Metric Mania

[Groove]

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Anybody else get these metric assessments on individual ER docs? I work for a CMG (IC 1099) and c-suite just started pumping out these monthly metric reports that the director will send out to all of us. They track all of us individually with:

Total patents, arrival to greet, arrival to bed, bed to physician greet, arrival to 1st order, greet to first order, greet to discharge order, greet to admit order, LOS-ESI 4&5 (but not 1-3?), Med Admit LOS, Med Discharge LOS

It comes in a handy dandy printout with all manner of color coding with pretty greens and blues for the (good boy) numbers and angry oranges and reds for the (bad ED "provider", black mark for you for this month!).

I realize this is part of the new age of metric based medicine but it's so demeaning. It makes me feel like a damn factory worker.

I'm fine with the ones I receive from my CMG but good grief, now the hospital admin is putting together their own?

 

[GeneralVeers]

I do the same thing with these that I do with Press-Ganey scores....

 

[namethatsmell]

It's a great example of noctors trying to create metrics they can understand, thus giving them the feeling of control and creating "goals" to work for. Perhaps your admins are running out of metric projects and are exploring the bottom of the barrel?

I view the printouts as re-affirming my commitment to recycling.

 

[alphaholic06]

I do the same thing with these that I do with Press-Ganey scores....

As do I...File 13.

Sent from my Pixel 3 XL using SDN mobile

 

[NYEMMED]

Anybody else get these metric assessments on individual ER docs? I work for a CMG (IC 1099) and c-suite just started pumping out these monthly metric reports that the director will send out to all of us. They track all of us individually with:

Total patents, arrival to greet, arrival to bed, bed to physician greet, arrival to 1st order, greet to first order, greet to discharge order, greet to admit order, LOS-ESI 4&5 (but not 1-3?), Med Admit LOS, Med Discharge LOS

It comes in a handy dandy printout with all manner of color coding with pretty greens and blues for the (good boy) numbers and angry oranges and reds for the (bad ED "provider", black mark for you for this month!).

I realize this is part of the new age of metric based medicine but it's so demeaning. It makes me feel like a damn factory worker.

I'm fine with the ones I receive from my CMG but good grief, now the hospital admin is putting together their own?

What CMG are you working for? That way we can stay away...

 

[Groove]

What CMG are you working for? That way we can stay away...

ApolloMD. We get one from the medical director every month showing how everyone breaks down in regards to total patients seen, each ESI number, admission rate, overall length of stay, RVU/hr, etc.. Honestly, I'm ok with that one. We got something similar when I worked for Schumacher and I always thought it was useful seeing where you stood in regards to your colleagues. It's informative and breeds some friendly competition and I don't really mind.

The c-suite report is just ridiculous. Now, I feel inundated with metric reports on our individualized performance each month. I'm actually a top performer on both lists but it's the principal that aggravates me.

 

[Birdstrike]

ApolloMD. We get one from the medical director every month showing how everyone breaks down in regards to total patients seen, each ESI number, admission rate, overall length of stay, RVU/hr, etc.. Honestly, I'm ok with that one. We got something similar when I worked for Schumacher and I always thought it was useful seeing where you stood in regards to your colleagues. It's informative and breeds some friendly competition and I don't really mind.

The c-suite report is just ridiculous. Now, I feel inundated with metric reports on our individualized performance each month. I'm actually a top performer on both lists but it's the principal that aggravates me.

I feel your pain. I think when we all got patients per hour reports and worked on efficiency, that was fine. But there's so many factors that go into ED throughput that are out of an individual physician's control, I think it's unfair to hold individual physicians responsible for more than a fraction of it.

That being said, we all know this is part of the reality of Medicine (as a whole) as big business now. I've always felt the best way to deal with this stuff is the goal post theory. Don't be the the lowest or the highest on the curve. If they're going to fire anyone over lack of efficiency, it'll always be the slowest person. If you're the fastest on the right end of the curve, perhaps slow down a hair and use some of that time to either recharge and ease the pressure, or or use it to document a little more completely to bolster yourself medical-legally. As long as you're not a goal post, you shouldn't have anything to worry about any of this, you're unlikely to be cannon fodder, and should be able to shred these reports without worry. Control what you can control and ignore that which you can't.

 

[bravotwozero]

I don't know what kind of C-suite culture you have, but I wouldn't be terribly worried (maybe if you work HCA). I don't know too many docs that were fired for low satisfaction scores. Usually, what they do is send some stupid corporate baby sitter who wants to shadow you for a few hours while you're on shift, and give you some 'feedback' on how to act like a human being. That's what happened to me, and then he said 'I was great'....he kept wanting to shadow me until I just politely told him to piss off, which he did. Not sure if origami is your thing, but those reports might come in handy if you wanna try it as a hobby.

At least that's how things are where I work. I work the most shifts out of anyone at my full-time gig, and have received the most surveys, and my scores aren't great. I am also past the point of giving a rat's @ss, and haven't really changed my behavior, except I'll sit down when talking to my patients, because it gives them the impression that I was there for a long time.

 

[Groove]

I don't know what kind of C-suite culture you have, but I wouldn't be terribly worried (maybe if you work HCA). I don't know too many docs that were fired for low satisfaction scores. Usually, what they do is send some stupid corporate baby sitter who wants to shadow you for a few hours while you're on shift, and give you some 'feedback' on how to act like a human being. That's what happened to me, and then he said 'I was great'....he kept wanting to shadow me until I just politely told him to piss off, which he did. Not sure if origami is your thing, but those reports might come in handy if you wanna try it as a hobby.

At least that's how things are where I work. I work the most shifts out of anyone at my full-time gig, and have received the most surveys, and my scores aren't great. I am also past the point of giving a rat's @ss, and haven't really changed my behavior, except I'll sit down when talking to my patients, because it gives them the impression that I was there for a long time.

Are you serious?? Admin sent someone down to follow you around and take notes?! I would lose my sh** if a nurse or suit followed me around and tried to tell me how to be a better EP. I don't know how you kept a positive attitude.

You're right of course. I'm just whining.... It's mildly soul crushing for me to accept the reality of our future which is adherence to a cumulation of metric reports and satisfaction surveys. My dad is retired ENT and likes to talk about the good ol days when they didn't have to deal with any of this bureaucratic b***s***.

I'd love to talk more but I've got to get back to analyzing my MIPS, TATs, Door to greet times and satisfaction surveys....

 

[WilcoWorld]

Anybody else get these metric assessments on individual ER docs? I work for a CMG (IC 1099) and c-suite just started pumping out these monthly metric reports that the director will send out to all of us. They track all of us individually with:

Total patents, arrival to greet, arrival to bed, bed to physician greet, arrival to 1st order, greet to first order, greet to discharge order, greet to admit order, LOS-ESI 4&5 (but not 1-3?), Med Admit LOS, Med Discharge LOS

It comes in a handy dandy printout with all manner of color coding with pretty greens and blues for the (good boy) numbers and angry oranges and reds for the (bad ED "provider", black mark for you for this month!).

I realize this is part of the new age of metric based medicine but it's so demeaning. It makes me feel like a damn factory worker.

I'm fine with the ones I receive from my CMG but good grief, now the hospital admin is putting together their own?

Where's the "patient outcome" metric?

 

[southerndoc]

We get MIPS and CT utilization reports, but I haven't seen the other stuff that you describe (other than PPH posted with our pay info on the .net site).

Honestly, I think PG and metrics will go away in 10-15 years. Will be brutal and will likely get worse before it gets better.

 

[namethatsmell]

Where's the "patient outcome" metric?

Amen.

The last time one of these bean-counting admin types came to our group meeting to talk about the mega-importance of sign in->doc times (right after they'd cut our staffing), I asked how well our patients were doing.

The hot air immediately stopped coming out of his mouth as he has no idea.

The meeting moved on.

 

[deleted836128]

I hate metrics. I was told my average discharge length of stay was “horrible” - it was all of 131 minutes at the facility where I see the sickest patients. Apparently they also had admin come down and “spy” on the providers unbeknownst to us because later on I heard that “admin overheard some of the PAs talking about how their weekend went with the nurses, and that could be adding to the discharge length of stay times.” And how the only way they will pay for scribes is if it helps us pick up patients for at least 11 hours of our 12 hour shifts - if they don’t see that we are picking up patients later they will take the scribes away. I even had the nurse ER director come up to me and complain that one of the PAs I oversee ordered an abdomen/pelvis CT with contrast instead of just a KUB x-ray because she (as a nurse) thought the KUB would tell the PA everything she needed to know and ordering the CT just increased the patient’s length of stay in the ER. I ripped her a new one for that. It is amazing to me how much ER providers are treated like machines.

 

[Psai]

I hate metrics. I was told my average discharge length of stay was “horrible” - it was all of 131 minutes at the facility where I see the sickest patients. Apparently they also had admin come down and “spy” on the providers unbeknownst to us because later on I heard that “admin overheard some of the PAs talking about how their weekend went with the nurses, and that could be adding to the discharge length of stay times.” And how the only way they will pay for scribes is if it helps us pick up patients for at least 11 hours of our 12 hour shifts - if they don’t see that we are picking up patients later they will take the scribes away. I even had the nurse ER director come up to me and complain that one of the PAs I oversee ordered an abdomen/pelvis CT with contrast instead of just a KUB x-ray because she (as a nurse) thought the KUB would tell the PA everything she needed to know and ordering the CT just increased the patient’s length of stay in the ER. I ripped her a new one for that. It is amazing to me how much ER providers are treated like machines.

That is absurd. You guys should go to the administration departments and listen in on their conversations so that every minute of their time is accounted for. No time wasted from making up brand new, useless metrics that help nobody.

 

[RoyBasch]

We get MIPS and CT utilization reports, but I haven't seen the other stuff that you describe (other than PPH posted with our pay info on the .net site).

Honestly, I think PG and metrics will go away in 10-15 years. Will be brutal and will likely get worse before it gets better.

I differ to your much greater experience in administration and I hope you are right. But, why do you think PG and metrics will go away? The powers that be seem to love them more than life itself.

 

[southerndoc]

I differ to your much greater experience in administration and I hope you are right. But, why do you think PG and metrics will go away? The powers that be seem to love them more than life itself.

Just a trend, and research is pointing toward higher costs and higher morbidity with their use. They aren't statistically sound. Hospitals waste tons of money on them.

 

[deleted245139]

That is absurd. You guys should go to the administration departments and listen in on their conversations so that every minute of their time is accounted for. No time wasted from making up brand new, useless metrics that help nobody.

I sorta like this.