Fraser Cobbe

Orange County Medical Society

Seminole County Medical Society

In response to pressure from a number of consumer groups including the AARP, CMS is considering a proposal to include open-ended patient reviews on the Medicare Physician Compare Website. In the initial proposal, it would be optional for physicians to participate in the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey measure. However, the CAHPS scores would also be included in the MeritBased Incentive Payment System (MIPS), so there will be economic pressure in the form of potential incentives, or penalties, for physicians to participate.

Our organizations are strongly opposed to patient satisfaction being linked to physician payment and quality programs due to the undue influence it will have on the physician-patient relationship.

The hallmark of an effective physician-patient relationship is the ability for the two parties to engage in direct and often uncomfortable conversations. Let's face it, as patients, family members, and a community, we need physicians willing to deliver tough medicine when tough medicine needs to be delivered. Encouraging patients to stop smoking, consider dietary alternatives, refusing to perform an expensive MRI when a plain X-ray will suffice, and canceling prescriptions for opioids that are more likely to fuel addiction rather than recovery.

For our older generation it is even more important for physicians and patients to freely engage in open and honest discussions about all end-of-life treatment options without external influence.

We need physicians to have these tough conversations even if it results in the patient perceiving they had a bad experience. Piling undue pressure on a physician's reputation or payment for services for engaging in these difficult conversations will be counter productive for all stake holders. Our organizations fully support transparency and the publication of evidence-based and effective quality measures so patients have the tools they need to evaluate and select the physicians they entrust with their health. Plenty of tools already exist to enable patients to sound off and rank their experiences online. We strongly believe that this additional effort to institutionalize patient satisfaction into the core of the Medicare system is counter productive for the physician-patient relationship.