Military patients left in the dark, new breast cancer screening guidelines, & should we pay for patient satisfaction?
April 23, 2015
In order to bring you more of the news you want to read, RightCare Weekly summarizes and interprets three important articles and provides headlines linking to the many other articles and editorials you’ll find interesting. As always, RightCare Weekly presents articles related to moving our healthcare system toward the right care for all patients.
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Hospitals may be paying too much attention to patient satisfaction scores since the Department of Health and Human Services decided three years ago to base 30 percent of their Medicare reimbursements on them. According to Alexandra Robbins in The Atlantic, some hospitals are attempting to create the “Ritz Carlton experience,” hiring expensive consultants to teach employees “good customer service” skills and tying clinician salaries and bonuses to their individual scores. But as in other cases where reimbursement is tied to metrics that aren’t directly related to outcomes, patient care may not be improved. A recent study that Robbins cites shows that “doctors who are reimbursed according to patient satisfaction scores may be less likely to talk patients out of treatments they unnecessarily request or to raise concerns about smoking, substance abuse, or mental-health issues.” And many survey questions target nurses, whom patients seem to blame for just about everything—such as failing to deliver a desired condiment for a meal. While Robbins believes these scores and metrics have their place, improving working conditions for nurses is a wiser approach. According to a Health Affairs study, when hospitals improve nurses’ working conditions, the quality of care gets better.
Many military hospitals may be failing to take crucial steps to ensure patient safety and learn from errors in patient care, according to a story this week in the New York Times. The story recounts a number of episodes in recent years where service members have experienced serious harms in military hospitals. Often reviews that were supposed to identify gaps in care never took place, or relevant information was poorly communicated to patients and families. Poor communication with patients and families is indicative of a larger problem in American healthcare. Hospitals have found repeatedly that creating a culture of patient safety depends on being open about errors, reducing the culture of individual blame, and committing to learning from errors. But those characteristics seem missing from military hospitals’ handling of medical errors. In addition, the malpractice liability system has been weaker in the military and disconnected from the civilian system, and perhaps most important, soldiers are discouraged from reporting poor care because it could hurt their careers.
The U.S. Preventive Services Task Force is updating its recommendations on screening for breast cancer, and the new recommendations incorporate concerns about overdiagnosis. The USPSTF still doesn’t recommend early screening (for women between 40 and 49), but frames that as an individual decision to be made after considering the potential benefits and harms. Similarly, the task force doesn’t make a recommendation for women 75 and over, but notes that no strong data support screening in that population. However, screening for BRCA genetic mutations may soon become more common, as a cheaper new genetic test comes to market. Leah Libresco notes at FiveThirtyEight that as with mammography screening, the balance of benefits and harms for BRCA screening is often unclear, and depending on the course of follow-up women choose to pursue, false positives could lead to major surgical intervention. For more on coverage of the new recommendations, see HealthNewsReview.
The Lown Institute is developing a national survey on physicians’ perceptions of medical overuse and seeks pilot survey takers in cardiology, oncology, and psychiatry for the cognitive testing phase. Physicians will be compensated for their participation. To learn more, please contact Carissa Fu at cfu@LownInstitute.org.