Home / Tag Archives: Press Ganey

Tag Archives: Press Ganey

Press Ganey and HealthGrades.com Are Medicine’s Fake News

Whether you agree with the Trump administration assertions about “fake news” or not, the term has gained legs and has at least put the American public on notice that you can’t trust everything that you read in the media or on the internet. Fake News Definition As the term “fake news” has become more commonplace, it remains loosely defined, often being used as a blanket pejorative against information that counters the interests of those using the term. This article from the Daily Caller describing how journalists are declaring war on fake news without knowing how to define it conjures ideas of the old Keystone Cops movies. I’m going define “fake news” as information that is reported as fact but is without foundation, is demonstrably false, or is presented in a manner that is intended to deceive the reader. To differentiate “fake news” from opinion pieces, we sometimes need to look at the actual or apparent intent of the report, since arguments may be intended to sway opinion, but shouldn’t necessarily be considered “fake news” if they are well-reasoned and supported by evidence. In some instances my definition may fall short, but then again, “fake news” may be one of those terms that is difficult to define but that “everyone knows it when they see it.” Compare that “recognition” definition with concepts such as “justice”, “due process,” and “pornography” which even courts have had some difficulty consistently defining. The internet realm of “fake news” includes such things as “clickbait” and sponsored posts. While I would initially fall for links to posts with phrases such as “this will make your jaw drop” or “you wouldn’t believe”, seldom was I incredulous or left with my mouth agape. Yet the clicks that those links created benefited the publisher by improving site stats and advertising revenue. Similarly, sponsored posts may seem like they’re intended solely for the information and benefit of the readers, but may also be created for compensation at the request of another interested party. These types of “fake news” are more difficult to detect, but the federal government was so concerned about the issue that the Federal Trade Commission created rules requiring disclosure of any sponsorship in posts endorsing a product. Applying Fake News to Healthcare Reports The event that prompted this post and bumped others that I was working on was the news story about former prominent Texas neurosurgeon Christopher Duntsch. I wrote about the story several years ago over at EPMonthly.com. My prior post was, in turn, prompted by an excellent article in the Texas Observer by Saul Elbein. The gist of Saul Elbein’s article was that Dr. Duntsch had multiple egregious medical misadventures while operating on patients and that those misadventures caused multiple serious patient injuries and one patient death. Dr. Duntsch would bounce from hospital to hospital after he started feeling heat from his malpractice, so it took some of the hospitals a while to figure out the problems. However, the Texas Medical Board was reportedly notified of these misadventures on multiple occasions by multiple physicians from multiple different hospitals, but Dr. Duntsch reportedly kept maiming patients in surgery while the Board “investigated” for more than a year before suspending his license. See Order of Temporary Suspension from the Texas Medical Board here (.pdf file). The recent articles on Dr. Duntsch provide some closure. He was tried criminally for his botched surgeries – an extremely difficult allegation to prove. However, after only four hours of deliberation, a jury convicted Dr. Duntsch of the first degree felony of “harming an elderly person” with regard to the care of one of his patients. Dr. Duntsch now faces life in prison. See more information on the trial in the ...

Read More »

Press Ganey’s Latest Business Model: Eavesdropping

A reader provided me with a report showing that in addition to the “let’s get hospital administrators to rely on invalid patient satisfaction statistics” business, Press Ganey is also in the “let’s eavesdrop on what are supposed to be private physician patient conversations” business. People acting on Press Ganey’s behalf are supposedly showing up in hospitals to evaluate the hospital settings … and snoop through patient’s protected health information in the hospital … and even eavesdrop on what are supposed to be private conversations between patients and their physicians in restricted areas. Below are some excerpts from the report I received which are transcribed for web searching purposes. Press Ganey apparently printed its report on dark paper in an attempt to make the report difficult to copy. Transcription: Sitting against the wall by the printer there is a sheet of patient labels with PHI that anyone can see when walking down the hallway. ED was very busy with all days [sic] occupied. The ED received three ambulance patients almost simultaneously while I was there. A new patient arrived via EMS. Initially, when the doctor and nurse went into the room, no one pulled the curtain for privacy. After the doctor exited the room, the nurse then pulled the curtain. During this interaction, the doctor explained what he was doing throughout the process and asked the patient’s permission, saying for example “can I listen to your heart and lungs?” A patient who was brought in via ambulance for alcohol abuse was very belligerent with the nurse. The patient told the nurse “don’t put one of those gowns on me.” The nurse said he wouldn’t put one on now, but would need to later. Then the nurse tried to put the patient in a gown again. The patient stated it was too cold to get undressed. The nurse offered warm blanket. Patient cursed and said to call administration down to the emergency department. The patient told the nurse to f*** you.” The nurse addressed the patient’s comments but in doing so also said the word “f***.” The nurse was doing a decent job of handling a very difficult patient but I did not think was appropriate occurs even if in addressing the patient comments. The patients who had arrived in the waiting room during my observations starting at 1703 were all still sitting in the waiting room I exited the emergency department. This included a teenage boy who was triaged at 1714, an infant boy, and another woman. Were these patients ever rounded on? I observed the patient being called back to a treatment room. The patient was called be a very loud overhead paid for number 4621 to come to the front desk. “Number 4621 to the front desk please.” You could hear the phone tone after the message until the receiver was hung up. The patient assigned number 4621 went to the front desk. The patient family waited to be addressed, and while they were standing at the desk, they paged the patient again. This process was very impersonal. How are patients who have disabilities assisted? The person creating this report appears to have little knowledge about hospital procedures, about emergency department flow, or about legal issues. Your correct response to a patient who is repeatedly verbally abusive to you and for whom you have no choice but to stabilize and treat should be … And when an emergency department is full and gets three ambulance runs in a row, the first thing on the overworked staff’s mind should be to go out in the emergency department waiting room and ...

Read More »

Hospital CEOs Earn Tens of Thousands of Dollars From Patient Satisfaction

Dan Diamond (@ddiamond) tweeted this slide from a lecture by Harvard’s Ashish K. Jha at this year’s Association for Healthcare Journalist’s Annual Meeting in Denver. The slide shows how CEO incomes are affected by different variables and contains a few interesting tidbits of information. First, hospital CEOs earn around $600,000. Far more than most physicians. Second, hospital CEO salaries are not significantly affected by multiple different, yet seemingly important factors, including “quality” scores, the number of patients who die in their hospitals, the number of readmissions to their hospital, or the amount of charity care they provide. Logically, it would seem that the payment system would want to incentivize hospital administrators to work on those topics: Improve quality scores, decrease hospital deaths, decrease readmissions, increase charity care. But payments systems apparently don’t work that way. Want to know the thing that affects a hospital CEO’s salary the most? Patient Satisfaction. Highly favorable patient satisfaction scores add an average of $51,000 to the income of hospital CEOs. When your CEO threatens your job because your satisfaction scores aren’t high enough, when your CEO relies upon the statistically insignificant data reported by companies like Press Ganey, and when your CEO ignores studies showing that highly satisfied patients are more likely to die and suffer adverse consequences, now you know why your CEO may be making those decisions. Plaintiff attorneys are crazy for not raising this issue in medical malpractice lawsuits. Companies provide invalid statistics to hospital CEOs. Hospital CEOs knowingly rely upon invalid statistics to influence medical care. Tie patient harm to the CEO’s decisions (and motives) and you have another defendant with deep pockets who isn’t subject to a malpractice insurance cap. Oh, and by the way, Press Ganey’s ratings over at Glassdoor – despite the obviously fake positive reviews – is still an abysmal 2.7 out of 5, with only 39% of employees willing to recommend this company to a friend. If doctors had those types of ratings, they would be fired immediately. Why is CEO Patrick Ryan still around?

Read More »

Why Patient “Satisfaction” Could Be Making You Sick

By  Birdstrike MD All patients should be treated with professionalism and respect.  We all want our patients leaving our care happy, healthy and satisfied, if at all possible.  However, sometimes patients don’t leave an Emergency Department very happy or satisfied.  Sometimes the doctor could have prevented it, but many if not most times, such dissatisfaction has little if anything to do with what the treating physician did, or didn’t do.  The reasons for a patient being dissatisfied with a particular healthcare encounter can be very complex.  It’s not so simple as to just include a line in a survey such as, “Were you satisfied with your doctor?”  Who should be held responsible for the results of these surveys, is where the crux of this debate lies. So why are Hospitals obsessed with “patient satisfaction”? It’s the same reason Walmart puts greeters at the front door (the ED), not the back door (in-patient floors) and the same reason the Government collects taxes and not sea shells: Money.  The question we really need to be asking is: Why is the obsession with patient satisfaction in the ED so soul-crushing to those that work there?  1-Lack of Control A patient pulls into the ED parking lot.  The lot is full.  He doesn’t feel well, he’s in a hurry and having to search for a parking spot irritates him.  The wait to see a doctor is long, too long.  Once finally in his room, he sees a drop of blood on the floor from the previous patient.  He’s disgusted.  Despite great care by the doctor, it biases his overall view of the experience.  As much as he tries to remain objective, the patient satisfaction score suffers.  The patient gives a “1 star out of 5” review after discharge, but writes in the comments, “Doctor and nurse were great, though!”  The tabulated score remains 1/5, or “FAIL.”  The doctor gets pulled aside at her next group meeting and is told she’s on watch due to low scores.  She’s never been fired from a job in her life, but now her job is in jeopardy, over something which she has no control. A patient leaves an ED satisfied.  He gets a patient satisfaction survey and throws it aside.  He has no need for it.  The visit went great.  It’s his preferred hospital for anytime he gets in a bar fight and needs to be sewed up.  He got in, got his knuckles stitched, and got a free Sierra mist and a meal tray.  On his way out the door, he tweets, “#CityGeneralERrocks!” on his smart phone to the world’s prospective ER “customers.”  Six weeks later, all has healed well, and there’s barely a scar.  Then, the bill comes.  “!&@!?#€!!!,” he thinks.  “$920?  Screw that place!”  He grabs the survey and nukes the hospital, doctor and nurse all with the lowest score possible.  He writes in the comments, “I would have rated you a ‘negative infinity’ if the scale went that low!” You can save a life, walk out of the trauma bay drained but proud, and be pulled aside and told that on last months survey, you didn’t get a patient a coffee “like they do at the car dealership.”  You are told, “Get those scores up.  Administration is watching.”  It translates into, “You suck.”  It’s not that big of a deal, right?  Maybe you should brush it off, but you are human.  You haven’t “evolved” to the “new way” yet.  You’ve heard of ER doctors losing their group contracts and therefore their jobs over things like this.  It bothers you. There’s a complete and utter ...

Read More »

Press Ganey CEO Patrick Ryan’s Hidden Relationships

Remember the expose about Press Ganey titled Why Rating Your Doctor is Bad For Your Health by Kai Falkenberg published in Forbes this past January? Turns out that Press Ganey and its CEO don’t like playing by their own rules. And they may just be trying to hide some interesting relationships from the public to boot. Let’s first look at one of the documents mentioned in the Forbes article. A July 2002 letter (.pdf) from The Gallup Organization’s Managing Partner Robert Nielsen to Thomas Scully, the administrator of the Centers for Medicare and Medicaid Services (otherwise known by the acronym “CMS”) specifically stated that response rates for mail questionnaires (which Press Ganey uses) are too low. With response rates of 20-40%, Mr. Nielsen admitted that “the standard rules of probability don’t exist.” Mr. Nielsen then noted that “This is a dirty little secret in our industry” and that such a non-response rate “produces bias and produces unreliable metrics.” In other words, the managing partner of an organization specializing in data collection acknowledged that the same data collection methods Press Ganey uses are biased, do not follow rules of probability, and produce unreliable results. He also acknowledged that the industry knows about these facts, but keeps it “secret” from the public. When commenting on Ms. Falkenberg’s article, Press Ganey’s CEO, Patrick Ryan’s response was basically that doctors need to “suck it up” – kind of like Press Ganey is doing with its business model, but that was the subject of another post. It shouldn’t matter that the statistics are unreliable and that the methods are biased. Press Ganey customers need to rely on those statistics, anyway. Think about what a dangerous precedent that sets. Imagine how many people would die in car crashes if car safety study statistics were unreliable. Imagine how many people would die from side effects if drug study statistics were unreliable and kept as a “dirty little secret in our industry”. That “dirty little secret” is just the industry’s way of saying “we don’t give a rat’s tail about the effects of our product, we just want to make money.” It doesn’t stop there, though. After the Forbes article was published, there was a plethora of comments made to Ms. Falkenberg’s investigation. Forbes highlighted several of them in a subsequent issue. (.pdf) Dr. Patrick Burnside noted that it was “Such a needed article.” Dr. Robert Solomon remarked that “Many physicians have written about this but are handicapped by Press Ganey’s ad hominem implication that they are just whiners because they don’t like being judged.” Cleveland Clinic’s Rafid Fadul called the surveys “a meaningless tool used essentially to ratchet down payments to physicians.” But according to Forbes, the “most heated response” came from Eugene D. Hill III, a managing partner at venture capital firm SV Life Sciences. His response to the article, as published in Forbes, is contained below. [The] article departed from FORBES’ usual high standard of investigative journalism. One of the principle [sic] unsupported assertions, that patient satisfaction is not correlated with clinical outcome, is refuted by common sense as well as a long history of patient satisfaction research, and most recently by a peer reviewed formal assessment that was published in the Jan. 17, 2013 issue of The New England Journal of Medicine.  It is not surprising that physicians, the understandably biased subjects of evaluation, some of whom have historically resisted both formal quality assessment as well as patient feedback (‘the doctor knows best syndrome’) and some of whom are lacking in interpersonal skills/bedside manner, might be less than willing to accept negative feedback.  To  criticize the evaluation service ...

Read More »

Unnecessary Care?

It isn’t much of a case, but it created questions in my mind. A mom brings her 8 year old daughter to the hospital for a nonproductive cough. No fever. No runny nose. Just a cough. The patient had started school again this week, and so the microbiome in her nasal passages had thus begun mixing with all of the other microbiomes on school lunch tables, desks, and childrens’ shirt sleeves. The end result was that now she was coughing for a couple of days – like a majority of other children in the school. The child looked fine. I told the mother that she likely had a “head cold” and that it would have to run its course. The mother wasn’t convinced. “How do you know she doesn’t have the flu”? “Well, I don’t know for sure, but even if she did have the flu, it wouldn’t change the management right now. It would still have to run its course.” “I want her tested for the flu.” “Influenza testing really won’t help us much. The test itself has a high false negative rate, meaning that even if the test is negative, a large percentage of people still end up having influenza.” “I want her tested for the flu.” Fine, I thought. It’s your money. Forty five minutes later, results from the influenza swab came back negative. “So like I was saying before, this is something that will have to run its course.” “You said that the test wasn’t accurate. There are a lot of kids in her school with influenza right now. I want her to get Tamiflu.” “Tamiflu isn’t going to help. It is only effective within the first 48 hours. You said the cough started two days ago.” “You know, I have always had good things to say about this hospital and I’ve never had this many problems with a doctor in the emergency department before. It hasn’t been 48 hours and I want her to get the Tamiflu.” Nice threat. So I gave the woman a prescription. Let her spend the $120 for a drug that won’t work. Then I began thinking. Would some bean counting clipboard carrier claim I provided unnecessary care? So what do you think? Knowing that rapid influenza testing has a significant false negative rate and knowing that influenza is widespread in the country, but also knowing that a patient has mild symptoms … [poll id=”8″] By the way, after the visit, a pharmacist called and said that the patient was requesting a different medication since the patient was on state “insurance” and the “insurance” didn’t cover the cost of the medication. Unfortunately, there isn’t anything else that works which was covered. UPDATE 1/15/2012Thanks for the votes and comments. When thinking about this situation, three issues came to my mind. First, Tamiflu is approved by the FDA for acute uncomplicated influenza when symptoms have been present for not more than two days. It is also approved for prevention of influenza. From a technical perspective, a Tamiflu prescription was indicated if the child had influenza or if the child was being prophylaxed against influenza. The indications for use do not contain a description of any symptoms that must be present before Tamiflu is prescribed. If influenza is diagnosed or being prevented, Tamiflu is indicated. Second, diagnosis of influenza in an inexact science. Rapid influenza testing is notoriously inaccurate. If the test is positive, there is a high likelihood that influenza is present (although about 1 in 50 patients with positive results do not have influenza). However, if the test is negative, one third ...

Read More »