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Thursday, May 30, 2013
Ahead of Print: The Last Thing EPs Should Do is Forget Press Ganey
Because of the greed of physician consultants and the companies that employ them and the cowardice of hospital administrators, an EP who wants to continue putting food on the table can no more ignore Press Ganey than he can ignore EMTALA or ACLS. (“Forget Press Ganey: Why You Should Embrace Patient Satisfaction,” EMN 2013;35[3]:1;
Patient satisfaction scores are the third rail of conversation in most of the EDs in the country. Honest, bright, hard-working EPs are being punished economically and professionally because of the lazy and inaccurate way that their work is being evaluated.
Let’s dispel a myth right here. EPs do not mind being honestly graded and evaluated. High school, college, med school, residency, fellowship — we have spent our entire lives being tested and graded. Most of us do not mind the challenge of a test and the judgment that comes from an honest grade. The grades that Press Ganey produces do not reflect reality. The number of responses that constitute my Press Ganey score for the past six months averages one to three percent of the total number of patients that I treat. In no month has my average been four percent or higher. Ninety-six to 99 percent of my work is not being “graded.” How is that a fair or honest appraisal of the quality of my work or my skill as a physician? If I were to grade the accuracy of your article, it would probably be a D+ or maybe a C- (you did include a paragraph acknowledging the inherent inaccuracy in the Press Ganey physician scores).
There are no opponents to patient satisfaction. Every emergency medicine provider that I have known over 20 years of practice cares deeply that patients feel safe, comfortable, and satisfied. What we object to is the impugnation of our work, the unfair and incorrect way that satisfaction is measured, and the patronizing and condescending inference that we don’t care about our patients.
He also uses the terms “patient satisfaction” and “patient-physician interaction” interchangeably. This is a mistake. He also conflagrates the terms “patient satisfaction scores” with “patient satisfaction.” I heard a politician recently discussing his plan to lower health care costs by “improving quality.” Satisfaction, interaction, quality — these are all very protean terms, depending on who is using them. Evidence is accumulating that patient satisfaction and satisfaction scores and quality are difficult to quantify, and are not interchangeable; one does not necessarily imply the other. We need to acknowledge and repeat over and over again that patient satisfaction scores, especially ones that only record one to three percent of the work performed, do not reflect actual patient satisfaction or quality.
If one really wants to know what is driving this patient satisfaction hysteria, just follow the money. Who is getting rich pushing the patient satisfaction Kool-Aid? Well, Press Ganey is an easy target. According to Forbes, the company was founded in 1985 and was considered a niche service until 2002 when the Centers for Medicaid and Medicare Services began a national program to survey patients and require public reporting of the results. That empowered Press Ganey, which was taken private in 2003 by American Securities 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.
There are competitor survey companies, to be sure, but Press Ganey is the big gorilla in this cottage industry that has spawned another detestable tumor — the consultant hired by hospital administrators to bully and berate physicians and nurses into scripted and hollow charades “guaranteed” to improve satisfaction scores. Prominent physicians and ACEP board members have traded their political and academic positions to make a quick buck as patient satisfaction consultants. These men and women should be ashamed of themselves and the naked betrayal of their colleagues.
The good news is that at some point this will all go away. All this patient satisfaction hysteria will someday be just a bad memory like polio or smallpox. I say this for two reasons; first, it cannot be sustained simply from a financial perspective. How much money is being spent on surveys and consultants and training, not to mention the expense of unnecessary testing and prescribing? A recent online poll found that an astounding 59 percent of respondent physicians admitted increasing the number of tests that they perform just because of patient satisfaction scores. This says nothing of the number of unnecessary prescriptions, procedures, or admissions performed. The system will collapse under the sheer weight of the cost of patient satisfaction. The second reason this will all go away is that it is a house built on sand. Everyone knows that the patient satisfaction surveys and responses are a joke. How long can the scam be kept up before someone (CMS or some other administrator or politician) that controls the money calls it out?
EPs are exhausted. The patient satisfaction portion of the monthly staff meeting has become the time for a bathroom break, much to the panic, horror, and chagrin of the administrators. Every honest EP has the moral responsibility to resist the patient satisfaction score hysteria for the sake and safety of our patients and the future of this great and noble profession.
Gerald F. O’Malley, DO
About the Author

Lisa Hoffman
Editor, Emergency Medicine News