PG scores

[squad41]

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This question is for docB or any other SDN all stars intimately familiar with PG scores. Im just a lowly med student with an EMS background and thus EM is high on my list; however, having my value or worth tied to such ridiculous parameters is a HUGE turn off. Thus, quesitons:

1) Are you familiar of any other inpatient only specialties, hospitalists, critical care, etc, that use PG scores and worship their results?

2) Can I trouble docB or someone else to basically give a cliff notes version of how PG scores work, how often they are done, what questions are asked, and how is this data used. Is it tied to bonuses, other things Im not thinking of, etc, etc. Furthermore, what type of parameters are in place to distinguish between legitimate patient complaints and the ridiculous? In other words, if a patient is clearly malingering and they are denied vitamin dilaudid, its not rocket science theyre not going to be happy.

Thanks so much for your time--cant tell you how much Ive learned over the years reading the EM forums!!!

 

[southerndoc]

We utilize Press-Ganey scores across all specialties, both inpatient and outpatient. You'd be surprised at how detailed the data is regarding which floors, docs, nurses, etc. get specific scores. However, I'm not saying that this data is valid. I think we put a lot of pressure on Press-Ganey and a lot of CEO's drink the kool-aid without questioning the validity of the data such as return bias (bad experience more likely to return survey), variables that affect it out of your control (patient volume, other staff attitudes, etc.).

Docs are asked 5 questions (not in this order):

1. Was your doctor courteous?
2. Did your doctor take the time to listen to your concerns?
3. Did your doctor take the time to keep you informed regarding your treatment?
4. Did your doctor seem concerned about your comfort?
5. Overall assessment

We give bonuses for our top performers. Some places give bonuses for top performers and take money away from bottom performers. There are hospitals and groups that will terminate physicians who consistently underperform.

 

[december07]

When do patients take this questionnaire? Right after leaving the ER? 2 days? random phone call to their home a week later?

I swear 1/2 of my patients cannot pronounce my name correctly, let alone remembering it. I'm sure the other half aren't too clear of the difference between an "attending" and a "resident" even though we clearly introduce ourselves every time.

 

[TallScrubs]

I went to urgent care at my local hospital for a broken foot during the summer. The nurse brought me a tablet computer with the questionairre on it and they essentially wouldn't let me leave until I filled it out.

 

[southerndoc]

When do patients take this questionnaire? Right after leaving the ER? 2 days? random phone call to their home a week later?

I swear 1/2 of my patients cannot pronounce my name correctly, let alone remembering it. I'm sure the other half aren't too clear of the difference between an "attending" and a "resident" even though we clearly introduce ourselves every time.

Usually 2-3 weeks after your visit (and timed to arrive before your bill).

 

[docB]

This question is for docB or any other SDN all stars intimately familiar with PG scores. Im just a lowly med student with an EMS background and thus EM is high on my list; however, having my value or worth tied to such ridiculous parameters is a HUGE turn off. Thus, quesitons:

1) Are you familiar of any other inpatient only specialties, hospitalists, critical care, etc, that use PG scores and worship their results?

2) Can I trouble docB or someone else to basically give a cliff notes version of how PG scores work, how often they are done, what questions are asked, and how is this data used. Is it tied to bonuses, other things Im not thinking of, etc, etc. Furthermore, what type of parameters are in place to distinguish between legitimate patient complaints and the ridiculous? In other words, if a patient is clearly malingering and they are denied vitamin dilaudid, its not rocket science theyre not going to be happy.

Thanks so much for your time--cant tell you how much Ive learned over the years reading the EM forums!!!

Great question. The vast majority of med students and residents are ignorant of patient polling and have no idea how much it will affect their lives.

Southerndoc gave you a great rundown on PG. We use Gallup and they work about the same.

One concept that everyone needs to understand about this farce is that they really don't try to sort out the patients who will definitely give bad reviews like drug seekers, malingerers, etc. They rely on "statistical power" to rate each doc against all the other docs in the same environment and then they reward or punish outliers. While any educated person knows this is still often invalid (e.g. a night doc will probably encounter more drug seekers and get lower ratings) it's how they sell their product. Never forget that these services are businesses and they put as much effort into marketing their product as they do creating it, ie. they spend a lot of time and money convincing hospital administrators of their validity.

When do patients take this questionnaire? Right after leaving the ER? 2 days? random phone call to their home a week later?

I swear 1/2 of my patients cannot pronounce my name correctly, let alone remembering it. I'm sure the other half aren't too clear of the difference between an "attending" and a "resident" even though we clearly introduce ourselves every time.

It doesn't matter if they know your name. The service knows who their doc was and will assign their data to you.

Among the most fatal flaws of these services is the fact that most EPs do our best most demanding work with patients who are unconscious and critically ill and often those who ultimately die. Those patients don't tend to fill out the glowing reviews that they should. As Southerndoc mentioned, there's significant reporting bias. No, this system focuses on patients with minor complaints who came to the ER and were discharged. The system rewards docs who are of the used car salesman type who spend more time smiling and shaking hands and fetching warm blankets than those who will have the hard talk about narcotics or antibiotics for viral illnesses. You can be a marginally competent doc and get great scores.

You also need to look the part. Young doc with an elderly patient population? Look out. You need some gray hair to get the gentry to give you the high marks. The old folks also like ties and white coats because they all grew up on Marcus Welby. And since they are the highly sought after insured population they get what they want. My 5 hospital system recently started requiring all of us to wear white coats😡.

Lastly everyone needs to know that no matter how bad this all sounds it sounded so good to CMS that they've bought a government supply of the Kool Aid. They have actually created a whole program designed to integrate customer satisfaction into Medicare and Medicaid payments. It's called HCAHPs and it's been brewing and growing for several years. It's not going away. Here's an old thread about it.

 

[SoCuteMD]

Great question. The vast majority of med students and residents are ignorant of patient polling and have no idea how much it will affect their lives.

Southerndoc gave you a great rundown on PG. We use Gallup and they work about the same.

One concept that everyone needs to understand about this farce is that they really don't try to sort out the patients who will definitely give bad reviews like drug seekers, malingerers, etc. They rely on "statistical power" to rate each doc against all the other docs in the same environment and then they reward or punish outliers. While any educated person knows this is still often invalid (e.g. a night doc will probably encounter more drug seekers and get lower ratings) it's how they sell their product. Never forget that these services are businesses and they put as much effort into marketing their product as they do creating it, ie. they spend a lot of time and money convincing hospital administrators of their validity.



It doesn't matter if they know your name. The service knows who their doc was and will assign their data to you.

Among the most fatal flaws of these services is the fact that most EPs do our best most demanding work with patients who are unconscious and critically ill and often those who ultimately die. Those patients don't tend to fill out the glowing reviews that they should. As Southerndoc mentioned, there's significant reporting bias. No, this system focuses on patients with minor complaints who came to the ER and were discharged. The system rewards docs who are of the used car salesman type who spend more time smiling and shaking hands and fetching warm blankets than those who will have the hard talk about narcotics or antibiotics for viral illnesses. You can be a marginally competent doc and get great scores.

You also need to look the part. Young doc with an elderly patient population? Look out. You need some gray hair to get the gentry to give you the high marks. The old folks also like ties and white coats because they all grew up on Marcus Welby. And since they are the highly sought after insured population they get what they want. My 5 hospital system recently started requiring all of us to wear white coats😡.

Lastly everyone needs to know that no matter how bad this all sounds it sounded so good to CMS that they've bought a government supply of the Kool Aid. They have actually created a whole program designed to integrate customer satisfaction into Medicare and Medicaid payments. It's called HCAHPs and it's been brewing and growing for several years. It's not going away. Here's an old thread about it.

Actually, I thought that patients who were admitted were given press-ganey surveys but they don't ask about their emergency department care.

I was a patient in my own ER one time. Never received a Press-Ganey survey, which is too bad because they took excellent care of me 🙂 (surprise, surprise).

 

[docB]

Actually, I thought that patients who were admitted were given press-ganey surveys but they don't ask about their emergency department care.

I was a patient in my own ER one time. Never received a Press-Ganey survey, which is too bad because they took excellent care of me 🙂 (surprise, surprise).

I'm not sure how PG does it. Gallup does inpatients but they weight the results differently assuming that the patient will have difficulty distinguishing the ER doc from other docs. HCAHPs gave up and just asks their questions referencing all the docs the patient met during their stay. HCAHPs only polls admitted patients oddly enough.

 

[Arcan57]

I'm not sure how PG does it. Gallup does inpatients but they weight the results differently assuming that the patient will have difficulty distinguishing the ER doc from other docs. HCAHPs gave up and just asks their questions referencing all the docs the patient met during their stay. HCAHPs only polls admitted patients oddly enough.

PG has a question regarding global ED care for admitted patients, but the doc specific questions are only asked of discharged patients.

 

[Greenbbs]

we get the detailed reports from PG every month (our chief sends em out for the entire department...so you see everyone's results and your own).

one bad PG score can bottom you out every month. Thank god it hasn't happened to me yet.

 

[la gringa]

some groups do their own... i know of one who doesn't even send them to admitted pts, thinking they can't differentiate the ED doc. the ED will show up on the PG though, sometimes mentioned by name. when i worked for them, i'd often get complaints about things the nurses did or didn't do.... even though the survey said it's for the "doctor or midlevel provider". i had great #'s but almost everyone who did one was there for something minor - somehow a guy i cardioverted then transferred got one, best patient satisfaction survey EVER... basically said "thanks for saving my life". i have a copy of it and look at it sometimes when the pts who suck the life out of you get me down!

 

[NinerNiner999]

Also, for those of you looking for new jobs (and even those outside of EM), often times "new hires" will be given an allocated bonus for satisfaction scores in their contract. Read the fine print. They may give you 100% bonus for this during your first year employed, then withhold what you "under perform" starting the next year. I've heard of contracts where satisfaction scores are upwards of 20% of your salary. This can mean an unexpected pay cut...

 

[deuist]

My hospital has the patients evaluate the residents through PG, too. The reason is that our program director wants us to be ready for it when we're attendings. Positive comments get collated and emailed to the listserv so everyone can see what a great job we did. I will say that one attending pointed out a smart move by saying, "Whenever you have a positive patient encounter, just before discharge tell them, 'You might be getting a survey in the mail in a few weeks asking how we did. If you do, could you fill it out and send it back?'"

 

[GeneralVeers]

The PG scores are the worst thing that has ever happened to Emergency Medicine. This along with the "customer service" nonsense that is pushed by hospital admins is making our specialty increasingly intolerable.

Hospital admins get bonuses based on the overall PG scores of the hospital, so they have no problem pushing us to improve these scores, even it it means we give inappropriate antibiotics, order unnecessary tests, or focus more time and energy on the worried well, instead of on the critically ill. They don't care about good practice of medicine, just as long as the patients are "happy" so they can collect their fat bonuses.

 

[DrQuinn]

Interesting forum. At my old digs in DC our hospital was one of the worst for its size. Here in the mecca midwest, our main hospital (30-40k) is in the top 1%ile. CRAZY. Probably because we are so efficient (our wait times are nil, and my average throughput time is < 90 minutes for all my pateints). This is a big driver of patietn sastifaction...

Hey. Our group will take it when our PG are super high. Kind of funny though that hospital administration is getting used to us being > 90%ile for the past few years, and one month we dipped below 90% and they got all fluffy.

Q

 

[xaelia]

my average throughput time is < 90 minutes for all my pateints).

The sheer number of GOP-protocol patients awaiting CT at our hospital makes that number a fantasy.

 

[docB]

The PG scores are the worst thing that has ever happened to Emergency Medicine. This along with the "customer service" nonsense that is pushed by hospital admins is making our specialty increasingly intolerable.

Hospital admins get bonuses based on the overall PG scores of the hospital, so they have no problem pushing us to improve these scores, even it it means we give inappropriate antibiotics, order unnecessary tests, or focus more time and energy on the worried well, instead of on the critically ill. They don't care about good practice of medicine, just as long as the patients are "happy" so they can collect their fat bonuses.

I can't agree enough with this. Our administrators demand that we achieve excellent "customer satisfaction" but we are also to be stewards for narcotics, antibiotics and imaging as well as screening out non-emergent patients. There is no way to do both.

The corporate trainers will tell you that you can do both by spending extra time with the patient and explaining the reason you will be denying them whatever it is that their PMD sent them to the ER to get because it was too time consuming to set it up as an outpatient. However we are still required to see 3+ patients per hour. So the "explain it away" answer is crap.

 

[GeneralVeers]

The corporate trainers will tell you that you can do both by spending extra time with the patient and explaining the reason you will be denying them whatever it is that their PMD sent them to the ER to get because it was too time consuming to set it up as an outpatient. However we are still required to see 3+ patients per hour. So the "explain it away" answer is crap.

The REAL problem is that we have unscrupulous groups like EmCare and TeamHealth who will take ANY contract by promising administration whatever they want. That gives most of us zero leverage, as administration will just threaten us with loss of contract if we give any argument to their insane (often dangerous) demands.

 

[docB]

The REAL problem is that we have unscrupulous groups like EmCare and TeamHealth who will take ANY contract by promising administration whatever they want. That gives most of us zero leverage, as administration will just threaten us with loss of contract if we give any argument to their insane (often dangerous) demands.

Touche. Although we are barraged with silly demands as well and have to acquiesce because there's always someone out there ready to step in.

 

[GeneralVeers]

Touche. Although we are barraged with silly demands as well and have to acquiesce because there's always someone out there ready to step in.

If Emergency groups got together and developed a list of things they will and won't accept, and made it universal, we would actually have a say in how things are run. As long as there's some other group who will ***** themselves out, we have no power.

 

[docB]

If Emergency groups got together and developed a list of things they will and won't accept, and made it universal, we would actually have a say in how things are run. As long as there's some other group who will ***** themselves out, we have no power.

It would be great if all the groups would agree on some set of conditions like the EP's Bill of Rights or something similar.

 

[december07]

If Emergency groups got together and developed a list of things they will and won't accept, and made it universal, we would actually have a say in how things are run. As long as there's some other group who will ***** themselves out, we have no power.

you don't mean....forming a UNION? 🙂

 

[GeneralVeers]

No, not a union. It would have nothing to do with wages/benefits.

It would purely set standards for appropriate staffing, bed ratios, and facilities.