Jack Percelay writes…
“I need to up my Press-Ganey Blog scores, so please, if there’s any reason you can’t rate me 5 out of 5 after reading this blog, please let me know before submitting your score so that I can make it right.” I don’t know about you, but I’m fed up with the intrusion of marketing techniques into healthcare.
Don’t get me wrong, I am a ferocious advocate of patient and family-centered care and incorporating patient preferences into medical decision-making. But all too often it seems to me that some marketing techniques are less about shared decision-making and more about “lies, damned lies, and statistics”, “putting lipstick on a pig,” or a Goldman Sachs like inability to recognize one’s professional and fiduciary responsibilities. (Don’t get me going there. That topic merits a stand alone column.)
What stirred my dander is my 17 yo daughter’s acne care. She’s being treated with a once daily oral antibiotic. I want to use the twice daily generic, but “what does Daddy know?” Turns out that this new antibiotic costs >$250 per month!!!! Generic would be about $10. When I complained to my wife about this, there was no need to worry; the dermatologist “gave” us a coupon so that the first 3 months would only be $10 a month. Ever try to get a teenage girl to switch medications after her face clears up? This sort of bait and switch offer is bad enough when it comes to cable or internet service, but it has absolutely no business in medicine! STOP THE MADNESS!!!! No wonder our healthcare costs are so high.
But before we hospitalists start throwing too many stones, we need to find out how much of my house is made of glass. Personally, I’ll take a pass on the number of admissions I accept as a hospitalist that I don’t think really need to be admitted. That represents the greatest potential for savings, but is also the most difficult to achieve.
We do have power over ordering medications, and think on the whole as hospitalists we do a good job using albuterol instead of xopenex and monitoring antibiotic usage. Hospital formularies and pharmacists help us keep track of our drug use. Imaging……….ooh, that’s another story. Not only expensive, but dangerous, especially when it comes to CT. And what about labs?? We still do way too much defensive medicine in my mind, ordering CYA tests that lead to inappropriate and potentially dangerous care.
But I digress. The issue at the start was marketing. How do we as physicians deal with this? I’d really like to hear your thoughts. To get the ball rolling, I’ll try to outline what I think is appropriate and inappropriate.
First, scripting can be very helpful. A little bit hokey, but something as simple as, “Is there anything else I can do for you? I have the time.” Can be very effective. Or, making sure that we wait to purell our hands in front of the patient rather than outside the hallway. That’s also okay. Follow up phone-calls? Great! We should do more of those as hospitalists. They serve three functions: answer patient questions, give hospitalists update on patient outcomes, and demonstrate caring to raise Press-Ganey scores. But calling up someone to ask them to give you a 5 out of 5 score seems unprofessional in my mind. I wouldn’t object to having a third party call up to ask on a systematic basis what the hospital team could do better to improve upon the patient experience, but that’s an open-ended question motivated by the desire to impact future performance rather than a subtle guilt trip to get discharged patients to rate their hospital stay highly.
Any loss leader prescription coupons also fail to pass my muster. Maybe free samples for patients without insurance, but only with clear explanation that the deciding factor is cost, the medications are equivalent, and if prices change down the road, medication can be changed as well.
So far I’m not getting any inappropriate pressures to practice marketing rather than medicine. Yes, we provide “customer service” to our referring physicians, but that also falls under the rubric of good communication. Will we get rated by Angie’s list? Probably, but not much I can do about it, and not clearly that much different from the “Best Physicians in XXXX” ratings that get published elsewhere.
Choose your battles. Right now, mine is my 17 yo daughter’s acne med. What’s yours?
Now, if I can only get my 17 year old to believe me.
As they say, “Reality Bites”. Unfortunately, you describe our newly emerging reality as physicians. Certainly, we can choose to ignore our reality & practice medicine the way we feel appropriate. However, with the quality push for practice guidelines & customer service, I suspect we can be replaced. Likely with a midlevel practitioner!
Press Ganey is in fact being replaced by the Hospital Consumer Assessment of Providers & Systems, administered by CMS. To attempt to influence the patients responses or suggest a “right” answer will be considered illegal.
Regarding your 17 year old’s prescrition, the set up is frustrating for her, you & likely her dermatologist. The dermatologists are providing what Pharma pushed into their hands. As a former private practitioner, I cannot tell you the frustration of having a similar set up on someone’s BP or DM meds, thus getting into a cycle of continually trying to keep people supplied with samples, completing indigent need forms & so on. Patients become convinced that they deserve & need the cadillac meds, as long as you can provide it for them. Have a conversation with the dermatologist, having them convince you that the best drug is really what they provided. If they are not convincing, ask for the more reasonably priced drug!
Jack,
Does this stuff actually happen? I guess that when PG gets an individual hospitalist survey widely rolled out it could be a problem.
Mike,
I wish I could say I’ve taken significant editorial liberties, but in fact I have seen hospitals where there are signs on the walls suggesting/reminding patients to answer follow up surveys with a score of 5, and have also heard of nursing units that make follow up phone calls that concludes with a request for a score of 5.
I am all for customer service as Julie suggests, but this sounds like ballot stuffing.
I believe that we as physicians have aresponsibilities to both the individual patient’s well being and the system’s financial stability. I am simply requesting that we be judged on a balanced scorecard that includes both perspectives.
Does CMS have a safeguard over this ?