The Effect of Workers’ Compensation Status
on the Patient Experience

An increasingly crucial component of value-based healthcare includes rating the patient experience. Unfortunately, validation of functional orthopedic patient assessments reduces ratings and patient satisfaction with Workers’ Compensation. The data represents the primary payer, demographic characteristics, orthopedic subspecialties, planned provider surgical interventions, and patient satisfaction.

Workers’ Compensation satisfaction ratings vary from other patient populations. As a result, Workers’ Compensation patients report less overall satisfaction. In addition, Workers’ Compensation patients were significantly less likely to provide higher scores and give a practice recommendation. A dissatisfied Workers’ Compensation status remained after adjusting for age, sex, native language, race, scheduled surgical procedures, and marital status analyses.

A non-modifiable independent predictor of dissatisfaction includes Workers’ Compensation status compared to other primary payer groups within healthcare. However, further research is necessary to comprehend patient satisfaction rating factors.

Satisfied Workers’ Compensation patients are likely male with higher mental health self-assessment. In addition, patient satisfaction improved with a planned surgical intervention. However, dissatisfied patients with Workers’ Compensation status appeared when adjusted for sex, language, race, and marital status. Workers’ Compensation patients indicated significantly lower scores compared to all other patients when evaluating all patient satisfaction domains, including lower mental health self-assessments.

In addition, Workers’ Compensation patients scored their overall health lower when compared to other patients, gave lower provider ratings on a 1-to-10 scale, and were not as likely to recommend the practice to others.

Patient satisfaction scores rate and compensates physicians. Therefore, considerable research is necessary to understand the factors influencing patient experience satisfaction. For example, the Press Ganey questionnaire (PGQ) surveys patient experience ratings but does not correlate with other validated orthopedic outcome methods.

Instead, it connects with patient mental health measures and non-modifiable patient factors, including distance to a medical provider. Press Ganey Associates utilizes patient satisfaction measurement tools and offers the only US Centers for Medicare and Medicaid Services approved survey. PGQ survey data grades, ranks, and reimburses hospitals and physicians.

The outpatient PGQ questionnaire collected primary payer information (Medicare, Medicaid, Workers’ Compensation, private insurance), age, sex, marital status (either married or not), primary language (English as native or non-native), race (white or not), orthopedic subspecialty, and identification of a scheduled surgical intervention with the provider.

The questionnaire asked the patient to rate the scale on a 1-to-5 scale, with one being poor and five being good then converted to a 0-to-100 scale. Then, evaluate the patient’s response to the “likelihood to recommend this practice” as the primary outcome.

The definition of a satisfied patient occurred with a practice recommendation and selected the highest score. An evaluation of the Care Provider subdomain, including ten items rating the provider, represented a secondary outcome.

The highest score within the Care Provider subdomain with Workers’ Compensations status determined the proportion of the surveys because PGQ data does not usually distribute and typically skews positive ratings. In addition, PGQ secondary outcomes identified question group differences covering overall health self-assessment, mental health self-assessment, and physician rating from 0-10.

The adjustment of physician reimbursement reflects the quality of care delivery and changes in US healthcare policy. Workers’ Compensation cases associate with increased healthcare resources, including the number of diagnostic tests and clinical encounters for complete condition treatment.

However, Workers’ Compensation exceeds the financial reimbursement of other payers. Workers’ Compensation patients report poorer functional scores on validated outcome tools. The correlation between Workers’ Compensation and patient satisfaction ratings has yet to receive sufficient examination despite recognizing poor clinical outcomes.

Evaluation of the relationship between Workers’ Compensation and the data reported patient satisfaction surveys with a hypothesis stating that Workers’ Compensation patient satisfaction scores vary significantly from non-Workers’ Compensation patients and are independent of other patient factors. As a result, analysis of the quality improvement measures, provider scores consideration, reimbursement, and overall clinical practice composition.

The Workers’ Compensation patients were demographically unique from patients using other payers (Medicare, Medicaid, private insurance) regarding age and sex. However, race, English as a native language, marital status, and education differed significantly.

In addition, workers’ Compensation patients were more likely to score their overall health lower than patients with private insurance or Medicaid but not Medicare. Finally, Workers’ Compensation patients rated their mental health lower than privately insured patients. In contrast, Workers’ Compensation patients did not significantly differ their mental health ratings in Medicare and Medicaid patients.

Workers’ Compensation patients were less likely to score higher than other payer patients across the six evaluated domains. In addition, Workers’ Compensation patients gave lower provider ratings on a 1-to-10 scale. Medicaid patients did not significantly differ in provider ratings. On the other hand, private insurance patients and Medicare patients notably provided higher ratings.

Therefore, representing a significant decrease in the provider score within the patient population limitations. Providers with >25.0% of Workers’ Compensation patients likely score lower provider ratings according to payer mix alone. A decreased overall score from 76.7% to 74.8% depicts a significant decline, and if the practice comprises >10.5% of Workers’ Compensation patients, the overall score will decrease.

Workers’ Compensation patients were less likely to recommend the practice and more likely to announce a dissatisfied category for their care. However, satisfied patients were more likely to be male, have higher mental health self-assessments, and have a surgical procedure scheduled.

The willingness to recommend the practice defines the correlation between patient satisfaction and primary payer, adjusted for overall health assessment, mental health assessment, age, sex, language, race, marital status, and scheduling surgical procedures. As a result of the adjustment, scheduled surgical intervention independently associates with improved patient satisfaction. However, Workers’ Compensation status associates with dissatisfaction with Medicare, Medicaid, and private payers. Excluding marital status did not significantly change the results.

Physicians, administrators, and the lay press provide substantial attention to patient satisfaction metrics. Predictors of patient satisfaction include non-modifiable patient factors, including age and traveling distance to the medical provider. Healthcare quality serves as patient satisfaction without reflecting ethical or evidence-based practice compliance. Satisfaction measures and the influence of individual healthcare providers are speculative without a better understanding of the determinants.

Outcome data between Workers’ Compensation and other patients differ likely due to multifactorial factors, but speculative. A significant source of bias includes non-response when assessing patients within orthopedic literature. The data reveals varying demographics of Workers’ Compensation patients than other patients regarding age and sex but does not address selection and non-response nuances.

Workers’ Compensation patients claimed poorer overall health than non-Workers’ Compensation patients. In addition, Workers’ Compensation patients contended their mental health self-assessment is affected more likely than other combined groups but significantly lower than private payer groups.

All payers were equally offered surgical procedures. However, workers’ Compensation patients were more likely satisfied with their surgical procedure. The literature indicates satisfaction scores impact patient expectations. In addition, clinician fulfillment or patient denial requests affect patient satisfaction. Surgical procedure patients consistently provided higher scores across all domains except “movement through a visit.” Therefore, using patient satisfaction is a questionable tool when evaluating the quality of care.

Workers’ Compensation patients were more likely to complete the questionnaire in orthopedic subspecialties of the hand, trauma, physical medicine, and rehabilitation. However, spine, foot, and ankle Workers’ Compensation patients had the lowest survey scores. Workers’ Compensation patient satisfaction data compromised hand, physical medicine and rehabilitation, and trauma subspecialties.

PGQ satisfaction scores were affected by these divisions. Therefore, the patient population affected the Workers’ Compensation PGQ overall patient satisfaction scores. For example, a clinic with >10.5% Workers’ Compensation patients significantly had a lower overall practice score. Non-modifiable factors, including Workers’ Compensation status ratings, should either become excluded or adjusted when a practice utilizes patient satisfaction data as a performance review, employment, or reimbursement metric.

Workers’ Compensation patients were more likely to be dissatisfied with healthcare than other primary payer groups. However, the data represents poorly understood factors, such as modifiable and non-modifiable influencing patient satisfaction. Therefore, providers may consider excluding or adjusting Workers’ Compensation patient satisfaction ratings. In addition, healthcare providers must understand the positive and negative factors influencing patient satisfaction when interpreting and utilizing feedback.