communication tricks to you and your staff . . . and it won’t last.

As P4P and the closely related "value-based purchasing" become more common in your marketplace, organizations that create a healthier, happier, less stressful workplace environment for their staff and doctors will establish a strong competitive advantage:

• Patients will want to be seen there.
• Quality doctors will want to work there.
• Your patient satisfaction scores will reflect the efforts to keep physicians and staff healthy and get systems out of the way of patient interactions.

3. Your first step to higher physician and patient satisfaction

Here is a question to get you and your leadership team going:

Start by looking back on the past 3 months in your own practice. What average score would you give your personal satisfaction level with your day-to-day practice experience on that same 5-point scale? Take a moment to actually give it a number.

Here is the scale: 1 = very low | 2 = low | 3 = OK | 4 = Good | 5 = Excellent

What is your physician satisfaction number? Keeping your score in mind . . .

(a)  What is the first thing you would change at work to improve your personal satisfaction score? Even if you have given up on this change being possible . . . what is the one thing that would make all the difference for you?

(b) What is the first step in making that change-the smallest step to making progress in the direction of a better workday?

Now . . . grab your medical director (or your team if you are the medical director) and get on it.

This simple process identifies a piece of low-hanging fruit for you and your organization to improve 3 things all at once:

• Your personal satisfaction
• Your patient satisfaction scores
• Ultimately . . . the size of your paycheck down the road

PLEASE LEAVE A COMMENT . . . what is the first step you would take to increase your personal physician satisfaction (and your patient satisfaction) score?

Dike Drummond, MD, is a family physician and provides burnout prevention and treatment services for health care professionals at his site, The Happy MD.