Physician Fights Back Against Patient Sat Insanity By Suing Huge Hospital System

[Birdstrike]

A doctor does the morally & medically right thing. During a nationwide opiate-overdose death crisis she refuses to prescribe unnecessary opiates to addicts looking to abuse narcotics, and dealers looking for drugs to sell to kids who'll OD & die. She then gets fired because doing the right thing caused "low patient satisfaction scores," because the hospital is worried about losing customers and profits. It's about time we fought back against this insanity. Thank you Dr. Eryn Alpert for leading the way.

Physician sues Kaiser Permanente over opioid-related patient satisfaction scores

An emergency medicine physician filed a lawsuit Sept. 18 against Kaiser Permanente over its patient satisfaction scoring methodology, which she alleges incentivized overprescribing of opioids and hurt her career at the Oakland, Calif.-based health system, The News Tribune reports.

www.beckershospitalreview.com

(My apologies if this has already been posted. I did a search and didn't see it.)

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[thegenius]

Wow that is in my general neighborhood. I work part time at Kaiser, but not that facility.

 

[RuralEDDoc]

A doctor does the morally & medically right thing. During a nationwide opiate-overdose death crisis she refuses to prescribe unnecessary opiates to addicts looking to abuse narcotics, and dealers looking for drugs to sell to kids who'll OD & die. She then gets fired because doing the right thing caused "low patient satisfaction scores," because the hospital is worried about losing customers and profits. It's about time we fought back against this insanity. Thank you Dr. Eryn Alpert for leading the way.

Physician sues Kaiser Permanente over opioid-related patient satisfaction scores

An emergency medicine physician filed a lawsuit Sept. 18 against Kaiser Permanente over its patient satisfaction scoring methodology, which she alleges incentivized overprescribing of opioids and hurt her career at the Oakland, Calif.-based health system, The News Tribune reports.

www.beckershospitalreview.com

(My apologies if this has already been posted. I did a search and didn't see it.)

I don’t know... my experience with kaiser (part-time) is that patient satisfaction (their MPS scores) is about 20% of the review criteria. And with that said, only a small fraction of your patients that fill out the survey will be opiate seekers. So this would not be the only reason this person was “fired”. I say “fired” as it appears that the person was not fired but rather not voted into the group (fellow physicians have to vote you in or out after three years - this person was apparently voted out).

 

[GonnaBeADoc2222]

I don’t know... my experience with kaiser (part-time) is that patient satisfaction (their MPS scores) is about 20% of the review criteria. And with that said, only a small fraction of your patients that fill out the survey will be opiate seekers. So this would not be the only reason this person was “fired”. I say “fired” as it appears that the person was not fired but rather not voted into the group (fellow physicians have to vote you in or out after three years - this person was apparently voted out).

The fact that 100% of all review criteria for everywhere isn't "are you a good physician" is the problem

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[KGflyboy]

I don’t know... my experience with kaiser (part-time) is that patient satisfaction (their MPS scores) is about 20% of the review criteria. And with that said, only a small fraction of your patients that fill out the survey will be opiate seekers. So this would not be the only reason this person was “fired”. I say “fired” as it appears that the person was not fired but rather not voted into the group (fellow physicians have to vote you in or out after three years - this person was apparently voted out).

I don't know how Kaiser works, but the article says she worked there for 5 years. So maybe she was well past the 3 year vote in or vote out period you mentioned when she was fired.

 

[DrGasPasser]

While I empathize with her cause, I think this doc is going to struggle to win this lawsuit. First, drug seekers rarely put that the reason for low marks was the physician’s failure to meet controlled substance prescribing expectations. The comments boxes are usually filled with more general claims that the physician was rude or uncaring. Thus, she would need to show that most or all of the bad survey responses are patients where she clearly documents a conflict over expectations for controlled substances.

Second, PG statistics are such that a couple of outliers can still tank a physician’s rolling 90-day percentile score. Thus, she is likely to be underwater even if they threw out all of bad scores that were clearly from people wanting opiates. That is to say, I bet she pissed off a couple of mother’s who expected antibiotics for their kids or pillars of the community who wanted grandma admitted for placement in the region’s best nursing home on Friday night.

Third, her former employer will probably be able to trot out a couple of her peers with reasonable scores and similar opioid prescribing patterns since PG scores tend to be random number generators for all but the most extreme outliers, IMHO.

Don’t get me wrong, I feel her pain. However, the problems associated with focusing on patient satisfaction as a benchmark of physician quality and performance go far beyond opioid prescribing and are hard to quantify.

 

[RuralEDDoc]

x

I don't know how Kaiser works, but the article says she worked there for 5 years. So maybe she was well past the 3 year vote in or vote out period you mentioned when she was fired.

You get three chances. So if you’re not voted in on year one (which I hear is rare) you have two chances to course correct and seek partnership again. If you fail three times in a row then you can’t work there anymore.
Regarding the post above this one - I don’t see why it’s unreasonable to have patient satisfaction surveys form a small part of a physician evaluation. “Are you a good doctor?” is really subjective - I don’t know if any great way to measure this (neither does the government, or kaiser, or Vituity, or Harvard, etc).

 

[Janders]

PG scores for most places down to the individual provider level are close to random number generators. Its just small sample size, and poor test design. You can be 1st percentile one month and 99th the next and... not change anything?

But individual patient complaints targeting specific providers? Also statistically meaningless, but EASY to see a "pattern" within, even its its just 1% of patients complaining...

 

[GonnaBeADoc2222]

x


You get three chances. So if you’re not voted in on year one (which I hear is rare) you have two chances to course correct and seek partnership again. If you fail three times in a row then you can’t work there anymore.
Regarding the post above this one - I don’t see why it’s unreasonable to have patient satisfaction surveys form a small part of a physician evaluation. “Are you a good doctor?” is really subjective - I don’t know if any great way to measure this (neither does the government, or kaiser, or Vituity, or Harvard, etc).

Random chart review. Did the physician provide standard of care?

Really easy to do.

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[GeneralVeers]

We used to get copies of our patient complaints a few years ago. Many patients would list various reasons like: "The ER was too cold!" or "The registration lady looked at me funny". Unless she can provide clear evidence that patients rated her poorly based solely on narcotics, she is not going to win.

Every time I've had this battle I'm told it's not narcotics but my "demeanor" which is causing low scores.

 

[RuralEDDoc]

Random chart review. Did the physician provide standard of care?

Really easy to do.

Sent from my Pixel 3 using SDN mobile

Spoken like somebody who has never managed physicians.

 

[deleted941485]

We used to get copies of our patient complaints a few years ago. Many patients would list various reasons like: "The ER was too cold!" or "The registration lady looked at me funny". Unless she can provide clear evidence that patients rated her poorly based solely on narcotics, she is not going to win.

Every time I've had this battle I'm told it's not narcotics but my "demeanor" which is causing low scores.

Wishing this doc the best but I think it’s a really tough case and good chance of it being dismissed. Big hospital Corp has retainer legal teams that sit in house all day and literally jerk it to scenarios like this and plan for them and right policies etc. the argument might be there but it’s an uphill battle when your opposition is well funded and has most of the angles figured out.

 

[VA Hopeful Dr]

We used to get copies of our patient complaints a few years ago. Many patients would list various reasons like: "The ER was too cold!" or "The registration lady looked at me funny". Unless she can provide clear evidence that patients rated her poorly based solely on narcotics, she is not going to win.

Every time I've had this battle I'm told it's not narcotics but my "demeanor" which is causing low scores.

I've had the same happen (except with antibiotics since I'm FM). So I did a little experiment.

Before I got fussed at about patient satisfaction, for viral URIs I'd spend roughly 10 minutes in the room with the patient taking a history, doing an exam, and explaining why antibiotics weren't needed and what to do instead.

When I decided to just say **** it and give everyone antibiotics, I timed myself. 5 minutes. Just enough history/physical to make sure they weren't actually sick, told them I was giving them an antibiotic with no other education whatsoever, and out the door.

My satisfaction scores jumped an insane amount.

 

[Birdstrike]

We used to get copies of our patient complaints a few years ago. Many patients would list various reasons like: "The ER was too cold!" or "The registration lady looked at me funny". Unless she can provide clear evidence that patients rated her poorly based solely on narcotics, she is not going to win.

Every time I've had this battle I'm told it's not narcotics but my "demeanor" which is causing low scores.

Patients are smart enough not to put, "He didn't give me drugs to sell," when the reason they're mad, is that they weren't prescribed drugs they planned to sell. They'll instead fill the report with every other possible real or imagined complaint they can come up with. But they'll never write, "I rate this doctor 1 out of five stars because I'm an addict and he didn't give me drugs to abuse," especially when that's the exact reason they're upset.

 

[Birdstrike]

I've had the same happen (except with antibiotics since I'm FM). So I did a little experiment.

Before I got fussed at about patient satisfaction, for viral URIs I'd spend roughly 10 minutes in the room with the patient taking a history, doing an exam, and explaining why antibiotics weren't needed and what to do instead.

When I decided to just say **** it and give everyone antibiotics, I timed myself. 5 minutes. Just enough history/physical to make sure they weren't actually sick, told them I was giving them an antibiotic with no other education whatsoever, and out the door.

My satisfaction scores jumped an insane amount.

That's a great example. When you practiced worse medicine, you're scores went up. There are so many examples of this yet no one seems to understand or care. What's most "satisfying" isn't always good medicine. Often it's the exact opposite. I have no idea why this is so hard for people to understand.

The dirty little secret is the business people and administrators requiring the surveys do understand that aggressively pushing for patient satisfaction literally kills people and is wasteful. But they don't care, because what they care about more than that is money. More happy customers, equals more traffic through their hospital which equals greater profits and money for them, even if those happier people are sicker. As long as they think they're being treated great, the business people don't care if they actually are or not.

There's an old expression that goes like this, "Take your medicine," implying that doing what it takes to get well, sometimes is unpleasant. Getting treatment for addiction and saving your life is hard. Losing weight and saving your life by preventing a heart attack is hard. Getting chemo to kill your cancer is not fun. Telling a patient they need to do any of these things can be described with many words, but "satisfying" is not one of them.

What's more immediately "satisfying" to someone? Telling them they can eat whatever they want and their weight is fine. Telling them they're not addicted and they can keep just cut back on the alcohol and keep drinking because they have special DNA like Keith Richard and they'll live forever. Telling them they don't need nauseating chemo, they just need to take holistic supplements, do yoga, pray and they'll be cured painlessly. But none of these things are good medicine.

We should all treat patients with respect, politeness and professionalism. But I honestly think 30 years from now the push for patient satisfaction will be looked back upon as a mistake as bad as pushing "addiction proof" opiates in the 1980's. It literally kills people and I'm not at all surprised, that despite having the greatest medical technology we've ever had on planet Earth, American life expectancy has ticked down the last few years. It may continue to do so, if we don't make some major changes.

JAMA: "In a nationally representative sample, higher patient satisfaction was associated with increased inpatient utilization and with increased health care expenditures overall and for prescription drugs. Patients with the highest degree of satisfaction also had significantly greater mortality risk."

 

[southerndoc]

This is not the first time that a physician has sued over termination due to poor scores.

 

[RuralEDDoc]

Kind of an aside, but If I’m a medical director (and I’m not currently), if the hospital is collecting patient satisfaction data (which they all are), then I would like to see that data when doing biannual reviews with providers. It’s one additional piece of information to look at when reviewing a physician, knowing that it must be taken with a grain of salt. I would not tie it to compensation or bonus. Its easy to get nurse, technician, and fellow physician feedback on a provider, but much more difficult to get the patient’s side. Patient satisfaction surveys definitely provide skewed data (which is why it should not be tied to compensation) but can be a warning signal that a provider has a problem that needs addressing.

 

[Janders]

Believe me, when you are a medical director you'll see every score and complaint. They may even be so kind as to forward them to you 5 days a week for commentary and investigation. :-D

 

[namethatsmell]

Kind of an aside, but If I’m a medical director (and I’m not currently), if the hospital is collecting patient satisfaction data (which they all are), then I would like to see that data when doing biannual reviews with providers. It’s one additional piece of information to look at when reviewing a physician, knowing that it must be taken with a grain of salt. I would not tie it to compensation or bonus. Its easy to get nurse, technician, and fellow physician feedback on a provider, but much more difficult to get the patient’s side. Patient satisfaction surveys definitely provide skewed data (which is why it should not be tied to compensation) but can be a warning signal that a provider has a problem that needs addressing.

Incorrect. These surveys are generally nothing more than harmful. I keep waiting for a class action suit against PG.

And if takes a director seeing patient complaints to help identify a doctor as possibly having issues...that director is probably useless and should be replaced.

And what’s up with all the “provider” talk on here recently?? Are we trying to help the muggles win?


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[RuralEDDoc]

Incorrect. These surveys are generally nothing more than harmful. I keep waiting for a class action suit against PG.

And if takes a director seeing patient complaints to help identify a doctor as possibly having issues...that director is probably useless and should be replaced.

And what’s up with all the “provider” talk on here recently?? Are we trying to help the muggles win?


Sent from my iPhone using SDN mobile

“Provider” because a medical director typically manages an entire department, which will include physicians and midlevels.
You’re right that directors should know about issues before they come back (weeks or months later) as surveys or complaints. Not saying patient satisfaction surveys replace anything. It’s a tool that can be used as long as one understands the flaws and shortcomings.

 

[RuralEDDoc]

Believe me, when you are a medical director you'll see every score and complaint. They may even be so kind as to forward them to you 5 days a week for commentary and investigation. :-D

I hear that. Responding to complaints was one of the worst parts of the job (my previous medical director position).

 

[emergentmd]

I've had the same happen (except with antibiotics since I'm FM). So I did a little experiment.

Before I got fussed at about patient satisfaction, for viral URIs I'd spend roughly 10 minutes in the room with the patient taking a history, doing an exam, and explaining why antibiotics weren't needed and what to do instead.

When I decided to just say **** it and give everyone antibiotics, I timed myself. 5 minutes. Just enough history/physical to make sure they weren't actually sick, told them I was giving them an antibiotic with no other education whatsoever, and out the door.

My satisfaction scores jumped an insane amount.

It took me 6 months to figure this out.
Walk in, long educational discussion about viral and no need for abx which they nod in agreement. Finished, and with a disappointed look pt asks, "So am I getting abx?" Just wait when that viral infection turns into a bacterial or when they go see another doc, get abx and feel better in 2 dys.

Its the American Mcdonalds phenomenon. They go to the ER to get a script, not to be told that they are too fat and shouldn't get their big mac.

 

[GonnaBeADoc2222]

I haven't been bothered about PG scores yet (don't think they're very good) so I've been trying to fight the good fight. I'm sure when I get harassed tho I'll just start tossing zpacks at everyone. Whatever. I gotta send my kid to college.

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[VA Hopeful Dr]

I haven't been bothered about PG scores yet (don't think they're very good) so I've been trying to fight the good fight. I'm sure when I get harassed tho I'll just start tossing zpacks at everyone. Whatever. I gotta send my kid to college.

Sent from my Pixel 3 using SDN mobile

I still do pick some battles: prepubescent kids I still do the right thing every time. Stand firm on opioids. I've loosened up slightly on benzos: no xanax ever, nothing else more than BID. And I don't give out potent antibiotics. If its viral, you get either doxy or a z-pack.

 

[RustedFox]

"Potent"?

 

[VA Hopeful Dr]

"Potent"?

Stuff that still has significant clinical usage or fairly frequent adverse effects.

For instance: lots of PCPs will still write FQs for "sinus infections".

 

[RustedFox]

Stuff that still has significant clinical usage or fairly frequent adverse effects.

For instance: lots of PCPs will still write FQs for "sinus infections".

Gotcha. Was on phone earlier, thus the brevity.

I'd put doxy in the category of significant clinical usage, though.
After all, "nobody dies without a dose of doxy".

 

[GeneralVeers]

It's interesting that with MIPS we can't prescribe antiobiotics for sinusitis and otitis externa. I like to use that now and say: "We are not allowed by the federal government to prescribe antibiotics for your illness". That seems to quiet down a lot of complaining.

 

[Groove]

It's interesting that with MIPS we can't prescribe antiobiotics for sinusitis and otitis externa. I like to use that now and say: "We are not allowed by the federal government to prescribe antibiotics for your illness". That seems to quiet down a lot of complaining.

Haha, I'm going to use that one.

Speaking of MIPS, are any of you guys getting dinged for MLP charts? Even on the ones I sign with no attestation, if they give abx for bronchitis, it dings my MIPS score, even though I never saw the pt. I asked my CMG about it and they just told me it was an unfortunate side effect of having MLP charts sent to the attending for signature. That would seem to imply the encounter is being billed through the physician for 100% instead of through the MLP. Isn't that fraudulent billing?

 

[VA Hopeful Dr]

Gotcha. Was on phone earlier, thus the brevity.

I'd put doxy in the category of significant clinical usage, though.
After all, "nobody dies without a dose of doxy".

True, but doxy seems weirdly immune to developing resistance. Could be that its just not used all that much in outpatient primary care, but its an awfully old drug that has the same resistance pattern now that it did 12 years ago when I first started paying attention.

 

[emergentmd]

To be a good ER doc, you must be able to keep working.

You can go by all the clinical research you want, but you will be out of a job soon.

Give pts what they want. Your life is easier, people love you, pts leave and love you, admin loves you. You get a good job with good pay.

Be a Hard A$$ and your marked whenever something bad happens.

"Pt came in with fever and you d/c them with viral syndrome?" They came back and was septic. Why did you not work them up????? I review cases like this all the time.

 

[DrGasPasser]

To be a good ER doc, you must be able to keep working.

You can go by all the clinical research you want, but you will be out of a job soon.

Give pts what they want. Your life is easier, people love you, pts leave and love you, admin loves you. You get a good job with good pay.

Be a Hard A$$ and your marked whenever something bad happens.

"Pt came in with fever and you d/c them with viral syndrome?" They came back and was septic. Why did you not work them up????? I review cases like this all the time.

Part of the reason why I left EM is due to the transactional nature that was evolving in the speciality. I say evolving because I literally felt it shift over the almost 2 decades that I practiced. America became less resilient and more demanding. I think EM was especially impacted due to the lack of longitudinal care and relationship development associated with a single visit. Not to mention our ever-expanding nanny state that entitles the FSA (free **** Army).

It’s better in the ICU. Not perfect but much less suffocating.

 

[Groove]

Part of the reason why I left EM is due to the transactional nature that was evolving in the speciality. I say evolving because I literally felt it shift over the almost 2 decades that I practiced. America became less resilient and more demanding. I think EM was especially impacted due to the lack of longitudinal care and relationship development associated with a single visit. Not to mention our ever-expanding nanny state that entitles the FSA (free **** Army).

It’s better in the ICU. Not perfect but much less suffocating.

You may have mentioned this before but did you do a CCM fellowship to jump into the ICU?

 

[DrGasPasser]

You may have mentioned this before but did you do a CCM fellowship to jump into the ICU?

Yeah, in in the process (not done yet). Call it another mid-life crisis...I’ve had a couple of those.

 

[RuralEDDoc]

Part of the reason why I left EM is due to the transactional nature that was evolving in the speciality. I say evolving because I literally felt it shift over the almost 2 decades that I practiced. America became less resilient and more demanding. I think EM was especially impacted due to the lack of longitudinal care and relationship development associated with a single visit. Not to mention our ever-expanding nanny state that entitles the FSA (free **** Army).

It’s better in the ICU. Not perfect but much less suffocating.

I really feel you on this - I’ve felt the same exact thing in my practice. The place that it is most noticeable is with teenage patients. 10 years ago I could get a teenager to pay attention and engage in a history and exam, this wasn’t always easy, but it was possible. Now I find the teenagers won’t make eye contact, the accompanying helicopter parent will give almost the entire history, as if the patient is unable to do so, and the teenager only engages to request that everything be done immediately and painlessly. Technology is amazing but touch screens and social media, among other factors, has destroyed society and I really fear for where this country and this specialty are headed.

 

[GonnaBeADoc2222]

I really feel you on this - I’ve felt the same exact thing in my practice. The place that it is most noticeable is with teenage patients. 10 years ago I could get a teenager to pay attention and engage in a history and exam, this wasn’t always easy, but it was possible. Now I find the teenagers won’t make eye contact, the accompanying helicopter parent will give almost the entire history, as if the patient is unable to do so, and the teenager only engages to request that everything be done immediately and painlessly. Technology is amazing but touch screens and social media, among other factors, has destroyed society and I really fear for where this country and this specialty are headed.

Well...

The country is headed to **** and the specialty it headed in the same direction as the rest of medicine.

Sent from my Pixel 3 using SDN mobile

 

[BAM!]

I really feel you on this - I’ve felt the same exact thing in my practice. The place that it is most noticeable is with teenage patients. 10 years ago I could get a teenager to pay attention and engage in a history and exam, this wasn’t always easy, but it was possible. Now I find the teenagers won’t make eye contact, the accompanying helicopter parent will give almost the entire history, as if the patient is unable to do so, and the teenager only engages to request that everything be done immediately and painlessly. Technology is amazing but touch screens and social media, among other factors, has destroyed society and I really fear for where this country and this specialty are headed.

And get off my lawn!

As much as I agree with the plaintiff's complaints against patient satisfaction scoring, she's fighting an uphill battle. When patients are seeing a doctor, they have an expectation to get something. If you are going to refuse opiates or antibiotics, it behooves you to have a back up plan, ie a large arsenal of symptom-treating medications the lay public has never heard of (voltaren, mobic, intranasal cromolyn, etc).

Much like Gen Veer's demeanor issues , I am sure this doctor has similar ones. If her colleagues and medical director truly liked her, she would have been voted into a shareholder position. It seems like a simple "She didn't fit well with our practice," is all they would need as defense of their voting her off the island.

 

[GeneralVeers]

And get off my lawn!

As much as I agree with the plaintiff's complaints against patient satisfaction scoring, she's fighting an uphill battle. When patients are seeing a doctor, they have an expectation to get something. If you are going to refuse opiates or antibiotics, it behooves you to have a back up plan, ie a large arsenal of symptom-treating medications the lay public has never heard of (voltaren, mobic, intranasal cromolyn, etc).

Much like Gen Veer's demeanor issues , I am sure this doctor has similar ones. If her colleagues and medical director truly liked her, she would have been voted into a shareholder position. It seems like a simple "She didn't fit well with our practice," is all they would need as defense of their voting her off the island.

I fight just enough of the good fight to keep myself sane, while trying to avoid complaints. Honestly it's the complaint letters that do in a physician much quicker than low patient sat scores.

 

[deleted497653]

@southerndoc did the physician winin the case you know about?

 

[southerndoc]

@southerndoc did the physician winin the case you know about?

Settled

 

[frog301]

Settled

Do you by chance know the range of amount that she settled for?

 

[southerndoc]

Most settlements are sealed.

 

[gro2001]

A doctor does the morally & medically right thing. During a nationwide opiate-overdose death crisis she refuses to prescribe unnecessary opiates to addicts looking to abuse narcotics, and dealers looking for drugs to sell to kids who'll OD & die. She then gets fired because doing the right thing caused "low patient satisfaction scores," because the hospital is worried about losing customers and profits. It's about time we fought back against this insanity. Thank you Dr. Eryn Alpert for leading the way.

Physician sues Kaiser Permanente over opioid-related patient satisfaction scores

An emergency medicine physician filed a lawsuit Sept. 18 against Kaiser Permanente over its patient satisfaction scoring methodology, which she alleges incentivized overprescribing of opioids and hurt her career at the Oakland, Calif.-based health system, The News Tribune reports.

www.beckershospitalreview.com

(My apologies if this has already been posted. I did a search and didn't see it.)

While I am sympathetic to the general sentiment, and hope something good comes out of this case for the profession and the doc, I am dubious that she would be fired just for 'doing the right thing'. Maybe it's my naiveté, and I don't know anything about how Kaiser works, but I feel there must be more to the story than her just having low satisfaction scores. It seems to me that it must be her having low satisfaction scores AND something else that would cause her to get fired.