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Tag Archives: Press Ganey

Press Ganey Mantra: Suck It Up

“It’s a case of good intentions gone badly awry – and it’s only getting worse.” Prophetic words in a Forbes Magazine article by Kai Falkenberg titled “Why Rating Your Doctor Is Bad For Your Health.” According to the article, Survey “response rates have been dramatically declining over the past decade,” says Paul Alexander Clark, founder of SmartPatient, a health care analytics company. He should know: Until 2007 Clark was in charge of Press Ganey’s patient-satisfaction improvement group. The response rates, he says, are now “too low to produce reliable results.” Insiders have known this for a decade. “This is a dirty little secret in our industry,” a senior Gallup executive wrote in a 2002 letter to the CMS chief. “At those levels the standard rules of probability don’t exist. … This means you may or may not be tracking real patient attitudes.” The article also states that “flawed survey methods and the decisions they induce, produce billions more in waste.” That’s $280 billion in waste according to estimates in the article. Wasted money so that hospitals don’t lose a percentage of their Medicare payments – government cuts which will total $1 – 2 billion under government mandates geared to save money. The thing is that a substantial portion of the $280 billion will be paid for care to Medicare and Medicaid patients. So the government is paying out a large percentage of $280 billion for increased medical care … to improve patient satisfaction … so that it can save $2 billion. They don’t call it the Affordable Care Act for nothing. Oh, and when the government was asked for its comments to the Forbes article, it “declined several requests to comment on the record.” Imagine that … refusing to comment on wasteful spending using an unreliable process which is associated with increased patient deaths. Press Ganey’s CEO, Patrick Ryan’s answer to this stinging criticism of his company’s methods? “Suck it up.” However, when you look at reviews of Press Ganey by its employees on GlassDoor.com, it is difficult to tell whether or not “suck it up” is advice for physicians who are the brunt of inaccurate statistics or whether it is a directive on how Press Ganey should run its business. Out of 16 Press Ganey employee ratings, only 25% would approve of Mr. Ryan as CEO. Let’s put this into perspective. The average doctor approval rating in Press Ganey’s surveys is in the 85% range – more than a 4 on a 1-5 scale. Mr. Ryan’s approval rating is in the 25% range — 0.25 on a 0-1 scale. Doctors get chastised for scoring more than 4 on a 1-5 scale while Patrick Ryan smugly smiles with his rating of about 1 on a 1-5 scale. If a doctor had a 25% approval rating in a hospital setting, that doctor would be fired. Done. And the doctor would have trouble finding another job, too. Patrick Ryan? He’s still working his magic at Press Ganey. But that’s not all. On GlassDoor.com, employees have repeatedly stated that Press Ganey management is “sucking up” the entire company. For example, one employee review notes that “The current senior managment comes accross as clueless. They have exciting visions with no ablitiy to execute on them.” Another employee review states that “Press Ganey sells a product that it doesn’t even believe in enough to use internally.” That’s right, folks, Patrick Ryan wants everyone else to “suck it up” and to believe his company’s surveys are statistically accurate, but he allegedly won’t even use those same surveys for his own company. Kind of like Congress exempting ...

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Pressure to Admit

We were away for the weekend, but in a restaurant, I caught glimpses of this segment on 60 Minutes called “The Cost of Admission.” Couldn’t hear the conversations in the restaurant, but luckily CBS posted the entire report online. If you didn’t see it, you really need to watch the video and/or read the transcript. In summary, 60 Minutes spent a year investigating irregularities in hospital admissions. Administrators at Health Management Associates and at EMCARE (one of the national emergency medicine contract groups) were accused of putting pressure on emergency physicians to admit at least 20% of patients that came to hospital emergency departments.  For Medicare patients, the “benchmark” for admissions at one hospital was allegedly 50%. The 60 Minutes expose also included spreadsheets showing comparisons of different physicians’ admission practices and text from e-mails saying such things as “I have been told to replace you if your numbers do not improve.” HMA held a conference call disputing the allegations and stating that they “take all allegations regarding compliance very seriously.” HMA allegedly had outside experts review the data (not the medical records?) and the experts determined that “the data simply do not support the allegations.” Now HMA is being investigated by the US Department of Justice for Medicare fraud. I predict that HMA will make a large settlement with the government to drop all charges (without admitting wrongdoing, of course) and that things will return to business as usual shortly thereafter. With things like this, I can’t really blame patients for thinking that medical care is “all about the Benjamins.” Patient satisfaction metrics are creating quite similar incentives with physicians. How long will it be before people wake up and see how much fraud that the satisfaction scores are causing?

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Undertreatment

I was surprised by the tenacity of a mother whose 12-year-old child had twisted her ankle while running in gym class. The exam showed minor pain and no soft tissue swelling. Perhaps a little point tenderness over the distal fibular growth plate. X-rays showed open growth plates (see orange arrows), but no other injuries. I discussed the possibility of a Type 1 Salter Harris injury and the generally excellent outcomes. I recommended rest, ice, and crutches. Asked the tech to place an air splint on the patient’s ankle. “She can’t use crutches. She needs a wheelchair. And an air splint isn’t going to protect her ankle well enough.” “Why can’t she use crutches?” “The last time she injured her ankle, the orthopedic specialist told her she needed a wheelchair. He wrote her a prescription for the wheelchair. She was in it for at least a month in school.” I looked through our medical records. No previous visits. Turns out the incident the mother described occurred in another state. “I can’t comment on what happened before or the reason that the orthopedist believed she needed a wheelchair for a month, but it looks like she’s more than capable of using crutches now. We’ll show her how to use them before we discharge you.” The patient apparently was on board with the mother’s plan. Even though she could hop on one foot from the wheelchair in the room onto the bed without problems, she nearly fell over twice when they were crutch-training her. One time, she landed on her bad foot and screamed in pain. That sent mom into a rage. So they got what they wanted. Short leg splint. Wheelchair for two days. Mandatory orthopedic follow-up within that time period. Then comes the Press Ganey comment several months later. “Doctor was rude and dangerous. Wouldn’t listen to me when I told him that my daughter needed a wheelchair for her injury. Missed an obvious fracture through both bones on my daughter’s x-ray. Tried to get her to walk on her bad leg and when she did, she fell, causing a worse injury to her ankle.” Of course, there is no way to respond to these untrue statements. And the complaints are taken as true by hospital administrators. In retrospect, I probably should have just admitted her and put her in traction for a couple of weeks. Silly me. ———————– This and all posts about patients may be fictional, may be my experiences, may be submitted by readers for publication here, or may be any combination of the above. Factual statements may or may not be accurate. If you would like to have a patient story published on WhiteCoat’s Call Room, please e-mail me.

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You Can Tie, You Can Lose, But You Can Never Win

The article below was forwarded to me by a reader. It was originally published on the Student Doctor Network by an anonymous poster who goes by the handle “BirdStrike” and was made free to republish. For those of you who want further insight into how patient satisfaction rankings adversely affect medical care in the emergency department (aside from the fact that highly satisfied healthy patients are twice as likely to die from their medical care) – it will be interesting reading. By the way, the “Death Knell” article is now number two on the list when you do a search for the term “Press Ganey”. The “Flunking Own Rating Scale” article I wrote is number three on the list. Clicking on the link to this article a lot will make it climb in the “Press Ganey” search term rankings as well. ————————– What you’re getting at, is the core of why patient satisfaction scores in the ED are so soul crushing to some of us and what is so fundamentally different psychologically and philosophical about being a physician in the ED, compared to any other setting. Outpatient physicians have always had their own version of “Press-Ganey”. So does every business in a free market. In their case it’s “name”, “reputation”, and “practice building”. If their patients don’t like them and aren’t “satisfied”, they go elsewhere and the practice, and ultimately the docs pocketbook, suffers. If their patients are satisfied, the physician benefits with a more robust practice and fatter wallet. This is like any other “business”. The better a business is at providing a product or service, the better off the business is. This is how it should be. Doctor makes patient happy, happy patient makes doctor happy. It’s a positive feedback loop. (Although a physicians practice is more than “just a business”, it is a professional practice held to ethical standards, it has to pay the bills, with dollars and cents, according to the rules of business.) However, the ED is like no other business in the world. In the ED, you’re swamped no matter what. You have no control over your workflow. There’s essentially no risk, ever, of not being busy enough to “put food on the table”. Being overwhelmed with patients is the rule. Whether or not there are too many patients to see, or twice as many patients than you can see, or three times as many patients as you can see, does not affect your pocketbook, and does not increase your job satisfaction. In fact, the busier it gets in the ED and the more”customers” there are, the worse the job satisfaction. It’s a negative feedback loop. Unlike the outpatient doc, where the more satisfied the patients are, the busier the practice is, the healthier the pocketbook is and the happier the doc is. In the ED it is the exact opposite. In fact, you are grinding the machine to increase the job satisfaction (and profits) of someone else such as an administrator that you might not have even met or barely know. This is why outpatient physicians in private practice (and all good businessmen including hospital CEOs), especially ones in their earlier years building a practice (or business), just don’t see what all the complaining is about. To them, “patient satisfaction” is their lifeblood. Without it, they can’t pay their staff, their practice overhead or their own salary let alone have any profits left over. This is a crucial difference. Another crucial difference is that when they reach the point of saturation, there are several protective mechanisms not available to ED physicians, that keep ...

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Press Ganey Flunks Own Rating Scale

So I happened to be looking through my blog stats to see which posts are most interesting to you all lately. One of the stats on the blog is search terms that cause people to end up on my blog. Some of them are amusing, such as “How do I disimpact myself” [ANSWER: You don’t] and “Why do hospitals want JCAHO accreditation anyway?” [ANSWER: It beats the heck out of me, too] I have become one of the de facto resources for people who want to know whether they need antibiotics to treat strep throat and for demonstrating what an infection of lice looks like … which is just wonderful because after I published to the world that my kids just got over lice, the search rank will probably go up even higher and I will soon be known as the Head Louse King. But I found it most amusing that my blog is the third on the list of Google search terms when someone does a search for “Press Ganey.” The article that pops up is “A Death Knell for Press Ganey” which I wrote in February. I flipped through the pages of results and happened across a page titled “Press Ganey Reviews.” What the heck, I thought. Let’s see how Press Ganey’s ratings stack up. According to Press Ganey‘s own ratings scale, it fails. Using ballpark estimates on a 1-5 scale, doctors and hospitals have an average rating of about a 4.3 or so. Drop to the 3.5 range on the 1-5 scale and you’re scraping the bottom of the barrel in the ol’ percentile rankings. Press Ganey’s rating on a 1-5 scale is a rocking 2.8. When compared to the scale that Press Ganey uses for hospitals and doctors, Press Ganey’s ratings flunk. And only 33% of employees approve of Press Ganey’s president Robert Rob Draughton. Allegations of nepotism, poor pay, high employee turnover in the comments section of the reviews (.pdf file in case site is removed). One employee stated that “Management does not take feedback.” A company that earns millions of dollars on feedback from other entities doesn’t take feedback on itself? Wow. If Press Ganey were a doctor, it would be out on its ear. I love irony.

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A Death Knell for Press Ganey?

For those of you who believe that patient satisfaction ratings are a detriment to health care and to our patients, a study published yesterday in the Archives of Internal Medicine titled “The Cost of Satisfaction” is a must-read. Not only does “satisfaction [have] little or no correlation with Health Plan Employer Data and Information Set quality metrics,” but, according to the results of this study, hospitals that push to have the highest satisfaction scores may be harming or even killing their patients. Noting the “tenuous link between patient satisfaction and health care quality and outcomes” the authors found that patients who had the highest satisfaction were more likely to be admitted to the hospital, spent more on health care, spent more on prescription drugs, and were 26% more likely to die than those who had the lowest satisfaction. When study authors excluded data for patients who rated their health as “poor” or who had a “substantial chronic disease burden,” they found that with “healthier” patients, the association between high patient satisfaction and increased patient deaths became even higher. Next time you see a hospital brag about its high patient satisfaction scores, remember what this study shows: High satisfaction with a health care facility means that you’re more likely to be admitted, you’re more likely to pay more for your care, and you’re more likely to be discharged in a body bag. Still think “satisfaction” and “quality” are synonymous?

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