Should Consumer Surveys Determine Medicare Payments to Hospitals?

The Wall Street Journal published an article discussing how hospitals are responding to new rules that will allocate $750 million "in payments to hospitals over the next year ... in part on patient satisfaction, determined by a 27-question government survey administered to patients."   Here is the list of composite ratings and their correlations.

• The article shows that hospitals respond to incentives.
• The article raises two interesting questions. Should the government consider consumer satisfaction when allocating payments or should payments be based completely on quantity of services and measures of outcomes? Will hospitals attempt to game the system?: the new rules award bonuses for high marks and for improvement.
• The article is misleading. The government will use the survey to allocate 30% of $750 million. The government will use more objective measures of care to allocate the other 70%. Kaiser Health news published this article describing the new rules and this article  discussing some of the potential bias of the survey. 
• The amount of funds "in play" will increase over time.
• The Patient Care and Affordability Act (Obamacare) mandates the new rules.
• An analyst quickly encounters a barrage of acronyms and initialisms when he or she investigates the new program. To learn how the sausage is made, read below. 

"CMS [The Centers for Medicare and Medicaid Services] along with the Agency for Healthcare Research and Quality, developed the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) Survey, also known as Hospital CAHPS®, to provide a standardized survey instrument and data collection methodology for measuring patients' perspectives on hospital care. The HCAHPS Survey is administered to a random sample of patients continuously throughout the year. CMS cleans, adjusts and analyzes the data, then publicly reports HCAHPS results. The HCAHPS survey is 27 questions in length—18 substantive items that encompass critical aspects of the hospital experience; four screening questions to skip patients to appropriate questions; and five demographic items, which are used for adjusting the mix of patients across hospitals and for analytical purposes. Hospital Compare reports results for 6 composite topics and the 4 individual topics, including the 2 overall rating questions" (http://www.hospitalcompare.hhs.gov/Data/PatientSurvey/Overview.aspx).