I supposed I should be stoned for my sins...

[Apollyon]

So, I just now get two PG surveys in my email.

First - woman complaining that her daughter has a history of kidney stones, and usually gets an "MRI" to look for them. As I did not expose her daughter to more radiation, I'm a sucky doctor.

Second - man who writes that he was "misdiagnosed" - returned "1 week later" and diagnosed with kidney stones. Since it's obviously the same thing one week later, I'm a sucky doctor. In the future, he'll go to the other hospital system in town.

Unfortunately, I can't access the hospital intraweb right now, so I can't go back and review the charts and see how I've horribly mismanaged these patients.

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[docB]

This will continue to get worse with HCAHPS. Essentially if you try to practice EBM you'll be punished. I suggest just giving the patients a menu and letting them pick what they want. Then they'll only be able to complain about the time involved.

 

[southerndoc]

We all need to quit being biotches to PG surveys and just stand up against them. Unfortunately I don't think we can get unity in our profession to do this. We would all have to do it at the same time. Somebody would sell their soul to the devil (hospital administration) to abide by PG's though.

The worst part is that PG's for admitted patients -- you know, those that are truly sick that we spend the most time with -- don't ask about ER physicians in their surveys.

I am aware of one physician who is suing his former employer after being fired for bad PG surveys. He contends that things outside his control also played into his poor score (long wait times, sucky nursing that didn't give pain meds quickly, too much volume that didn't allow him to spend time with patients, etc.). I foresee this happening more and more in the future.

 

[southerndoc]

This will continue to get worse with HCAHPS. Essentially if you try to practice EBM you'll be punished. I suggest just giving the patients a menu and letting them pick what they want. Then they'll only be able to complain about the time involved.

Maybe a computerized touch screen in the waiting room? Let them choose their chief complaint, lab and radiographic tests, etc. When they choose dilaudid for pain control, the computer should say "you have made an invalid selection." When they choose work excuse, the computer should prompt them to insert a $20 bill or swipe their credit card.

 

[Apollyon]

Maybe a computerized touch screen in the waiting room? Let them choose their chief complaint, lab and radiographic tests, etc. When they choose dilaudid for pain control, the computer should say "you have made an invalid selection." When they choose work excuse, the computer should prompt them to insert a $20 bill or swipe their credit card.

Although I hate smileys, As the staff has said, an Ativan salt lick, Lortab vending machine, and another machine that prints out work notes, and we're out of business.

 

[theCamel]

as an upcoming EM resident, i am terrified about what i'm getting myself into, and reading this only confirms my suspicions. i can't imagine tailoring my practice to these surveys, and i'm hoping that whatever group i sign on with has no PG score incentives or whatnot.

 

[docB]

as an upcoming EM resident, i am terrified about what i'm getting myself into, and reading this only confirms my suspicions. i can't imagine tailoring my practice to these surveys, and i'm hoping that whatever group i sign on with has no PG score incentives or whatnot.

It doesn't matter what group you're with. HCAHPS will be inflicted by Medicare/Medicaid on everyone.

See relevent thread on HCAHPS

 

[GeneralVeers]

It doesn't matter what group you're with. HCAHPS will be inflicted by Medicare/Medicaid on everyone.

See relevent thread on HCAHPS

Our salaries will be tied to Press-Ganey scores, it's inevitable. I can actually foresee a future where JCAHO gets involved, and will only accredit hospitals with certain scores. Eventually this may even be tied to medicare reimbursement as government looks for more arbitrary reasons to reduce or restrict payments.

 

[EM2BE]

Our salaries will be tied to Press-Ganey scores, it's inevitable. I can actually foresee a future where JCAHO gets involved, and will only accredit hospitals with certain scores. Eventually this may even be tied to medicare reimbursement as government looks for more arbitrary reasons to reduce or restrict payments.

I heard this same statement today from some director of a hospital. Scary.

 

[Squad51]

Our salaries will be tied to Press-Ganey scores, it's inevitable. I can actually foresee a future where JCAHO gets involved, and will only accredit hospitals with certain scores. Eventually this may even be tied to medicare reimbursement as government looks for more arbitrary reasons to reduce or restrict payments.

It may be tied to a score, but it won't be press-ganey. Most of the groups that use press-ganey do so with targets based on percentiles within comparable hospitals. "Eye on 90" (the 90th percentile) is their common theme for those hospitals they consult for. The trick here is that what would seem to be "good" scores (e.g., 4.51 on a 5 point scale) are really poor scores (at or around the 50th percentile). To use press ganey scores "raw" wouldn't be bad - in actuality the scores are quite high on average. But if they tied them to the average percentile they would deny payment to huge numbers of facilities. Which won't happen.

The bigger worry is that the government will develop it's own scoring system, one likely to be worse than P-G.

Hopefully the outcry against the ethics of such schemes will prevent their institution. I can tell you that I've seen fellows all but ignore patients once it was obvious they would be admitted. Why? Because they wouldn't be getting a survey. Ethicists have pointed out that such practices would become widespread if pay for performance begins. Patients that were somehow "excluded" from the measures will be ignored.

 

[Febrifuge]

Somebody's going to have to find a way to explain that whatever the CEO of some insurance company might say, healthcare is not a business that operates under normal economic laws, market forces, or any of that other widget-paradigm stuff.

Except of course in veterinary medicine. But that's a different digression.

I was in the corporate world long enough. I actually taught customer-service courses for a while. This whole patient-survey thing is fundamentally unsound. Intelligent people surely find a way to avoid or ignore it, but I bet that's exactly how the evil trolls will get us. (Then again, everybody loves warm fuzzy caring PAs who take time to listen, so I should be golden.)

 

[southerndoc]

I can tell you that I've seen fellows all but ignore patients once it was obvious they would be admitted. Why? Because they wouldn't be getting a survey. Ethicists have pointed out that such practices would become widespread if pay for performance begins. Patients that were somehow "excluded" from the measures will be ignored.

As I've heard before from someone who will remain nameless but is big into the customer satisfaction surveys:

"If given a chance between spending time informing someone of their condition upon discharge and spending time letting someone know they are being admitted and explaining their condition... Well, the admitted patient will figure it out soon enough on their way upstairs."

 

[docB]

My personal feeling is that we will wind up socializing (I'm not for it but I think it's inevitable) and then "customer satisfaction" will go right out the window. For example the Soviets never once contracted the Gallup org to see what their people thought about the gulags and so on. I am quietly looking forward to the day when my motto can stop being "May I get you a warm blanket or give you a foot massage?" and switch to the DMV tried and true "Get bent scumbag."

 

[Arcan57]

While I like the idea of a single-payer system for other reasons, I don't think it will necessarily lead to a decrease in patient satisfaction as an outcome measure. England has a "pt. must be seen within 4 hr rule", and I could easily see the US implementing something similar.

http://waittimes.blogspot.com/2008/06/should-us-canada-adopt-4-hour-er-wait.html

We do love the unfunded mandate.

 

[Speed Racer]

My personal feeling is that we will wind up socializing (I'm not for it but I think it's inevitable) and then "customer satisfaction" will go right out the window. For example the Soviets never once contracted the Gallup org to see what their people thought about the gulags and so on. I am quietly looking forward to the day when my motto can stop being "May I get you a warm blanket or give you a foot massage?" to the DMV tried and true "Get bent scumbag."

My favorite FU thing to do is listen politely....nod...then stare for an uncomfortable 5 seconds in silence, carefully observing their anticipation of a response, and then walking away. I've only done it twice and that was because the alternative was verbally incinerating the patient.

 

[roja]

I stand on very few absolutes. This is one. Patients are not customers. Period. (this doesn't mean we shouldn't strive to make things better, civil etc) but they are PATIENTS not customers.

/soapbox

 

[Hayduke]

I stand on very few absolutes. This is one. Patients are not customers. Period. (this doesn't mean we shouldn't strive to make things better, civil etc) but they are PATIENTS not customers.

/soapbox

I agree, but can you translate this absolute to community/private group practice?

 

[Jeff698]

I stand on very few absolutes. This is one. Patients are not customers. Period. (this doesn't mean we shouldn't strive to make things better, civil etc) but they are PATIENTS not customers.

Sure, and I guess you think you're a physician not a provider, huh?

Take care,
Jeff

 

[GeneralVeers]

My personal feeling is that we will wind up socializing (I'm not for it but I think it's inevitable) and then "customer satisfaction" will go right out the window. For example the Soviets never once contracted the Gallup org to see what their people thought about the gulags and so on. I am quietly looking forward to the day when my motto can stop being "May I get you a warm blanket or give you a foot massage?" and switch to the DMV tried and true "Get bent scumbag."

I agree that the system will inevitably become socialized. I disagree with you that Press-Ganey goes out the window. The government is always looking for ways to cut costs and "customer satisfaction" is a method for the government to reduce or deny payments to huge numbers of hospitals and physicians who are "underperorforming". We'll also have tons of core measures with the goal of finding excuses to deny payment.

 

[docB]

I agree that the system will inevitably become socialized. I disagree with you that Press-Ganey goes out the window. The government is always looking for ways to cut costs and "customer satisfaction" is a method for the government to reduce or deny payments to huge numbers of hospitals and physicians who are "underperorforming". We'll also have tons of core measures with the goal of finding excuses to deny payment.

True but I think that the gubmit will realize that not writing people for antibiotics when they're not indicated (same as narcs, CT scans, warm blankies and so on) is cheaper. So even though the "customers" will be less satisfied the savings will trump the whining.

 

[Tiger26]

Sure, and I guess you think you're a physician not a provider, huh?

Take care,
Jeff

No hold on for just one minute here--I'm not going to 4 years of provider school just so I can be called a physician, no sir

 

[GeneralVeers]

True but I think that the gubmit will realize that not writing people for antibiotics when they're not indicated (same as narcs, CT scans, warm blankies and so on) is cheaper. So even though the "customers" will be less satisfied the savings will trump the whining.

It's not about customer satisfaction, just like core measures and decubitus ulcers are not about patient care. It's about denying payment in order to trim costs.

 

[Faebinder]

Seriously, I dont know what are you guys scared about... you want to be really scared, come see the psychiatry satisfaction scores... where all the psychotics are mad at you for keeping them inhouse and all the malingerers/addicts are mad at you for refusing to give them the meds they want or admit them.

 

[Jeff698]

Seriously, I dont know what are you guys scared about... you want to be really scared, come see the psychiatry satisfaction scores... where all the psychotics are mad at you for keeping them inhouse and all the malingerers/addicts are mad at you for refusing to give them the meds they want or admit them.

OK, you win.

The reason my scores suck is because your patients come to my ED. Fortunately, I have some other patients to dilute the mix while you're freebasing the pure stuff.

My hats off to you. Seriously, thanks for the perspective.

Take care,
Jeff

 

[tkim]

Seriously, I dont know what are you guys scared about... you want to be really scared, come see the psychiatry satisfaction scores... where all the psychotics are mad at you for keeping them inhouse and all the malingerers/addicts are mad at you for refusing to give them the meds they want or admit them.

Is your pay tied to those scores?

 

[Faebinder]

Is your pay tied to those scores?

As a resident...no, but we hear all about the customer service satisfaction crap in the psych ER and even in the involuntary and voluntary unit.

 

[southerndoc]

Is your pay tied to those scores?

In many places, yes.

 

[roja]

I agree, but can you translate this absolute to community/private group practice?

I think the question is not can one, but should one. This does not mean you shouldn't try and make patients comfortable.

It comes down to a basic philosophy: Do you think health care is a right or a privilege? If you think its a right, then its not something that should be for profit, and patients aren't customers. If you think its a privilege, then you should treat them as customers and go for profit.

Sure, and I guess you think you're a physician not a provider, huh?

I don't know if I should laugh or cry.

 

[tkim]

In many places, yes.

I meant for the psych people. I know the PG is tied into ED visits.

 

[tkim]

As a resident...no, but we hear all about the customer service satisfaction crap in the psych ER and even in the involuntary and voluntary unit.

The reason I ask is that some EP's have their pay based on those satisfaction scores, so if your attendings don't have their pay based on those scores as well, well, that's the reason why EM complains about it and you don't see it as a big deal.