Patient Satisfaction/Patient Experience, Patient-Reported Outcomes, and Healthcare Quality: Are We Focusing on the Wrong Metrics?

Abstract

Background: To meet the Institute of Medicine goal of patient-centered healthcare quality, Patient Satisfaction/Patient Experience (PS/PE) has evolved to become 25 percent of the U.S. government’s Medicare and Medicaid Value-Based Purchasing (VBP) Program. PS/PE is most commonly measured by CAHPS® and Press Ganey® (PG) surveys. Patient-reported Outcomes (PROs) are also measured as part of the VBP, but are not used for reimbursement. Materials and Methods: We performed a MEDLINE literature search to evaluate whether high-level evidence (randomized controlled trials, systematic reviews, or meta-analyses) exist to show that CAHPS®, PG®, and PROMIS® survey scores correspond with improved quality of healthcare. Results: The number of publications on PS/PE and PRO has increased significantly since the initiation of patient surveys. One systematic review found that CAHPS® scores were inconsistently associated with patient-reported quality. Zero studies were found to show that PG® scores were associated with improved quality. Five studies showed that PROMIS® had convergent validity with legacy measures of PRO. Further review of the literature showed concerns inherent in the way CAHPS® and PG® are used which may adversely affect healthcare quality. Conclusion: PS/PE is weighted highly for reimbursement. The most-utilized PS/PE surveys have psychometric and methodologic flaws and, using the above literature search method, we found very little high-level data showing that CAHPS® and PG® scores correlate with improved healthcare quality as defined by the IOM. PROMIS® is a reliable, valid, and precise measure of patient-reported health status. CMS should consider a policy change to decrease the weight of PS/PE in the VBP program. At the same time, CMS should consider incorporating PRO data into reimbursement