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    MACRA will not save money


    The fatal bias of patient satisfaction scores

    Let me close by condemning MACRA's reliance on patient satisfaction surveys as a factor in physician compensation. The fact that a clinician retains a patient who is free to choose a different clinician tells you everything you need to know about patient satisfaction. Patients vote with their feet, and they do not hesitate to vote themselves a new doctor if their needs are not being satisfied. Traditional Medicare allows patients to switch doctors freely, a freedom which may exact some cost in continuity of care, but which increases satisfaction for patients and doctors alike.


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    Surveys are fatally biased by the fact that angry patients are much more motivated to fill out a survey than are satisfied patients. Read the handwritten comments by the patients and ignore the standardized rating numbers they circled. The comments tell the true story:

    • The patient had to wait for over an hour (because their stingy HMO forces the doctor to overbook to pay the overhead).

    • The doctor's medical assistant was nasty to the patient (because most doctors today have no control over the hiring and firing of ancillary staff).

    • The billing department turned their account over to collections (because the front desk staff failed to contact the patient when their bills were "returned to sender" by the post office).

    • The doctor refused to refer the patient for acupuncture or to prescribe medical marijuana (for a condition lacking evidence of benefit of either treatment).

    Doctors prefer to satisfy their patients as much as possible, but there must be limits.


    David L. Keller, MD is a retired internist who resides in Lomita, California.


    David L. Keller, MD
    David L. Keller, MD is a retired internist who resides in Lomita, California.


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