2016 NCCL

Delegates Address Patient Satisfaction as Quality Metric, Other Issues

May 13, 2016 10:49 am Chris Crawford Kansas City, Mo. –

During the 2016 National Conference of Constituency Leaders (NCCL) held here May 5-7, AAFP members from the five constituency groups -- women; minorities; new physicians; international medical graduates (IMGs); and gay, lesbian, bisexual and transgender (GLBT) physicians and those supportive of GLBT issues -- acted on resolutions considered by the Reference Committee on Advocacy.

Jessica Triche, M.D., (left) a women's delegate from Bath, N.C., speaks about a resolution she co-authored on how patient satisfaction surveys should be used internally but not by third-party payers to determine financial reimbursement.

Issues discussed during the May 6 committee hearing included use of patient satisfaction data as a quality metric, the need to educate a diverse workforce and availability of mental health services for all.

Eliminating Patient Satisfaction Scores as Third-party Quality Metric

During the May 7 business session, delegates adopted a substitute resolution that directed the AAFP to support collecting patient satisfaction/experience data for internal quality improvement use but not for the purpose of determining rankings or ratings that could result in financial consequences from third-party payers. Delegates also asked that a letter be sent to CMS to discourage the use of patient satisfaction scores as a health care quality metric.

Jessica Triche, M.D., a women's delegate from Bath, N.C., and co-author of the original resolution, explained the problem.

"For many of us, our salaries and bonuses are based on these patient satisfaction surveys, which do not accurately reflect the quality of care that we give," she said. "They instead reflect the quality of care that patients perceive," she said.

Story highlights
  • During the 2016 National Conference of Constituency Leaders business session on May 7, delegates adopted a substitute resolution first considered by the Reference Committee on Advocacy that asked the AAFP to support collecting patient satisfaction/experience data for internal quality improvement use but not for use by third-party payers.
  • Another substitute resolution delegates adopted called for the AAFP to support pipeline programs, including encouraging support services for underrepresented minority students beginning as early as elementary school.
  • A third substitute resolution delegates adopted asked the AAFP to advocate for increased value-based payments for mental health counseling and services and greater availability of mental health care professionals.

Triche went on to explain that patient satisfaction surveys can lead to physician burnout when physicians who know they have been practicing sound, evidence-based medicine receive low satisfaction scores.

Leanne Swiderski, M.D., a new physician delegate from Saint Clair Shores, Mich., and another co-author of the resolution, said these surveys have become a driver in how physicians are reimbursed.

"It seems there is a perception that (the surveys) add to providing quality care, but we know very clearly that they are associated with increased costs, increased prescription use -- opioids and antibiotics -- and, probably most frightening to me, increased mortality for patients," she said.

Wael Mourad, M.D., an IMG delegate from Kansas City, Mo., also supported the resolution, noting that although patient satisfaction surveys may bring value to patient care, scores should not be used for punitive measures against physicians.

"I think we all can agree that withholding pay is a punitive measure. Physicians should not be punished for measures they have no control over," he said.

Educating a Diverse Physician Workforce

Another substitute resolution adopted during the business session called for the AAFP to support pipeline programs and encourage providing support services for underrepresented minority students beginning as early as elementary school and continuing through college, medical school and residency.

The resolution also directed the Academy to support the AMA in recommending that medical school admissions be based on a holistic evaluation of applicants, taking into account the diversity of preparation and talents these students bring to medical school and residency.

Finally, the measure asked the AAFP to support the AMA in its efforts to improve the diversity of the physician workforce, including advocating that the National Resident Matching Program track and disseminate demographic information on race and ethnicity that is collected from Electronic Residency Application Service applications.

Ada Stewart, M.D., a minority delegate from Columbia, S.C., and co-author of this resolution, said the resolution is intended to support a measure that is scheduled to be introduced during the annual meeting of the AMA House of Delegates in June.

"We realize it is important for us to have a diverse (physician) workforce to provide care to our diverse populations," she said. "We would like the Academy to support the AMA's Minority Affairs consortium to address this issue."

General registrant Sabesan Karuppiah, M.D., M.P.H., an AMA-YPS (Young Physician Section) delegate from Duncansville, Pa., explains a resolution he co-authored that calls for more research on the paucity of diversity in practicing physicians.

General registrant Sabesan Karuppiah, M.D., M.P.H., an AMA-YPS (Young Physician Section) delegate from Duncansville, Pa., and a co-author of the resolution, called for more research and data to be presented on the paucity of diversity in practicing physicians.

"If you don't measure something, you won't know it's a problem; and if you don't know it's a problem, you will never do anything about it," he said.

Mitigating Disparities in Availability of Mental Health Services

A third substitute resolution delegates adopted asked the AAFP to advocate for increased value-based payments for mental health counseling and services and greater availability of mental health care professionals.

Alan Michael Vargas, M.D., an IMG delegate from Glenwood Springs, Colo., and co-author of the resolution, said there is significant disparity in the availability of psychiatric and mental health services throughout the country.

"The problem is access," he testified. "So I'm hoping we could increase the value-based reimbursement of psychiatric care with family practitioners. This would allow us to bill for the time of services that we are rendering rather than (use) a single payment code."

An increase in this value-based payment could lead to an increase in psychiatric care, Vargas noted. "This could help alleviate the burden we are seeing in this country," he said.

Other Issues

Among other measures considered by the reference committee, NCCL delegates adopted resolutions that asked the Academy to

  • advocate for legislation to eliminate the Medicare Advantage and Medigap programs and fold the benefits of Part C plans and Medigap plans into traditional Medicare;
  • join the 18 other health care organizations who have already published and released statements strongly condemning existing state laws that punish rather than assist pregnant women suffering from addiction by releasing a statement that highlights our updated policy on this issue; and
  • advocate that currently licensed and practicing family physicians actively participate in the evaluation and resolution of any licensure and disciplinary issues for family physicians.

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