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

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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I agree with most of what you’re saying. I just posted something similar to what you’re talking about on my blog. Here’s part of what I said about the types of automated trading robots you would like to have. There are basically 2 types of trading robots. A semi automated and a fully automated. If you want some controls to your trading, you can go for semi automated robot. This robot will create trading signals or what we call buy sell signals and notify the trader about it. The other type is fully automated trading. For those who do not… Read more »

Nancy Irving
Guest
Nancy Irving

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.

MD as HELL
Guest
MD as HELL

Larceny by trick. Still illegal.

DeterminedMD
Guest
DeterminedMD

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… Read more »

Lynn
Guest
Lynn

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.

MD as HELL
Guest
MD as HELL

BS

James
Guest
James

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… Read more »

pcp
Guest

“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?

Craig "Quack" Vickstrom, M.D.
Guest
Craig "Quack" Vickstrom, M.D.

Accountability is un-American; particularly for self.

kent bottles
Guest

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

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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.

MD as HELL
Guest
MD as HELL

They will still deploy their goons

James
Guest
James

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,… Read more »

rbaer
Guest

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… Read more »

James
Guest
James

“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)… Read more »

steve
Guest
steve

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

James
Guest
James

“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.

steve
Guest
steve

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