Providing more low value care does not lead to a higher score of the patient experience

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As hospitals, insurance companies, and policymakers try to improve the quality of health care and reduce rising medical costs, an important metric used to evaluate clinicians depends on how patients feel about their healthcare experience. Many healthcare providers and policymakers fear that increased pressure to please patients and, consequently, ensure high satisfaction, could lead to excessive use of low-value care that provides no clinical benefit, while increasing unnecessary 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 a JAMA Internal Medicine, found no relationship between favorable patient ratings and further exposure .

“Some believe that a lot of low value care is provided by doctors because they feel they need to calm down . This concern has increased as patient scores are increasingly used in new payment models and in the public health classification report, ”said lead author Prachi Sanghavi, Ph.D., professor Deputy Public Health Sciences in Chicago. ” For example, if a patient requests additional testing or detection when it is not medically indicated. Should doctors worry about getting a bad score if they don’t comply? At the same time, doctors are under pressure to reduce unnecessary testing and procedures whenever possible, as they are wasteful and can cause damage downstream. “

At least one study often cited supports the concern that focusing on patient ratings will lead to lower care, as the finding that patients with higher satisfaction ratings are more likely to be admitted to hospital patients, higher drug costs with prescription and medical care and higher mortality. This study implied that attending to patient satisfaction can lead to worse outcomes. But, says Sanghavi, these results are likely to be a reflection of the methods used in the study.

“Past research was not properly adjusted for certain key factors, such as the disease a patient might have, which could be a confounding factor,” Sanghavi said. “For example, people with chronic or terminal illnesses may use more care and may develop closer relationships with their doctors, which in turn could lead to greater patient satisfaction.”

In their new study, Sanghavi and his team examined federal data Consumer Assessment Survey of Healthcare Providers and Systems (CAHPS), which uses the observations provided by the patient to measure things like communication with a doctor, the 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 doctor’s patient group. Unlike previous studies, the researchers ’approach was based on the independence of sampling and the low overlap between patients in the CAHPS dataset and claims. With this innovative methodology, the researchers were able to eliminate unrelated factors at the patient level that could influence outcomes and gain a less biased view of the relationship between patient satisfaction and low-value care exposure.

“Although we found a wide range of low-value care among panels of medical patients, there was no systematic association between exposure to low-value care and favorable patient ratings,” he said. Sanghavi. “Thus, physicians whose patients receive more low-value care do not get higher grades.”

These results, according to the researchers, should help alleviate the concern that reducing the number of unnecessary care offerings will negatively impact patients ’opinions about their doctors or health care organizations.

“In short, the concern is overwhelmed,” said study co-researcher Michael McWilliams, a professor of health care policy at Harvard Medical School and a general internist at Brigham and Women Hospital. “Either because less wasteful physicians are adept at informing patients why a requested test or procedure is not necessary, or because most of the low-value care is due to providers’ practice patterns and not to patient demand, we should ensure that we can address waste in the system without major patient reactions or providers flunking to their “dashboards.”

The researchers said they were not surprised by the findings, as previous studies relied so heavily on anecdotal evidence.

“In fact, it is not resolved whether patients advocate even low-value services,” Sanghavi said. “Either way, it’s reasonable to imagine that patients base their experience qualifications on a range of quality dimensions and not just on the way their doctors give in to demands, in case they were making them.”

Understanding how patients ’experiences and qualifications are affected by the types of care they receive has important implications for future policies and funding models aimed at reducing unnecessary healthcare spending while improving the overall quality of care.

“These results should help alleviate the stress that doctors may experience and make it possible for dissatisfied patients because they have not done anything the patient asked for,” Sanghavi said. “It should also relieve pressure to provide unnecessary care in order to raise ratings.”


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More information:
“Association of low-value healthcare exposure with assessments of healthcare experience among patient panels.” JAMA Internal Medicine (2021). DOI: 10.1001 / jamainternmed.2021.1974 , jamanetwork.com/journals/jama/ … ainternmed.2021.1974

Citation: Providing more low value care does not lead to a higher score in the patient experience (2021, May 28) retrieved on May 28, 2021 at https://medicalxpress.com/news/2021-05-low -value-doesnt-higher-patient .html

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