Potential Bias of Patient Payer Category on CG-CAHPS Scores and Its Impact on Physician Reimbursement

Introduction: Patient satisfaction scores play an ever increasing role in physician reimbursement. Positive scores contribute to a physician earning up to 9% reimbursement bonuses, while negative scores may contribute up to 9% reduction in reimbursement. This method of reimbursement modification is already standard within the Centers for Medicare and Medicaid Services and is quickly catching on with commercial payers. We suspect patient satisfaction scores will eventually influence reimbursement for all payers. Incentivizing patient satisfaction calls into question whether patient-specific variables exist that inherently impact survey scores without any physician input. Methods: This review specifically assesses the effect insurance status has on CG-CAHPS (R) scores since the survey was first implemented in 2007. Peer-reviewed articles that met inclusion criteria were graded on a scale of 0-3 according to significance of patient bias observed. Results: Commercial insurance and Medicare are associated with higher patient satisfaction survey scores, while Medicaid and Workers' Compensation are associated with lower scores. Conclusions: Because most physicians have no control over the type of insurance that covers their patients, we recommend augmenting reimbursement models to account for payer mix.