Limitations of patient experience reports to evaluate physician quality in spine surgery: analysis of 7485 surveys

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The Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) is a standardized patient experience survey that is used to evaluate the quality of care delivered by physicians. The authors sought to determine which factors influenced CG-CAHPS scores for spine surgery, and compare them to their cranial-focused cohorts.


A retrospective study of prospectively obtained data was performed to evaluate CG-CAHPS scores. Between May 2013 and May 2017, all patients 18 years of age or older with an outpatient encounter with a neurosurgeon (5 spine-focused neurosurgeons and 20 cranial-focused neurosurgeons) received a CG-CAHPS survey. Three domains were assessed: overall physician rating, likelihood to recommend, and physician communication. Statistical analyses were performed using chi-square tests.


Seven thousand four hundred eighty-five patient surveys (2319 spine and 5166 cranial) were collected from patients presenting to the outpatient offices of an attending neurosurgeon. Analysis of the overall physician rating showed that 81.1% of spine neurosurgeons received a “top-box” score (answers of “yes, definitely”), whereas 86.2% of cranial neurosurgeons received a top-box response (p < 0.001). A similar difference was observed with the domains of “likelihood to recommend” and “physician communication.” Overall physician rating was also significantly influenced by the general and mental health of the patients surveyed (p < 0.001). For spine surgeons seeing patients at more than one facility, the scores with respect to location were also significantly different in all domains for each individual provider (p < 0.001).


Overall, spine-focused neurosurgeon ratings differed significantly from those of cranial-focused neurosurgical subspecialty providers. Office location also affected provider ratings for spine neurosurgeons. These results suggest that physician ratings obtained via patient experience surveys may be representative of factors aside from just the quality of physician care provided. This information should be considered as payers, government, and health systems design performance programs based on patient experience scores.

ABBREVIATIONS CG-CAHPS = Clinician and Group Consumer Assessment of Healthcare Providers and Systems; CMS = Centers for Medicare and Medicaid Services; H-CAHPS = Hospital Consumer Assessment of Healthcare Providers and Systems; MIPS = Merit-based Incentive Payment System; VBP = Value-Based Purchasing.

Article Information

Correspondence Adam S. Kanter: University of Pittsburgh Medical Center, Pittsburgh, PA.

INCLUDE WHEN CITING Published online January 11, 2019; DOI: 10.3171/2018.8.SPINE18104.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.






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