patient satisfaction surveys as part of getting full pay

[resident_1]

Have an employed job that has guaranteed salary for 2 years, after this goes to production based model where 80% is production and 20% is based on "quality" metrics.  This 20% is paid every 6months.  The contract was confusing from the start, and now I'm realizing that the "quality" component is setup such that getting the entire amount will be impossible.

Patient satisfaction surveys ("press ganey is on the forms) are sent to patients of every doc in medical group.   The administration then looks at "Overall doctor rating" by the patient and wants every doc to be at least in 75th percentile for patient satisfaction scores.

So when I get an e-mail with my latest monthly patient surveys my overall rating is in 6th percentile.  I see that 7 people filled out the survey. 5 rated me 9 or 10 out of 10, and 2 rated me 8out of 10.  No scores lower than an 8 (I'm doing a good job right?). But then when percentile rating is calculated I'm in the 6th percentile (wtf?). Administration then tells me that I need to have more patient surveys to increase the percentile rank.  What is worse, is if a single patient gives you a low score (say you refuse to prescribe their 30mg of Valium or 90mg of Adderall per day that they came to you with from prior doc) your overall percentile rank is tanked. The only way to meet this 75th percentile requirement is for every patient to score you as 9-10 out of 10.

So essentially its not about "quality" (since a few bad ratings will tank your score), but about keeping salaries down.

Is it unusual to have patient quality scores as part of salary calculation (or is it becoming more common)?

Anyone have similar contracts?

I'm not going to be staying here past 2years, so for me its a lesson of what type of contract not to sign. But I'm sure the other docs who have been there for some time are upset.

 

[Peds]

we call them uni-bombers (score you a 1).

thankfully ours are only tied to bonus pay (for now).

good luck. get your smile on and your Rx pad out.

[q-school]

We switched to top box but yes income is tied to patient satisfaction surveys

[MochaDoc]

Peds wrote:

get your smile on and your Rx pad out.

Click to expand...

LOLFR.

[AlexxT]

I dealt with similar surveys, with some salary at risk.

Your frustration and anger is understandable, but possibly misplaced.

These surveys are rapidly becoming the norm, or perhaps they already are.  I wouldn't leave your job just because of this quality metric, because you'll probably run into the same thing at your next job.

Think of this:   If you have your own practice, your income will depend on patient satisfaction, but you won't have a numeric score to tell you that your patients don't like you.  Instead, you'll have unfilled appointment slots.

When I looked at other doctors' scores, they generally corresponded to what I would have expected.  There were few surprises.  The friendly doctors had high scores.  The grumpy, brusque ones had low scores.  My hospital had consultants who would coach low scoring docs, and it seemed to help.  Also of particular note is that new doctors generally started out with very low scores, which would generally rise quickly to scores more in line with the more experienced doctors.

So I suggest that you give this some time, and seek advice or formal coaching if possible.   Some doctors were videotaped during their patient visits ( with patient permission, of course ) as part of their training.

I know one surgeon who always scored 100%, year after year.  I don't know what he did to achieve that.  Another surgeon used to send an email, similar to one that i get from some businesses: " You may be getting a survey in the mail.  Please let me know if you feel that you can't give me a 10, so that i can improve my care to your satisfaction".   I think it worked.  I never did any of this, because I usually didn't get dinged ( but sometimes I did).  The whole process is demeaning, but then, there's a lot of demeaning things that I would do for money.

The bottom line for you is that for whatever reason, you may be doing worse than your peers, so you should try to find out what they are doing better than you, even if it's only gaming the system, whether or not you stay in this job.

 

 

[Matas]

How much of the 20% quality component is the Press Ganey? have they showed you the data confirming 6th %-tile? Hard to believe if you are getting a median of 9/10.

[q-school]

At least when we looked at press ganey the formula was proprietary. We think they only counted tens. Nines don't help. We complained long enough to change to top box.

I think the disdain for press ganey might be stronger than that for emr. At least at our institution.

[ENT Doc]

What a load of crap.  The bias on the patient side is that a doctor/organization perceived as doing more and acquiescing to their demands is rated higher.  It should then come as no surprise that the research on this shows higher mortality with higher satisfaction scores after controlling for health factors.  In this pursuit of value based care institutions and our government forgot to read Porter's work on what matters most for determining quality.

[VagabondMD]

Sounds brutal. I feel bad for you docs who have to put up with this [BS]!  (Am I allowed to use that word here? I am about to find out...)

 

[No, you're not, even if it is-WCI]

[Hank]

Everybody's worried about the opioid crisis, but you're screwed if you aren't a prescriber of choice.

These rating systems of choice are friggin' ridiculous.

[G]

AlexxT wrote:

I dealt with similar surveys, with some salary at risk.

Your frustration and anger is understandable, but possibly misplaced.

These surveys are rapidly becoming the norm, or perhaps they already are.  I wouldn’t leave your job just because of this quality metric, because you’ll probably run into the same thing at your next job.

Think of this:   If you have your own practice, your income will depend on patient satisfaction, but you won’t have a numeric score to tell you that your patients don’t like you.  Instead, you’ll have unfilled appointment slots.

When I looked at other doctors’ scores, they generally corresponded to what I would have expected.  There were few surprises.  The friendly doctors had high scores.  The grumpy, brusque ones had low scores.  My hospital had consultants who would coach low scoring docs, and it seemed to help.  Also of particular note is that new doctors generally started out with very low scores, which would generally rise quickly to scores more in line with the more experienced doctors.

So I suggest that you give this some time, and seek advice or formal coaching if possible.   Some doctors were videotaped during their patient visits ( with patient permission, of course ) as part of their training.

I know one surgeon who always scored 100%, year after year.  I don’t know what he did to achieve that.  Another surgeon used to send an email, similar to one that i get from some businesses: ” You may be getting a survey in the mail.  Please let me know if you feel that you can’t give me a 10, so that i can improve my care to your satisfaction”.   I think it worked.  I never did any of this, because I usually didn’t get dinged ( but sometimes I did).  The whole process is demeaning, but then, there’s a lot of demeaning things that I would do for money.

The bottom line for you is that for whatever reason, you may be doing worse than your peers, so you should try to find out what they are doing better than you, even if it’s only gaming the system, whether or not you stay in this job.

 

 

Click to expand...

I agree.  We all know it's a game, but it is a game that the hospital is incentivized to win...meaning that the hospital docs will be incentivized to win...or more likely punished for losing.  In your case, I would be very interested in the numbers that your hospital peers are bringing in.  If they all stink, this is likely a hospital problem.  We were fortunate to staff one big city hospital and another slow suburban place (with private rooms, fancy menus, etc) to show the difference to Hospital admin...multiple docs would get 1% at one and 99% at the other (I bet you can guess which was which).  Anyway, you can work with that on a systems level.

Coaching/scripting is the way to go.  It is similar to framing discussed in psychology texts or negotiation work.  For example, in the ER, comfort used to be a big deal; so you'd say something along the lines of "I want you to be comfortable, so I am going to write you for some acetaminophen [morphine, ice on the boo-boo, pillow to occlude your airway, etc]."  If the hospital offers coaching, I would try it out; I don't have data to support this, but I think that "satisfied" patients are less likely to sue.  FWIW, since only 1/2500 of my patients will get a survey, the one that is upset I'm not a drug-dealer will most likely not get a survey.  If they do, I'll be at 1% that quarter...but the rest of the time, I'm 99%.

And to OP's original question, yes, customer satisfaction surveys affect our reimbursement and there have been a few rare instances where it has affected employment.

[Matas]

If they were fair about it, they (admin) would then link their compensation to physician engagement scores. Yea, that'll happen...

[wideopenspaces]

We get a bonus of like 3k per year if we are in the 90th percentile on press ganey. Our overall clinic score is in the 60's, but all the doc scores are in the 90's. I hate controlled substances and don't prescribe them often relative to my colleagues but my scores are always fine. I'd be stressed out though if a large chunk of my salary was tied to those scores.

[Jaqen Haghar MD]

A sad reality, but a reality nonetheless.  It's pretty common, ranging from directly tied to compensation, to simpily focused on constantly.

For now, the satisfaction incentive seems to be a constant. You are the variable.  Accept it, and see if you can change.  Coaching, scripting, and some psychological techniques in manipulation go a long way in shaping these scores.  Learn how to increase the scores.

If you can't increase the scores, maybe you are actually going to be making 20% less than you expected.

Perhaps you don't have the skill set to increase the scores (ouch, who wants to hear that? -though it is useful to think about it in this context).  Or perhaps the deck is stacked against you (clinic has rats, you work with twelve Nurse Ratcheds, your patients are all seeking dilaudums -less useful).

If these are the case, seek life elsewhere.

 

[GXA]

Ouch.  A couple 8s and the rest 9s and 10s sounds pretty good to me!

I do think my patient interactions and work environment are more enjoyable with a civil, positive interactions with patients.  Higher scores may mitigate some liability and perhaps even some physician burnout.  But that is easy for me to say as none of my comp is tied to it, and I work in a little lower volume ED with time to talk to patients...