Are Mystery Shoppers Such a Bad Idea for Health Care Quality Improvement?

Are Mystery Shoppers Such a Bad Idea for Health Care Quality Improvement?

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The decision by the Obama administration to employ “mystery shoppers” to pose as patients to see how difficult it is to get an appointment with a physician has sparked criticism from physicians. However, access to primary care physicians is a very real public policy issue that needs to be understood if we are to successfully care for the more than 30 million Americans who receive coverage under the Affordable Care Act.Is the use of “mystery shoppers” a bad idea?

Dr. Raymond Scalettar certainly thinks it is a bad idea. “I don’t like the idea of the government snooping. It’s a pernicious practice – Big Brother tactics, which should be opposed.”

Dr. George Petruncio says, “This is not the way to build trust in government. Why should I trust someone who does not correctly identify himself.”

Westby Fisher, MD writes in his blog: “When information gathering trumps patient care – particularly fictitious care – we’ve got a problem. Is this a new quality standard we can expect from our new government health care initiative?  Just like scam-artists that phish for unsuspecting people’s financial information online, governmental appointment phishing should not be tolerated in any way, shape, or form. It is fraud – plain and simple.”

Several physicians on twitter retweeted Dr. Fisher’s blog post and indicated they agreed with his analysis.

 

A mystery shopper is a quality improvement tool that has been used in the retail and hotel industry for decades. In 2004 the health care industry accounted for 2% of mystery shopper revenue, but the use in health care is increasing.

In health care, mystery shoppers have been used to provide feedback on every step in the patient experience: making an appointment, environment of the waiting room, encounter with nurses and office staff, and visit with the physician. There has been an increased interest in mystery shoppers by health care providers since CMS started posting patient satisfaction information on hospitals as part of the Website Hospital Compare.

The use of mystery shoppers has been reported to lead to better patient flow and improved wait times, extension of office hours, improved telephone etiquette, better physician communication with patients, and more time with patients answering questions about surgery.

The AMA Council on Ethical and Judicial Affairs studied the mystery shopper question and concluded that a sound program would include:

1) The places that unannounced visits will affect should know about the program.

2) The information should be used for improvement and not punitive actions.

3) Mystery shoppers should not be the sole source of data for evaluating clinical performance

4) The program should not adversely affect access to medical care by legitimate patients.

I disagree with my colleagues that a properly planned and implemented mystery shopper program is a bad idea for trying to improve health care. For far too long, we in medicine have been too arrogant to learn lessons from other industries that improve quality. I think we need all the help we can get to take better care of patients.

Kent Bottles, MD, is past-Vice President and Chief Medical Officer of Iowa Health System (a $2 billionhealth care organization with 23 hospitals). He was responsible for the day-to-day operations of a large education and research organization in Michigan prior to his work with in Iowa with IHS. Kent blogs at Kent Bottles Private Views.

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35 Comments on "Are Mystery Shoppers Such a Bad Idea for Health Care Quality Improvement?"


Guest

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Nancy Irving
Jun 30, 2011

Many doctors in private practice now consider themselves businessmen as well as professionals, using marketing strategies to increase income, focusing their practices on procedures with the greatest monetary “return,” and the like.

Since they are now businesses as well as medical practices, they should accept that they will be judged partly by business “metrics,” and that means they should submit to mystery “shoppers.” They can’t have it both ways.

Guest
MD as HELL
Jun 30, 2011

Larceny by trick. Still illegal.

Guest
DeterminedMD
Jun 29, 2011

As noted above by the author of the post, this disgusting plan has been withdrawn, but you think it was because of common sense, or, they were exposed for the fraud the government is:

http://washingtonexaminer.com/opinion/2011/06/spying-doctors-prologue-obamacare

As I have said over and over at this and other sites, what the hell was the AMA thinking when they supported this nightmare legislation?! As my colleague above MD-H said so well, flaming idiots is an understatement!

The usual diehard apologists and defenders will paint those like me who argue against government intrusion as just being selfish and greedy, but, come on, what healthy persons who need to make an income can have someone else look them in the face and tell them to take a loss for their job and then this “advisor” expect to be thanked for the suggestion? Only a politician and their ilk supporters would stoop to this level of insult!!!

This isn’t about people supporting this legislation as being simply insincere, they are the poster children for hypocrisy gone mad and obnoxious examples of “do as I say, not as I do”.

Again, will not let the lie go unchallenged!

Guest
Lynn
Jun 29, 2011

Give’em credit for recognizing stupid when it is pointed out to them and deciding to walk away. (If only it were so easy in Afghanistan or Iraq.) Really stupid would have been to continue. One observation is that normally intelligent people captured and held by the Washington beltway for too long will almost always have an acute attack of bad judgment. It must be in the water (after all Washington was originally a swamp!) Acknowledging this is a step in recovery.

Guest
MD as HELL
Jun 29, 2011

BS

Guest
James
Jun 29, 2011

What must be remembered is that in Medicaid there are people whose JOB it is to recruit physicians into the program. This is the same whether we are talking fee for service (FFS) or HMO. In the latter, there are network adequecy requirements in the HMO contracts. There are also people whose JOB it is to investigate and resolve client complaints that they cannot get an appointment. Again, this is the case whether it is FFS or HMO. There are also oodles of adminstrative data available to discern if patients are not getting needed doctor visits. Why not use what is already readily available as resources to looki into the matter?

Guest
Jun 29, 2011

“We really do have a hard time holding anybody accountable in American health care”

If this survey had proceeded, who would be “held accountable” for what?

Guest
Craig "Quack" Vickstrom, M.D.
Jun 30, 2011

Accountability is un-American; particularly for self.

Guest
Jun 29, 2011

http://ow.ly/5sLWa How can HHS say with a straight face that politics had nothing to do with canceling the mystery shopper program? Come on

Guest
Jun 29, 2011

http://thehill.com/blogs/healthwatch/other/168905-hhs-cancels-qmystery-shopperq-proposal Late Tuesday night the Obama Administration and HHS decided to withdraw their proposal to use mystery shoppers to assess availability of physician appointment slots. We really do have a hard time holding anybody accountable in American health care.

Guest
MD as HELL
Jun 29, 2011

They will still deploy their goons

Guest
James
Jun 28, 2011

The root problem is that there is dishonesty at work. How does one build trust with providers when people on your employ will CALL THEM UP AND LIE TO THEM.

Next, I simply reject the contention that ASKING THE CLIENTS if they are having problems scheduling appointments or asking doctors if they have panel openings costs as much as hiring a survey firm. Seriously, the Medicaid or Medicare agency is already communicating with both parties. If it through an MCO model (Medicaid Managed Care), then the MCO is contractually obligated to provide an adequate network. If clients can’t get access, they are breaching their contracts. Also, if it is a Medicaid agency, they are taking complaints if a client can’t get access. Simply track the complaints and look for patterns with better data collection at the time of the call. Existing data and existing client and vendor relationships can – and should – be what is used to gather usable data on accessgaps. Sorry, but this is still a complete waste of cash.

Guest
Jun 28, 2011

What do we want to achieve? Verify access for medicaid patients? If there is a problem, it just indicates that there is a mismatch of reimbursement between medicaid and other payors.

Clinical quality is very hard to measure. There are some surrogate parameters that medicare is already measuring (beta blockers for MI, time to ABx), more in depth assessment could probably done via independent peer review only.

Patient surveys are heavily biased by convenience factors such as parking, pleasantness of facility etc, and many patients are easily seduced by perceived “cutting edge” nonsense (as are many physicians). Even communication assessments can be flawed when patient’s don’t like the provider’s message.

I practice in a competitive metropolitan area (and practiced in an even more competitive one before). Patient satisfaction centeredness brings you quick access (too quick access drives up costs), very polite, pleasant docs (a good thing, but not when docs feel they have to take patient requests for testing, without asking because that could make ’em unhappy), shiny facilities with marble, valet parking and birthing suites, and stupid direct to consumer advertising for the latest technology … it’s good for the wealthy if they want pay for it. The bottom half needs just reasonable, affordable healthcare that is not doing diagnostic& therapeutic overkill.

Guest
James
Jun 28, 2011

“If there is a problem, it just indicates that there is a mismatch of reimbursement between medicaid and other payors.”

In general you are correct, but it can also indicate a lot of other things. It can indicate that the provider (and we are talking more broadly than just docs) finds the hassles of Medicaid to be too cumbersome. Maybe they dislike the prior auth procedures, feel too many claims are rejected, that payments are late, or the clients are hard to deal with due to no-shows, non-compliance, language or medical literacy issues, a prevelance of MH/SA (mental health/substance abuse) issues above the rest of their panel, that clients lose coverage too often, etc.

Patient surveys can indeed be flawed if you measure subjective (even nebulous) terms like satisfaction. However. asking a new Medicaid patient if they were able to get PCP after joining the program isn’t rocket science. it is an objective question, with a binary answer. Ditto for asking the ER frequent flyer with asthma why they show no claims for a PCP visit. Target the queries to get right to the problems.

You call for good basic health care is one of merit, by the way.

Guest
steve
Jun 28, 2011

Sometimes what everyone knows is not true. If true, it needs to be quantified. Why should we just guess? I fail to see what people are worried about.

Steve

Guest
James
Jun 28, 2011

“I fail to see what people are worried about.”

For one thing, we are borrowing 40 cents on the dollar right now – and this was a wholly uneeded expense. Medicare and Medicaid could get this same data from multiple existing sources, as was already noted above. Just SURVEY THE PATIENTS for gosh sakes! There would be no need to have people be dishonest with doctors and their staff.

Guest
steve
Jun 28, 2011

Patient surveys have their own problems, and if you do them correctly, they cost just as much. Aaron Carroll links to a new article from the Archives of Internal Medicine which claims much higher acceptance of new Medicare patients than is commonly thought. Lower for private patients than one would expect. We cannot make good decisions w/o good data. How else do we get it? The study, as I have seen it described, should resolve a number of problems with methodology issues.

http://theincidentaleconomist.com/wordpress/doctors-arent-accepting-new-patients-with-private-insurance-either/

Steve