Doctors' Dilemma: Lower Costs, Please Patients, or Avoid Lawsuits?

Leigh Page, MS

Disclosures

September 11, 2014

In This Article

Physicians Face "Poor Ratings" Pressures

Hospital-employed doctors, especially emergency physicians, face an added concern when patients demand unnecessary care. If emergency physicians don't prescribe an antibiotic to the patient with a sore throat, that patient may give them a low score on patient satisfaction surveys that every hospital is required to collect, using contractors like South Bend, Indiana-based Press Ganey.

In these surveys, physicians are evaluated only on courtesy, listening, and explanation, and not on medical skills. Nevertheless, some hospitals tie a small but significant part of their salary to the score, and continual low-scorers may be fired, according to William Sullivan, DO, an emergency physician and attorney in the Chicago area.

Because the number of surveys for one particular physician is often too small to be statistically valid, "a few very negative surveys can significantly affect your overall score," and survey results can vary wildly from month to month, he said.

Emergency physicians often give in to patient demands to improve their score. A 2010 online poll of caregivers for an article by Dr. Sullivan in Emergency Physicians Monthly found that almost half altered medical treatments to improve their scores.[6]

Because of the surveys' validity problems, "the results should be kept out of the hands of hospital administrators," said William R. Sonnenberg, MD, a solo family physician in Titusville, Pennsylvania. "They do not understand the metrics and are using them poorly."

Boissonnault, the quality measures expert, defended patient satisfaction surveys, noting that unhappy patients are more likely to sue. "From the hospital's point of view, it makes sense to identify these points of dissatisfaction and make sure they're addressed," he said.

Meanwhile, Boissonnault said employed physicians are under potentially much greater pressure to utilize hospital services and admit more patients, which also add to healthcare costs.

The amount of services the physician orders can also be tied to pay bonuses -- and can also lead to firings. In a 2012 New York Times article, several hospital-employed physicians admitted that they were under great pressure to refer patients within the system.[7]

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