The ISA had a practice management dinner seminar at Carlucci’s Restaurant in Rosemont in August with a discussion on the uses and misuses of patient surveys. Our lead speaker was Bob Vosburgh, the President and Founder of Survey Vitals, who offers a specialized patient satisfaction survey tool dedicated to anesthesiologists.
Vosburgh has given many practice management lectures over the years, and has authored a book on leadership, as well undertaking many corporate positions (including company CEO). His career started in the Air Force as a fighter pilot, where he received a Top Gun flight award. Uniquely, our practice management lecture included video of the speaker in actual air combat successfully dogfighting an F16. Vosburgh started Survey Vitals to meet a need for efficient, effective patient feedback. His company now provides services for 58 different specialties.
Why perform patient surveys? Each satisfied patient tells two friends how happy he is with care. In contrast, each dissatisfied patient tells 20 people about his unhappy experience. Satisfied patients are less likely to litigate. Physician and staff turnover are less in locations with higher patient satisfaction scores. Insurance companies are believers in patient satisfaction surveys. Several liability insurers believe the patient survey process is so effective at reducing litigation they have retained Survey Vitals for physicians as part of their insurance coverage at no cost to physicians. In those circumstances, Survey Vitals contractually refuses to release physician survey results to the insurer.
CMS requires HCAHPS surveys (Hospital Consumer Assessment of Healthcare Providers and Systems). These assessments must be performed by live phone calls or mailed paper surveys. HCAHPS provide delayed responses, are expensive, and require a small number of survey returns, as few as three hundred. Many questions have controversial psychometric validity. Survey Vitals conducts surveys digitally, most by text message, which is a far more effective approach, and achieves a much higher (and valid) response rate.
Mandated HCAHPS surveys usually do not provide feedback to physicians, which reduces their effectiveness. The typical HCAHPS-compliant survey will obtain only 400 responses and cost $70000, while a digital survey by Survey Vitals or other vendors of 10000 patients may cost far less in total. Vosburgh is in direct conversation with CMS leadership to improve their survey processes.
How do you avoid mistakes with patient surveys? Simply put, be sure to actually look at results and allow the physicians surveyed to see their results. Patient alerts and low scores should not be ignored, although everyone should realize a certain number of patients may be chronically angry. Usually the strongest pushback against surveys comes from physicians who have the lowest scores, usually below 5% national rank, which must be considered in context. Lowest ranking physicians have rarely viewed their own survey results.
Vosburgh gave several examples of organizations who unfortunately never provide physicians their own survey results. HCAHPS rarely provides physician feedback, and when it does, it is too delayed to be useful. Vosburgh provided data illustrating that physicians who simply review their own surveys show significant improvements in patient satisfaction even if no one else sees this information.
Anonymous self-nominated patient surveys used by companies like Health Grades can be worse than useless. Nevertheless, patients display surprising trust to comments posted here. This doesn’t work. He recounted one organization that successfully hired anonymous non-patients to systemically post terrible comments on a competitor.
CMS ties hospital payments to patient surveys. Whether this is a good idea for physicians remains to be seen. Examples of clumsy or counterproductive ties to compensation were mentioned. In one major organization, physicians were penalized for survey results without ever receiving survey results or any specific improvement goals.
Survey Vitals also surveys itself. Several questions will be changed or eliminated for better data. Anesthesiologists can use Survey Vitals to not only get feedback from patients, but also from surgeons and institution administrators. Some procedures are intrinsically miserable for patients, which may cause an unhappy feedback baseline. Surveys can be compared by CPT code nationally to avoid this bias.
The comment section in patient responses can give unique information. A new “semantic engine” is in the works to analyze comments automatically, and give some sort of trending. A new “provider widget” on a smartphone gives ever better ways to look at individual survey data. Full client customization isn’t advisable, because it increases costs and may challenge validity.
A lively discussion followed, with many concerns about challenges in the effective use of surveys. Many worried about managing low survey ratings caused by events out of their control. For example, one ISA member worried about refusal of hospitals to invest in adequate privacy curtains in pre-anesthesia interview areas.
Patient feedback is here to stay, and will be one more tool for delivering first class anesthesia. Surveys will change over time, and we will learn new ways to use them whether we are in academics or private practice. One great bottom line: physician satisfaction may increase with effective, properly administered patient feedback.
The Illinois Society of Anesthesiologists thanks Anesthesia Business Consultants LLC for generous sponsorship of this practice management program and dinner.