the Press Ganey

[bla_3x]

Does anyone have any information as to exactly why/what the rationale behind the Press Ganey scores only go to the DC'd patients?

I ask people and get usually something akin to that's just how it goes...
It seems to me...and I am only an EM2...that this is horribly flawed and biased.

Are there any efforts under way to get this changed?

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[GeneralVeers]

It's all about "customer service". The rationale is that patients who are discharged probably came with a non-emergent complain. The hospital wants them to return next time they have a BS complaint, so they use Press-Ganey as a tool to measure patient satisfaction.

Ironically the admitted patients are the ones who truly need to come to the ER, and we don't send them surveys.

I know they are blasting you guys at UMC over the Press-Ganeys. They're even trying to tie our salary to our percentile rank.

 

[southerndoc]

We get bonuses based on PG scores. Admitted patients are sent a PG survey, but it's more of a survey for hospital care as opposed to ED specific care.

Unfortunately we always spend more time with admitted patients and that's where we can make a difference.

 

[Old_Mil]

Does anyone have any information as to exactly why/what the rationale behind the Press Ganey scores only go to the DC'd patients?

I ask people and get usually something akin to that's just how it goes...
It seems to me...and I am only an EM2...that this is horribly flawed and biased.

Are there any efforts under way to get this changed?

I love EM, and am going to go into the field...it's these wretched Press-Ganey rankings that make me worry about the future of it a bit though.

I wonder - does the fire department send out "customer service" surveys to people whose houses they try and prevent from burning down? Or only to people whose cats get stuck in trees?

Or maybe they don't send out such things at all.

EMS? Anyone heard of EMS sending transported patients customer service surveys?

 

[docB]

The main reason that PG and Gallup (what we use in the VHS) only use d/cd patient's input for ED scoring is that once they get admitted it becomes very difficult to figure out what the responses are based on. For example if the question is "Was your doctor cool?" the patient won't know if they're talking about the ER doc, the internist, the consult, etc. If they try to ask specifically about the ER doc vs. the internist vs. the consult it becomes so complex that the responses are useless (more useless, you know what I mean).

While I think that holding the guys over at UMC's feet to the fire over patient satisfaction is like punishing the band on the Titanic because their tune isn't peppy enough we're all just going to get more of this in the future. HCAHPS is comming and our reimbursement is going to depend on patient "staisfaction." That's significantly different than having your bonus tied to PG. With HCAHPS we'll all have the amount of money our groups collect influenced by how well we can kiss ass.

Previous thread on HCAHPS

 

[GeneralVeers]

Yes Mr. Drugseeker, I'll give you a prescription for Oxycontin. What's that? You want 30 of them? Hell I'll give you 90! Please give me a "5" or tell me why not.

 

[docB]

Yes Mr. Drugseeker, I'll give you a prescription for Oxycontin. What's that? You want 30 of them? Hell I'll give you 90! Please give me a "5" or tell me why not.

I agree. I plan to lead off every encounter with "How much Dilaudid do I have to give you to get a good HCAHPS ranking?" You can have good medical care or satisfied patients but not both. If you tie my pay to "satisfaction" I'll satisfy 'em. EBM and standard of care will be out the window but I'll satisfy them.

What HCAHPS rating you can expect from a patient you correctly told you won't write for antibiotics for their viral URI? I'd say we'll all be giving out azithro like it's candy.

 

[bla_3x]

I heard that there is a more hospital specific survey that pts get.

However, it seems that hospitals, at least their admin, get wet over these scores. If getting a good idea of what your patients ED experience was is important you really need to put in the minimal extra work and have an ED specific survey that has to be given to the patients or their surrogates within a fixed amount of time. Like, 24hrs in house or if ICU critical, can be given to family if they experienced the care in the ED and these sort of things. Mention specific ED care questions and have it done soon enough that they are not confused with the hospitalists etc.

The rational that this even works on the DCd pts is flawed because it assumes all pts coming into the ED have legit complaints.

I know that patient satisfaction is gonna steer our careers greatly, and I think that I can do well in that arena. But, have a tool that can legitimately evaluate my skills and shortcomings!

 

[Apollyon]

Patients that leave AMA and psychiatric/substance abuse patients aren't supposed to get put in the mix for a survey (at least in our hospital system), but who gets put in the pool to get a survey is dictated by how the business office person enters the discharge in the computer (so, when there's a lazy slug in there, a random person who should not get a survey does).

Getting a survey yanked about a pt that should not have received one is possible, but like yanking teeth. Get this - PG doesn't want to introduce "selection bias". They parade statistics that reek of that sense of "with over 100million capsules already, could we afford to give this away for free?" (of the late-night "increase your manhood" commercials) - irrespective of reality.

 

[EC3]

and we wonder why our healthcare system is an absolute disaster. let's continue to give more and more control of the system to the uneducated consumers as opposed to the intellectuals actually running the system. while we're at it, let's involve some more MBAs and insurance agents to really get this machine oiled up.

 

[beriberi]

I love the PGs as much as anyone (and do have an annual bonus that is tied to my performance) -- but I wouldn't worry to much about your basic scum of the earth bringing you down.

In order to get a PG survey you have to have 1)an accurate address 2) the ability to get mail at that address 3) literacy 4) enough energy/concern/anger to fill out the survey and return it.

Most of my really annoying patients do not fulfill the above criteria.

 

[EM_Rebuilder]

I agree. I plan to lead off every encounter with "How much Dilaudid do I have to give you to get a good HCAHPS ranking?" You can have good medical care or satisfied patients but not both. If you tie my pay to "satisfaction" I'll satisfy 'em. EBM and standard of care will be out the window but I'll satisfy them.

What HCAHPS rating you can expect from a patient you correctly told you won't write for antibiotics for their viral URI? I'd say we'll all be giving out azithro like it's candy.

I'm with you here. I am just a junior resident so I have not had PG shoved down my throat, yet, but when the time comes, its certainly not overly hard to 'make patients happy'. Giving antibiotics when you shouldn't and giving too many Narcs do not really fit 'malpractice'. It might not quite fit our professional model of 'doing the right thing' and puzzle into the Hippocrates Oath, but everyone else in the world is most worried about watching their hind pocket, why should we not?

 

[turtle md]

Giving antibiotics when you shouldn't and giving too many Narcs do not really fit 'malpractice'.

Not until they have a severe allergic reaction to the antibiotic or die from self-dosing too many narcs.

I saw a case where the PCP but a pt on an antibiotic for her URI. She came in 4 days later in SJS and nearly died. No medicine is completely safe and we should not just give them out to make people happy.

I try to be nice while giving the care I deem best, but I try not to just give the patient what they want. If my medical knowledge and my bedside manner don't win me big points, then at least I sleep better...