One of the newest trends in insurance payments is a "pay-for-performance" where the government sets up a payment schedule based on how well you meet certain core guidelines regarding treatment. To be clear, I am in favor of increasing compliance for treatment. However, I am NOT in favor of the other part of this plan, which involves paying providers based on Press Ganey scores, which are, in essence, a grade sheet filled out by patients about their care. To illustrate why I am against this, see the following adage:
Patient: "This is the worst hospital I have ever been in."
Me: "Well, ma'am, we managed to save your life, despite that."
Patient: "I'm not talking about that. That nurse took 30 minutes to bring me a refill on my water. I could have died of thirst."
Me: "..."
You see, the average American only cares about the minutiae in their care. They nitpick over the things that they think they are capable of doing themselves and use those as a basis to judge the entire stay on. These get translated into a worse Press Ganey score and thus, a lower payment to the provider. Because we took too long getting her a fucking glass of water. We quite literally saved this woman's life and her only concern is about the length of time it took for us to play waiter. Not that we have other people with their lives in jeopardy that we are caring for, only for her immediate physical desires.
Now, all of these changes are dressed up in the guise that they are in the patient's best interests and, to the extent regarding core measures, I agree. But what lies at the heart of this is money. You see, the government plays a game with providers where, every few years, they change the way you have to bill in order to get paid. A prime example of this is the term "urosepsis." A few years ago, writing this in the chart allowed you to bill at a higher level for a urinary tract infection, plus sepsis. Then the government randomly decided that urosepsis only coded to the lower level "urinary tract infection." It took months to years for physicians to catch onto this so the government saves money by paying out lower reimbursements until the doctors catch on, at which time they change the rules again. These new enactments are no different. It is an excuse to pay less to hospitals and providers, only this time using the patients themselves as a weapon. Hospitals are under-staffed and overcrowded so they rely on this dissatisfaction with the whole system to work against us. It's a ruse, don't be fooled.
Now, if I have misunderstood any of the plans to use Press Ganey and you have better information, please enlighten me (I'm serious). This is just the way I understand what is happening and I work far too much to read through the whole plan.
3 comments:
Couldn't agree more. We've also proven in marketing that disatissfied customers will fill out or respond to a survey more than satisfied customers, thus skewing the data horribly.
Also did you hear the Journal on Internal Medicine just released a studying showing correlation between hospitals with higher patient satisfaction ratings and higher mortality rates?
I actually believe that, since those hospitals are focusing more on placating people than providing care.
Okay, I understand what you are saying and hate being put in the middle. But you have to see it from the other side too. It isn't always trivial things that frustrate patients. Take my last hospital stay, I am privately insured. The hospital wasn't counting on my vote of satisfaction. I could care less about the water bottle, and in fact they never even brought me one. I eat gluten free, but no gluten free option was offered for the food I eat. I take levothyroxine. It needs to be taken a half hour before food and other medication. The nurse ignored my breakfast in the hall until 11:00 and brought my pills in shortly after I ate lunch, which meant I needed to wait for 4 hours before taking my medication, that I was already hours late on taking. Minor issues like the hat in the toilet being full and not emptied and recorded until hours after I asked paled in consideration of my frustration. We aren't being trivial. I can better manage my medication and I can record the urine output and be able to go to the bathroom without painfully holding it for hours by myself. It is demeaning to have to ask to go to the toilet. The lack of control that we have over basic functions makes us hostile. We may be nice about it, but we do all feel the hostility.
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