Who is Satisfied?

How are we going to do this?

In other industries customer satisfaction is part of the delivery, but not directly tied to product price. Companies are “paid” by happy customers with more business (referral, word of mouth, etc), or market leverage to increase the cost of service (increased value of product) with customers happy to pay that increase due to increased value, to them.

This works in a market system, where individuals are in charge of their monetary decisions. But that isn’t health care.

In a move towards payment for outcomes, where will customer satisfaction have a role? (we don’t know whether we will be paid better for better outcomes, or paid a set fee for an average expected outcome and it’s up to us to beat that average… who knows)

Is there any talk of adding customer satisfaction directly to payment? Sometimes that’s all we have. No significant change in patient status, but a very satisfied customer with the care, service, advise and input given. Perhaps they leave with an understanding of their condition, ways to manage it and strategies to avoid deleterious effects of their disease/dysfunctional process… but no change in ROM, strength or patient reported outcome measures.

Because of this, I hope there is some talk of customer satisfaction being tied to the outcomes-payment model. We know that FOTOinc takes satisfaction data for those that buy their service. As of now it is used to rate an employee (probably), but since sometimes our only outcome is a satisfied person, will this aspect be tied to payment?

If we are not paid (through 3rd party payers) for better customer satisfaction, how can we capitalize on it? How do you engage a community (as other industries do) promoting better customer experience, when most people just come to PT because they have to? Granted they can choose your clinic over another, but in this case, being better gets you more patients to treat, not more income per value/time given to that patient.

These questions are novel and unanswered because this is not a 1-to-1 market interaction. It gets confusing because we are in this 3rd party payer, insurance-land with multiple political, cultural and socioeconomic considerations around the payment for, and delivery of, health care. If becoming better (better outcomes and/or satisfaction) increased your pay… where would the money come from? From under-performing clinics? (a net-zero type of philosophy)

In PT we are primarily behind the referral curtain (thankfully so, as we are the premier evidenced based rehabilitory and return-to-function profession). And we should indeed be within the fold of the medical system. Our customer satisfaction has previously primarily been the referral source. The physician is happy… we get more biz. As an industry, we have this aspect of customer satisfaction down.

I wonder: does it matter, currently, the degree to which the customer is satisfied? I’m not talking about an unhappy customer vs. a happy one (that’s a fairly obvious one). I’m asking about a happy customer vs. a happier customer. Would your business notice a difference in some manner if your customer satisfaction scores went from 90% to 96% satisfied?

Choosing a 1-to-1 market model seems to be the clearest way to address the value to payment question. (known as Cash PT) However it severely under-addresses low and middle socioeconomic groups and regions. It certainly works for the one-off visit, the affluent area or the niche market. The rest of the patients are left waiting for their insurance to pay for highly skilled care… heck, and so are we.

Health is something that you cannot pay for. It’s priceless. So do not get caught in the argument that we are “paying for health.” Society and individuals pay people. Most often we pay for time, services or goods of varying degrees of importance and benefit. Perhaps this is where the complexity lies. We are attempting to pay people, which we know how to do, for an outcome (health) which is non-quantifiable, variable, changing, and not fully under the control of any individual, and even less-so a health-care provider.

With all that up-in-the-air, when it comes down to it, we are going to remain passionate about our patients, their outcomes and satisfaction with care. Just like we did yesterday and the day before. Looking for an external reward system to give above average care is not totally how we humans work right? See Daniel Pink’s work here on that.

*My formal apologies for all the questions (with few answered) in this post.

Related Post: Treating in the Low Socioeconomic Climate

Related Post: The Meaning of Cost in Value

Related Post: The 4th Pillar of Evidence Based Practice

Related Post: The Problem with Preventative Medicine

Related Post: O Western Medicine… What Have We Done?

Matt D

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2 thoughts on “Who is Satisfied?

  1. Pingback: A Year In Review: II | PTbraintrust

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