What follows is an article written by Forbes editorial counselor Kai Falkenberg, along with a MedicalMiscreant response:
Ms. Kai Falkenberg
SUFFERING FROM A TOOTHACHE, a woman in South Carolina headed to her local emergency room a few months ago. The doctor there responded by administering Dilaudid, a powerful narcotic typically reserved for cancer-related pain. Why, his nurse queried, was he killing a flea with a sledgehammer? Afraid of malpractice? No, the doc replied. “Press Ganey. My scores last month were low.”
Press who? The little-known company has become a hated target of hospital physicians, outstripping even trial lawyers. Utter its name and you’ll likely unleash a cloud of four-letter words. Press Ganey is the nation’s leading provider of patient satisfaction surveys, the Yelp equivalent for hospitals and doctors.
Over the past decade the government has fully embraced the “patient is always right” model–these surveys focus on areas like waiting times, pain management and communication skills–betting that increased customer satisfaction will improve the quality of care and reduce costs. There’s some evidence they have. An ObamaCare initiative adds extra teeth, to the tune of $850 million, reducing Medicare reimbursement fees for hospitals with less-than-stellar scores.
Accordingly, hospitals kowtow to Press Ganey. In November nearly 2,000 administrators spent $1,100 or more each to attend Press Ganey’s glittery client conference–a closed-to-the-public affair in Washington, D.C., with keynotes by Jeb Bush and astronaut Mark Kelly and his wife, former congresswoman Gabby Giffords. Press Ganey is helping hospitals fulfill their mandated obligation. Some have taken an extra step, tying physicians’ compensation to their ratings.
That may sound like a good thing. Why shouldn’t you grade the quality of your medical care, the way that you pass judgments on other services, whether hotel stays via TripAdvisor or contractors via Angie’s List?
The short reason: The current system might just kill you. Many doctors, in order to get high ratings (and a higher salary), overprescribe and overtest, just to “satisfy” patients, who probably aren’t qualified to judge their care. And there’s a financial cost, as flawed survey methods and the decisions they induce, produce billions more in waste. It’s a case of good intentions gone badly awry–and it’s only getting worse.
But what exactly are Press Ganey and its two main rivals, the Gallup polling company and the publicly traded National Research Corp., measuring? Customers know what they want when they review spaghetti carbonara for Zagat. But giving patients exactly what they want, versus what the doctor thinks is right, can be very bad medicine. Last February researchers at UC Davis, using data from nearly 52,000 adults, found that the most satisfied patients spent the most on health care and prescription drugs. They were 12% more likely to be admitted to the hospital. Strikingly, they were also the ones more likely to die.
Why? The UC Davis authors posit that the most satisfied patients have a higher mortality rate because they receive more discretionary services–interventions that carry a risk of adverse effects. Even routine screenings for diseases like prostate cancer can lead to unnecessary drugs and operations with allergic reactions and surgical complications that leave patients worse off.
“Numerous studies have found that patients are consistently highly satisfied with one of the most common downsides of medical care–false-positive test results and the downstream events that follow,” wrote Dr. Brenda Sirovich of the VA Outcomes Group in White River Junction, Vt., commenting on the UC Davis study. “Almost any unnecessary or discretionary test has a good chance of detecting an abnormality.” Such testing “is a double-edged sword,” explains Dr. H. Gilbert Welch in his 2011 book, Overdiagnosed, often leading to “the detection of abnormalities that are not destined to ever bother us.”
Our health care system already suffers from a “more is always better” fallacy. “Practicing physicians have learned–from reimbursement systems, the medical liability environment and clinical performance scorekeepers–that they will be rewarded for excess and penalized if they risk not doing enough,” says Sirovich. An overreliance on patient surveys, she says, only inflames the problem of overtreatment.
As hospitals increasingly tie physicians’ compensation to patient wishes, doctors are pushed even further down the dangerous path of overtreatment. Nearly two-thirds of all physicians now have annual incentive plans, according to the Hay Group, a Philadelphia-based management consultancy that surveyed 182 health care groups. Of those, 66% rely on patient satisfaction to measure physician performance; that number has increased 23% over the past two years.
THE MATH IS NOW SIMPLE FOR DOCTORS: More tests and stronger drugs equal more satisfied patients, and more satisfied patients equal more pay. The biggest loser: the patient, who may not receive appropriate care.
“By creating a monetary incentive to increase patient satisfaction, the government is not only increasing expenses but promoting a metric that significantly increases death rates,” says William P. Sullivan, an emergency room doctor in Spring Valley, Illinois.
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Doctor Andrea Sharp made the following comments:
“Suggesting MD’s are ordering excessive tests solely based on desires for increased compensation is ludicrous.”
Dr. Sharp, it is our sincere hope that the reason you say this is simply because you are too busy in your daily work to pay much attention to the reality outside of your normal purview.
It is our hope you are not deliberately choosing to turn a blind eye to the jaw-dropping amount of fraud perpetrated by physicians nationwide.
You may well not be aware that almost exactly 10 physicians are found guilty of felony-level behavior every single court calendar day of the year – just over 200 doctor convictions EVERY month.
As an emergency professional who has treated more than 20,000 patients myself, I can promise you I ignored the crimes that I witnessed by MDs for years. I found it extremely difficult to open my mouth and actually admit that the status quo in medicine is exactly what has brought the roof down on the excellent practitioners among us.
Tell me this: if you were the CEO of an insurance payor organization, for example. How generous would you be toward a profession that performs well over 100,000 unnecessary (and occasionally lethal) surgical procedures per month?
Sadly, we as a society are way, way past the day when the lay-public – or law enforcement, for that matter – believed that physicians in the aggregate are ethical enough to police themselves.
The Nat’l Practitioner Data Bank can give you 100,000 reasons why that just isn’t true.
“There should be some leniency and trust that a person who chooses a profession “to help people”, sacrifices at minimum 12years of education, and commits to life-long learning and service will do the best with the education and skills they have worked hard to develop.”
Until the day comes when ethical & competent physicians stop turning a blind eye to their peers who should be behind bars, you ought not be surprised that others, outside the profession, feel the imperative to change the seriously ugly status quo.
11,000 doctor convictions over the last decade is not a small matter. And the impact of those arrests has dramatically changed the playing field upon which physicians of excellence – presumably like yourself – find themselves.
“Society has unrealistic expectations regarding their health care and what is necessary.”
You are absolutely right. But with 1,000 TV commercials each day yammering about the miracles of treatments from ED drugs to restless leg syndrome, why on earth would you expect otherwise?