An Open Letter to HHS Secretary Robert F. Kennedy Jr.

Dear Mr. Secretary Kennedy,

Congratulations on your appointment as Secretary of Health and Human Services!

I AM A NURSE! A member of a time-honored profession trusted with saving lives and stomping out disease. It is a profession that maintains the public’s confidence, year after year, as nurses have been recognized as the most honest professionals and with the utmost ethical standards of any industry. I have the professional scars to prove it. In 2012, I published “The Customer is NEVER Right: A Nurse Practitioner’s Perspective,”—a thought-provoking account of our nation’s most shameful, tolerated, and ignored silent national crisis: the overwhelming collateral damage inflicted by accommodating patients at significant cost due to the emphasis on customer service satisfaction ratings in healthcare.

Healthcare, once dedicated to saving lives and stomping out disease, experienced a significant shift in focus in the 1990s, prioritizing customer satisfaction above all else. This misguided IDIOT-ology [sic] failed to enhance satisfaction levels, resulting in poor outcomes and jeopardizing the safety of healthcare workers and patients.

Healthcare is like no other industry—none! It is the only industry with patients, the only one with our waiting rooms, where patients come during the worst moments of their lives, at inconvenient times, for uncertain, unpredictable, and volatile choices in unfamiliar, unpleasant, and unforgiving places. We fight for every patient and mourn them if they succumb.

After nearly forty years in healthcare, I do not believe healthcare is broken. Instead, it prioritizes customer retention for profit, regardless of the cost and significant losses.

Research indicates there is no link between satisfaction scores and quality healthcare; however, satisfaction scores continue to drive the healthcare industry. The literature includes numerous professional and non-professional articles outlining why evaluating customer service in healthcare is ineffective (1). The most compelling argument is that the most satisfied patients not only incur the highest healthcare costs but are also the most likely to experience hospitalization and mortality (2).

Many, including Senator Chuck Grassley (IA), emphasize the pervasive incentives (10:10)(3) in healthcare that lead to significant collateral damage: (1) Reduced access to healthcare, as those unable to keep up are forced to shut down. (2) An increase in healthcare-related violence (4), which has become more frequent, bold, and severe. (3)The ongoing opioid abuse epidemic. (4) Billions of dollars lost to fraud, waste, and abuse (5). (5) Worst of all, thousands die each year due to medical errors (6). None of it new!

The Hospital Consumer Assessment of Healthcare Providers & Systems (HCAHPS) is the driver our great nation can do without, ultimately abolishing all customer satisfaction ratings in healthcare. We can no longer uphold this IDIOT-ology [sic] of rating customer satisfaction in healthcare simply because we have invested significant money, time, and effort into this disastrous mistake.

As if that weren't enough, in 2010, HCAHPS was weaponized against healthcare to support the Affordable Care Act (ACA), which would not survive without withholding nearly $800,000 per average hospital (over 4,000 hospitals in our nation) every year (7) through Medicare reimbursements from HCAHPS underperformers. Thus, after rescinding the ACA’s public mandate in 2019, abolishing HCAHPS would deliver the final blow to the ACA.

Sadly, the weaponization of HCAHPS was so punitively effective that in 2013, it inspired President Barack H. Obama to propose a similar federal regulation for evaluating colleges and universities (8). Fortunately, that college ranking mandate was abandoned after college leaders, unlike healthcare administrators, firmly resisted, arguing that the misguided rating system was “uncharacteristically clueless, quite wrongheaded, oversimplified to the point that it actually misleads, and prioritized moneymaking.”Criticisms that emerged, as expected in healthcare, regarding HCAHPS and private rating systems, yet they were ignored.

Everyone claims to be searching for ways to enhance healthcare, yet they overlook the true solution. Evaluating customer satisfaction in healthcare has failed for thirty years; it isn’t the answer and is, instead, part of the problem within healthcare.

Rather than placating to customer satisfaction scores, healthcare would benefit most if we placed all our energy, time, and money on clinical outcomes and the safety of healthcare workers and patients.

I understand your office has priorities; however, I urge you to address this immediately. Healthcare can no longer endure this ignored and shameful silent national crisis that insults healthcare workers and patients, putting them in harm’s way.

As a healthcare worker, I have focused on providing patient care, saving lives, and stomping out disease. Rinse and repeat for nearly forty years. Abolishing HCAHPS and satisfaction ratings in healthcare will not only MAKE HEALTHCARE GREAT AGAIN for healthcare workers, healthcare, and patients but also MAKE AMERICA HEALTHY AGAIN!

Sincerely,

José Angel Torres, NP

I AM A NURSE!

Resources:

1. https://www.forbes.com/sites/kaifalkenberg/2013/01/02/why-rating-your-doctor-is-bad-for-your-health/

2. https://pubmed.ncbi.nlm.nih.gov/22331982/

3. https://archive.org/details/CSPAN_20160128_030400_Hearing_on_Heroin_Addiction

4. https://www.scientificamerican.com/article/epidemic-of-violence-against-health-care-workers-plagues-hospitals/

5. https://www.healthaffairs.org/content/briefs/reducing-waste-health-care

6. https://www.npr.org/sections/health-shots/2016/05/03/476636183/death-certificates-undercount-toll-of-medical-errors

7. https://www.totalinnovationgroup.com/blog/how-hcahps-is-impacting-hospitals-financially/

8. https://www.nytimes.com/2015/09/13/us/with-website-to-research-colleges-obama-abandons-ranking-system.html?_r=1