Absolute must-read: Why Rating Your Doctor Is Bad For Your Health

January 5, 2013, 4:42 pm

Forbes has posted a detailed and well-researched article (set to appear in the magazine’s January 21, 2013 issue) reviewing the amazing history of Press Ganey Associates, and pointing out statistical problems — not to mention potential dangers — inherent in patient satisfaction surveys.

As reporter Kai Falkenberg notes, the Press Ganey company was started in 1985 by 2 academics from Notre Dame.

Until the government got involved, surveying patients was a sleepy niche business. Then, in 2002, CMS announced a national program to survey patients and require public reporting of the results. The move was part of a Bush Administration initiative to improve accountability and public disclosure and to empower patients to make more informed decisions about health care.

One wonders if there were any lobbyists or self-interested parties pushing for this initiative. Was it really all about accountability and empowerment and yadda yadda? Just asking.

Investors have also reaped the rewards. Press Ganey was taken private in 2003 by American Securities, a New York private equity firm, for a reported $100 million. Four years later it was flipped to another private equity outfit, Vestar, for a reported $673 million. Since then revenue at Press Ganey has grown at high single digits; it earned $82 million (Ebitda) on $217 million in sales in 2011.

Falkenberg points out that there are many reasons to question the reliability and even safety of this type of patient survey. For one thing, only a handful a patients are surveyed — a small sample size can make it impossible to derive statistically valid data.

Press Ganey admits that survey sample sizes sometimes are too small and says a minimum of 30 responses from an ER is necessary to draw meaningful conclusions from its data. But William Sullivan, the Illinois ER doctor, says that Press Ganey reports monthly results to his hospital even when there are as few as eight to ten surveys. His department has ranked in the first percentile one month and in the 99th percentile two months later.

Then again, patients who respond to the surveys tend to be a self-selected group, heavy on those who are really pissed off for whatever reason. In response, Press Ganey CEO Patrick Ryan told Forbes there’s no proof that “only the angry people respond.”

The article also calls into question claims that these patient satisfaction surveys will improve care and result in better clinical outcomes. It notes that some hospitals have linked physician bonuses and compensation to results from these surveys.

That might sound like a good thing. Why shouldn’t you grade the quality of your medical care, the way you pass judgments on other services, whether hotel stays via TripAdvisor or contractors via Angie’s List?
The short reason: The current system might just kill you. Many doctors, in order to get high ratings (and a higher salary), overprescribe and over test, just to “satisfy” patients, who probably aren’t qualified to judge their care. And there’s a financial cost, as flawed survey methods and the decisions they induce, produce billions more in waste. It’s a case of good intentions give badly awry — and it’s only getting worse.

Unfortunately, the Yelp approach to physician evaluation has become codified in the Affordable Care Act’s “pay-for-performance” program, which will tie hospital payments to results from patient-satisfaction surveys.

Kudos to Kai Falkenbery and Forbes. This article is absolutely essential reading.

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