Press Ganey in your groups' contracts

[DrQuinn]

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All-
Long time no post. Occasional prowler.

Are any of your contracts including a press ganey clause? Our group has consistently been > 90%ile since I've been here for four years. Now over the past few months some of our hospital contracts are due and now they are requiring us to stay above 90%ile or they'll do a 5% holdback on our pay.

I am obviously well aware of the fallacy and crapiness of PG, and obviously our group has done well in it, and I think our hospital CEOs are just used to us being at the top and want us to continue to stay there, but I think by putting it in our contracts is very uncool.

I have heard anecdotally that even PG itself says it shouldn't be used in contract negotiations? Does anyone know if this is true? Are any of your current contracts requiring a PG minimum? So annoying....
Q

 

[NinerNiner999]

Hey bud. Hospital employed group? Now sure how else they would hold back, unless they're asking your private group to pay them for poor performance (which I have heard of).

Are you part of an ACO and are they planning to bundle your payments? Not sure about PG's position on contracting...

 

[Birdstrike]

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[DrQuinn]

nope. independent group.

 

[DrQuinn]

Maybe you should ask them why they want to push you to follow a policy, that according to at least one well respected peer reviewed journal (JAMA) is associated with higher rates of death:

http://archinte.jamanetwork.com/article.aspx?articleid=1108766

Maybe you should show them this article, and explain that you are against higher death rates for your patients.

Is it ethical for you to sign, or for them to ask you to sign, a contract that according to recent data may be associated higher death rates, higher overall health care and prescription drug expenditures?




http://www.epmonthly.com/whitecoat/2012/06/you-can-tie-you-can-lose-but-you-can-never-win/

yeah... i've shown them that article. it is clear they dont' give a snot about anything more than the numbers. honestly they are super happy with us, we witih them, etc. i think they just want to make sure we stay there. we've never had an issue with PG (like i said our group is usually 99%ile but always > 90%) but for some reason its in there. I'm questioning if anyone else has PG stipulations in their group/hospital contracts (probably more the independent folks) and if it is even ethical to do so. I swear I read somewhere that PG has said themselves that PG scores shouldnt' be tied to a contract but it might have been a throwaway.
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[Birdstrike]

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[DrQuinn]

Trust me. Its killing me. I'm not sure where this pressure is coming from. But, yeah. They've been so used to us being so high I think they don't really understand it. 90%ile is FANTASTIC. Its not a B+ like it is in high school. sheesh.
Q

 

[la gringa]

oh c'mon birdstrike, you know the studies on both ends about patient satisfaction are flawed... the two aren't mutually exclusive. i'm 90-95th %ile at my current job and was at my prior one, and i have a very low rate of bouncebacks and no horrific misses of which i am aware.

speed demon i am not... something's gotta give!!

i do agree that the PG method is a terrible way of deciding how to reimburse a group.

 

[Birdstrike]

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[la gringa]

how do you know i smile a lot?

 

[Birdstrike]

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[la gringa]

i sit down, shake hands, smile, explain things... things my mama and growing up in the south taught me 😉 they're not acts, that's just me!

 

[DrMom]

how do you know i smile a lot?

Your patient sat scores show it. LOL.

I actually had someone complain because I smiled at them. I wish I were kidding.

 

[NinerNiner999]

nope. independent group.

So they are actually asking your group to give them 5% of your gross if you don't meet your scores? How do they calculate this? Do they see your books? These are some of the issues that arise when these types of contract holds occur.

 

[name?]

We get a performance stipend from the hospital if we're above a certain %. We had been getting it regularly, so when we missed last quarter (for unclear reasons), the group took a fair hit for the quarter. For us, it's extra money missed rather than money taken away. It probably feels the same if you don't get that money, but with numbers like you're talking about, it sounds unreasonable to me.

 

[DrQuinn]

We get a performance stipend from the hospital if we're above a certain %. We had been getting it regularly, so when we missed last quarter (for unclear reasons), the group took a fair hit for the quarter. For us, it's extra money missed rather than money taken away. It probably feels the same if you don't get that money, but with numbers like you're talking about, it sounds unreasonable to me.

Yeah. I am ok with it being an incentive for being > 90%ile, but our hospital CEOs are so used to us being so high that they want us to consistently maintain it from here on out. which is crazy. I undesrtand why they want it because of all the new measures in place.... but sheesh!

And the hospital pays us per hour of physician coverage so we send an invoice and get a check to cover our MD salaries, so they could do a withold (to answer your question niner).

 

[spyderdoc]

Hey Quinn, long time no hear!

We are indie group as well. We recently renewed our contract, but took a long time of back and forth between the hospital and our group attorneys.

There were a couple of new clauses they literally snuck in there, the 2 biggest ones were for us to increase our malpractice to 2M and an indemnity clause that somehow gets the hospital out of a malpractice suit.....

So, we went back and forth, and eventually, the hospital removed those god awful clauses. There were a couple of more that were removed as well, but I don't remember specifics...There is a patient satisfaction clause, but no percentiles or penalties noted.

Our group does not get any money from the hospital in any form, so I guess they would not be able to hold back something they don't give us to begin with.....

Good luck....I would try to negotiate this with the CEO, but since they give you guys money, may be difficult to do....

 

[southerndoc]

Never, ever sign an indemnity clause! Nurses screw up, you get sued along with the hospital, and the hospital gets off free.

 

[Arcan57]

Yeah. I am ok with it being an incentive for being > 90%ile, but our hospital CEOs are so used to us being so high that they want us to consistently maintain it from here on out. which is crazy. I undesrtand why they want it because of all the new measures in place.... but sheesh!

And the hospital pays us per hour of physician coverage so we send an invoice and get a check to cover our MD salaries, so they could do a withold (to answer your question niner).

PG is a system measure and I would fight tooth and nail to keep a 5% holdback (which is substantial) on something that I had so little control over. If your volume bumps or your nursing leadership changes you might see a significant drop in your PGs that has nothing to do with physician behavior. Also, I'd try to find out what your CEOs bonus is based on, since it sounds like they are trying to set up a situation where regardless of what happens with PG they are covered: either they are sky high and they get their performance bonuses or they drop and they get to claim a 5% reduction in physician expenses to keep their bosses/shareholders happy.

 

[GeneralVeers]

Never, ever sign an indemnity clause! Nurses screw up, you get sued along with the hospital, and the hospital gets off free.

Our large hospital chain recently made us up our coverage to $3 million/$6 million. There was no discussion, and the implied threat was that if we didn't agree, we'd be out on our asses and the (more) predatory group we compete with would happily agree to the terms to get our contract.

The sad fact is that if a hospital contract is profitable for an EM group, we have very little negotiating power anymore. If we don't do what the hospital wants, then TeamHealth, EmCare, CEP or another group will ***** themselves out.

 

[TysonCook]

Another option is that you as staff get to rate them as well.

You'll let them have their 5%, but if their monthly scores (submitted by the group) are less than "90% excellent", then its a wash.

What I've come to find is that you can't have patient satisfaction if the rooms are dirty (janitorial), there isn't free parking (hospital), the rooms are dated (hospital), you can't bring someone a drink (food and nutrition services), the RN has an attitude (nursing admin), and their bill is confusing (billing).

They (other facets of the hospital) are just as much a part of it as we are, so they should be equally accountable.

I know we ALL know this is total BS, but in the end admin has no skin in the game, and expect us to take the entire burden.

 

[TysonCook]

 

[southerndoc]

Our large hospital chain recently made us up our coverage to $3 million/$6 million. There was no discussion, and the implied threat was that if we didn't agree, we'd be out on our asses and the (more) predatory group we compete with would happily agree to the terms to get our contract.

The sad fact is that if a hospital contract is profitable for an EM group, we have very little negotiating power anymore. If we don't do what the hospital wants, then TeamHealth, EmCare, CEP or another group will ***** themselves out.

Upping your malpractice coverage is wise actually. Signing an indemnity clause is just plain stupid. I would never work for a group with an indemnity clause. No way am I going to be solely responsible for an error made by a hospital employee (think of a nurse giving the wrong medication and killing a patient), a delay in diagnosis because the CT scanner is down for maintenance, etc.

Hospitals don't require their private admitting physicians to sign indemnity clauses, and neither should emergency physicians. They don't require their employed hospitalists to sign indemnity clauses.

 

[GeneralVeers]

Hospitals don't require their private admitting physicians to sign indemnity clauses, and neither should emergency physicians. They don't require their employed hospitalists to sign indemnity clauses.

Hospitalists, surgeons, and specialists bring revenue to the hospital. ER physicians cost the hospital money (at least in their view). I routinely see our hospital admin tolerate behavior from surgeons and specialists, that would get me fired.

 

[NinerNiner999]

Well said. ED revenue is actually a huge component of hospital income when factoring in admissions, consultants, studies, and all the bells and whistles of an inpatient stay. That is, of course, assuming the patient pays. I think I read a study where the hospital reimbursement actually offsets the loss of no-pays by 25%. Of course, most of their money is made by turning the beds over and discharging patients.

Sadly, one "good day" in the ED is easily overshadowed by an average day in the OR...

Quinn - you guys are lucky the hospital is paying your group at all in today's environment! I assume your group also generates its own revenue through billing if you are truly independent. There are some good ideas in this thread. This will be tough to negotiate as has been stated, and looking at how your C-suite gets their bonus is critical. See if they are giving you your payment as EBITDA, or if they are depreciating the expense as a deduction. I suspect the former and it will impact their bonus pay. The later would be more palatable for both parties, give them a deduction to offset any loss of CMS reimbursement, and would not effect their bonus. Of course, assuming your group is profitable, may open them up to re-negotiate your pay rate....

Keep us posted, as I feel this is where most EM contracts will be in the next 10 years.

 

[StevieStud]

The real enemy..... as I sit in an 8x8 room with no windows typing reports while sitting in a 20 year old chair but the deputy assistant administor office directly above me is 4 times as large, he gets a wall of windows over looking a nice park, twice my pay, none of my liabilities plus the cute private secretary to handle his dictation and other needs.

 

[la gringa]

Another option is that you as staff get to rate them as well.

You'll let them have their 5%, but if their monthly scores (submitted by the group) are less than "90% excellent", then its a wash.

What I've come to find is that you can't have patient satisfaction if the rooms are dirty (janitorial), there isn't free parking (hospital), the rooms are dated (hospital), you can't bring someone a drink (food and nutrition services), the RN has an attitude (nursing admin), and their bill is confusing (billing).

They (other facets of the hospital) are just as much a part of it as we are, so they should be equally accountable.

I know we ALL know this is total BS, but in the end admin has no skin in the game, and expect us to take the entire burden.

i know there are concerns about HIPPA and all, but if i hear one more patient complain about something and add in "well it's not even busy", i'm gonna scream!

just b/c there's no one in the WR and you don't hear screaming, doesn't mean my nurses and i aren't running our butts off. and if there's even 1 person there sicker than you are, then your care MAY be briefly interrupted while i deal w/ an issue of theirs.

people... aye.

 

[PikminOC]

As a large group, can't you negotiate to have the PG clause taken out of your contract? Is your hospital really going to go find another hospital ER group?

 

[GeneralVeers]

As a large group, can't you negotiate to have the PG clause taken out of your contract? Is your hospital really going to go find another hospital ER group?

Yes. It comes down to money. CEOs and hospital admin are bonused based on performance metrics. PG is one of them. They will go with any ER group that will hit their PG targets so they can make more salary.

 

[8654Marine]

The real enemy..... as I sit in an 8x8 room with no windows typing reports while sitting in a 20 year old chair but the deputy assistant administor office directly above me is 4 times as large, he gets a wall of windows over looking a nice park, twice my pay, none of my liabilities plus the cute private secretary to handle his dictation and other needs.

Could not agree more.

The rise in the bureaucracy and administrative cost of healthcare is, IMHO, a significant reason for the disproportionate rise of medical care cost.

Ever notice when there's talk of cuts to medical care, it's always nurses, techs, or "ancillary staff" who get cut or doctor's salaries? What about the paper pushers and desk sitters?

 

[Birdstrike]

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[PikminOC]

I can't help but think with the massive increase in complexity, regulations, red-tape and requirements of Obamacare, the number of required administrators will not decrease, but will explode exponentially in size in the next 10 years.

With an extra 1 trillion dollars committed to healthcare through Obamacare, somebody is going to make that money. With plans for physician reimbursement cuts, likely that money will go to hospital, government and insurance administrators.

When people discuss the govt takg over health care why does no one mention the VA system since the govt has been in charge of that forever? Do ppl want their care to be like the VA?

 

[Apollyon]

When people discuss the govt takg over health care why does no one mention the VA system since the govt has been in charge of that forever? Do ppl want their care to be like the VA?

The best part of the VA is the patient base. After that, the whole thing goes to ****. Now, if the whole government supported/provided healthcare system was run the VA way, that means a piss poor system, but, now, with a whole bunch of worthless, useless, shiftless manipulating losers as the recipients. The one thing that made providers think that they were doing at least a little bit of good would be gone.

 

[Birdstrike]

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[GeneralVeers]

When people discuss the govt takg over health care why does no one mention the VA system since the govt has been in charge of that forever? Do ppl want their care to be like the VA?

The simple answer is that government can NEVER EVER do anything as well as the private sector, period.

 

[bougiecric]

Very good question. This question has been asked by many in this debate. Your question, along with its answer, has been negligently ignored by the government-run healthcare crowd for years.

What are your thoughts on the fact that the government is already the largest payer for healthcare in the United States (medicare and medicaid)?

I'm not sure why republicans hate the ACA, but seem to love medicare. It was the recent President Bush who passed the gigantic Medicare Prescription Drug Modernization Act. Not very small government.

Why do conservatives emphasize "private better than public" in general, but would be aghast if medicare were to disappear?

 

[Bojack Horseman]

What are your thoughts on the fact that the government is already the largest payer for healthcare in the United States (medicare and medicaid)?

I'm not sure why republicans hate the ACA, but seem to love medicare. It was the recent President Bush who passed the gigantic Medicare Prescription Drug Modernization Act. Not very small government.

Why do conservatives emphasize "private better than public" in general, but would be aghast if medicare were to disappear?

Because they count on votes from seniors who rely on Medicare...

 

[Birdstrike]

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[8654Marine]

The current practice of healthcare delivery and the need to comply with multiple metrics and regulations, often, seem to supersede the practice of medicine.