Virginia ER docs advance nationwide push for accountability in ED patient surveys
Before the ACEP 2026 Scientific Assembly kicked off in Chicago this week, ACEP Council met to determine the future direction of emergency medicine nationwide.
The Council, which includes representatives from ACEP's 53 chapters and other emergency medicine organizations, helps shape national policy and advocacy priorities. This year, delegates considered 56 resolutions addressing issues affecting emergency physicians, their workplaces, and patient care.
Among the proposals considered was a resolution from Virginia ACEP aimed at strengthening accountability in how patient experience surveys are used to evaluate emergency physicians.
Resolution 56, Strengthening ACEP Policy on the Appropriate Use of Emergency Department Patient Experience Surveys, addresses longstanding concerns about the fairness and validity of patient satisfaction surveys — particularly when the results are used to evaluate physician performance, determine compensation, or make employment decisions.
Emergency physicians have long argued that patient experience scores can be influenced by factors outside their control, including hospital wait times, staffing shortages, inpatient boarding and other operational challenges. Despite existing ACEP policy discouraging the use of these surveys for physician compensation and employment decisions, concerns remain about how hospitals and third-party survey companies collect, interpret, and apply the results.
The Virginia resolution generated discussion at the Council meeting and was amended to remove two provisions. The first reaffirmed ACEP's existing policy, which had been updated in September 2025 (and is copied below). It was considered unnecessary.
The second amendment sought to address how surveys attribute patient experiences to individual physicians. Some Councillors raised concerns that patients who were admitted or transferred may have received care from multiple physicians, making it difficult to determine which physician a survey response was evaluating.
The remaining provision calls for ACEP to work with the American Medical Association (AMA) to strengthen accountability for hospitals and survey companies that use patient experience data. The goal is to move beyond existing policy statements and pursue meaningful changes in how surveys are administered and used.
VACEP President
"Based on our resolution, ACEP will work with the American Medical Association to hold hospitals and surveying companies accountable."
Joran Sequeira, MD, FACEP
The resolution reflects VACEP's continuing advocacy for fair, evidence-based physician evaluations and recognition that emergency physicians should not be penalized for hospital-wide operational challenges beyond their control.
Read Virginia's Resolution 56
Review the resolution introduced by VACEP at the 2026 ACEP Council meeting.
View / Download Resolution 56 (PDF) →ACEP Policy: Patient Experience of Care Surveys
Revised September 2025, February 2023, June 2016 with current title. Originally approved September 2010 titled "Patient Satisfaction Surveys."
ACEP recognizes that patient experience of care surveys that are methodologically and statistically sound can be reflective of the patient's perception of their health care experience, and that patient outcomes can be related to perceived patient experience of care.
However, neither institutions nor survey vendors have established widespread standardization of survey tools, populations, or methodologies. Inclusion and exclusion criteria have not been consistently applied, resulting in inconsistent survey results. Hospitals and survey vendors may sample or receive responses from a small percentage of the patients seen in the ED potentially leading to results with poor validity. Importantly, acutely ill or injured patients who are admitted to the hospital are typically excluded, the very patients to whom emergency physicians appropriately devote disproportionate amounts of time and attention. Moreover, factors leading to poor patient experience scores, including wait times, are often related to factors extrinsic to ED operations and outside of the control of the staff working in the ED.
Consumer Assessment of Healthcare Providers & Systems (CAHPS) was a program introduced by the CMS in the mid-2000s as part of the overall shift of health care from a fee-for-service to a pay-for-performance model. The program was designed to assess the experiences of adult ED patients who were subsequently discharged home. An early version of a care quality survey for EDs, based on outpatient tools, was initially conceived as ED PEC (Patient Experience of Care); however, despite a prolonged trial of ED PEC and its offspring instrument, labeled ED CAHPS, CMS has still not validated nor issued standard ED surveys.
ACEP holds that patient experience of care survey tools should be:
- Standardized and validated for the average education level of those being surveyed.
- Administered and tabulated as close to the date of service as possible.
- Based on a statistically valid sample size free from selection bias.
- Administered to all categories of ED patients regardless of location seen or admission/discharge/observation/transfer status to create a broad representation of patient experiences without marginalizing certain populations.
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Structured with methods to exclude patients who:
- Leave without being seen/elope
- Leave against medical advice
- Require security intervention or restraint
- Have altered mental status or lack capacity due to medical or psychiatric illness
- Are held under involuntary behavioral health holds
- Are evaluated in the custody of law enforcement
- Have been surveyed within the last 30 days
- Expired in the course of the ED/hospital stay
- Transparent in the administration and analysis
- Explicit in the intended purpose and use
- Designed to address clinically meaningful aspects of the patient's perception of care in the ED
Due to the difficulty in refining whether patient experience of care scores are the result of physician performance or due to demands and restrictions on the current health care system, implicit bias, or other factors out of the control of the physician, patient experience of care metrics should not be used for purposes such as credentialing, contract renewal, or incentive bonus programs.
Using patient experience of care scores for credentialing, contract renewal, or incentive bonus programs could have potential negative impacts on quality patient care including safe prescribing of controlled substances, use of antibiotics, and utilization of imaging. Patient experience surveys are best utilized collaboratively between physicians and healthcare organizations to assess the patient experience of care in the ED. They should not be used for individual physician payment, reimbursement, or employment decisions. In addition, personal physicians' patient experience scores should not be published, transmitted, or released.
ACEP believes that:
- Patient experience scores whether attributed to an individual physician, other elements of the department, or the entire ED must be criterion-referenced. The standard to which it is compared must be previously determined and applicable to similar institutions in similar settings. The use of rank-ordered percentiles must be abandoned, given irrelevant meaning of such comparative positioning.
- CMS should provide emergency physicians the opportunity to provide input into the ED CAHPS survey and methodology.
- Methodologies should be based on national standards.
- Patient experience of care measurement and methods to assess the validity of individual survey tools be incorporated into the training of residents in emergency medicine.
Original ACEP Policy: The September 2025 policy is also available through Annals of Emergency Medicine. Access to the full article may require a subscription or institutional login. View the policy in Annals of Emergency Medicine →
