In the U.S., we're striving to limit time patients spend in hospitals, especially limiting readmissions for the same illnesses/calls. To do this, EMS agencies and hospitals will need to share data to ensure patient care is at its best, and work together to make improvements and maintain funding.
In other countries that have socialized medicine, such as England, limiting hospital time by tying quality to funding is in full effect. They're taking it a step further, bundling patient satisfaction with other EMS quality measurements.
(This video explains it in greater detail: http://www.jems.com/video/2020vision/measuring-patient-satisfaction.)
You hit on two separate issues here. The first is tying reimbursement to quality and I think that is going to have a HUGE impact on all of health care, EMS included, in the near future. While current laws aren't yet hitting EMS in the pay-for-performance (P4P) criteria, it is already starting to change care coordination inside many medical centers. One of the aspects of this care coordination will be stepping-down patients from tertiary care centers back to their community hospitals. This will increase EMS IFT traffic down the road, but here's the catch... Many large centers are affiliating with or outright acquiring community hospitals within their catchment areas. This will make the hospitals a larger payer of EMS interfacility costs, and they will eventually be tying quality to payment. Why? It makes sense for them to do so; if their reimbursement is tied to quality and outcomes, and EMS is in the game they will want to have only the best players involved in that game. Once that ball starts rolling, you can bet it wont take the insurance companies long to come up with their own matrix on EMS quality and tie that into reimbursement as well. It is a pretty complex change to health care reimbursement, and so far we have generally been insulated from it, but our time is coming.
Patient satisfaction is a fungible measurement, but one that we should be looking at. By fungible I mean that a patient can receive great care from a medical standpoint, but affect, attitude or circumstance can sway their opinion in the wrong direction. Let's think of the hospitality industry for a second. You can be at a 5 star hotel, with great staff, pristine living conditions, and delectable food. People will still complain, and often do, without cause. Sometimes it's to get money off their bill, a free room, or because they are just a irritable person with a poor attitude. We serve the same people in EMS, and this is where I think satisfaction surveys can fall short. Now, if I am looking at a bunch of surveys about transports from my department, I think they can be a valuable tool. The outliers are normally easily identifiable, and trends can be watched and services adjusted when needed. But this would be done on a micro-level not a broad based system like would have to happen to tie payment to them in anyway. Don't take this as I am against monitoring patient satisfaction, I am not - I'm just not 'there' yet to tie payment to them.
I'm good with measuring patient satisfaction. 80% of what we do does not involve critical medicine, or in many of those cases, any medicine at all. The services that we provide are (a) compassion, and (b) transportation. We SHOULD measure whether we were nice, and whether the ride was comfortable. That's OK.
I think patient & family satisfaction should be way up there at the tippy-top of our list, but its value in the field (and in the ED) mandates some qualified interpretation. Anybody who's been lied to about a million times will tell you our mission is to provide sick people with the services they need, not always the ones they want. You do need to be nice, caring and thoughtful. But you also need to be competent.
I agree with all of your comments. EMS will need to shift the way it does things in the future so it can maintain what little funding it gets. I think if there are no new ways to get funding, patient satisfaction and positive patient outcomes will be two of the most important measurements EMS can use to demonstrate its importance as part of the healthcare continuum. If there ARE new ways to get funding, such as through shared cost-savings programs with hospitals and mobile healthcare opportunities, these will be the only two things to separate us from other types of agencies trying to survive out there.