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

Discussion in 'Emergency Medicine' started by Apollyon, Dec 17, 2008.

  1. Apollyon

    Apollyon Screw the GST
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    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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  3. docB

    docB Chronically painful
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    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.
     
  4. southerndoc

    southerndoc life is good
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    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.
     
  5. southerndoc

    southerndoc life is good
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    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.
     
  6. Apollyon

    Apollyon Screw the GST
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    Although I hate smileys, :thumbup: 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.
     
  7. theCamel

    theCamel wessssside
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    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.
     
  8. docB

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

    See relevent thread on HCAHPS
     
  9. GeneralVeers

    GeneralVeers Globus Hystericus
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    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.
     
  10. EM2BE

    EM2BE Elf
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    I heard this same statement today from some director of a hospital. Scary.
     
  11. Squad51

    Squad51 Paracelsus'es Love Child
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    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.
     
  12. Febrifuge

    Febrifuge Grizzled Old Newcomer
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    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.)
     
  13. southerndoc

    southerndoc life is good
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    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."
     
  14. docB

    docB Chronically painful
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    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."
     
    #13 docB, Dec 19, 2008
    Last edited: Dec 20, 2008
  15. Arcan57

    Arcan57 Junior Member
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  16. Speed Racer

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    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.
     
  17. roja

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    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
     
  18. Hayduke

    Hayduke Member
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    I agree, but can you translate this absolute to community/private group practice?
     
  19. Jeff698

    Jeff698 EM/EMS nerd
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    Sure, and I guess you think you're a physician not a provider, huh? :)

    Take care,
    Jeff
     
  20. GeneralVeers

    GeneralVeers Globus Hystericus
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    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.
     
  21. docB

    docB Chronically painful
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    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.
     
  22. Tiger26

    Tiger26 Senior Member
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    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
     
  23. GeneralVeers

    GeneralVeers Globus Hystericus
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    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.
     
  24. Faebinder

    Faebinder Slow Wave Smurf
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    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.
     
  25. Jeff698

    Jeff698 EM/EMS nerd
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    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
     
  26. tkim

    tkim 10 cc's cordrazine
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    Is your pay tied to those scores?
     
  27. Faebinder

    Faebinder Slow Wave Smurf
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    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.
     
  28. southerndoc

    southerndoc life is good
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    In many places, yes.
     
  29. roja

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    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. :D


    I don't know if I should laugh or cry. :)
     
  30. tkim

    tkim 10 cc's cordrazine
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    I meant for the psych people. I know the PG is tied into ED visits.
     
  31. tkim

    tkim 10 cc's cordrazine
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    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.
     

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