WhiteCoat

Press Ganey Mantra: Suck It Up

“It’s a case of good intentions gone badly awry – and it’s only getting worse.”

Prophetic words in a Forbes Magazine article by Kai Falkenberg titled “Why Rating Your Doctor Is Bad For Your Health.”

According to the article,

Survey “response rates have been dramatically declining over the past decade,” says Paul Alexander Clark, founder of SmartPatient, a health care analytics company. He should know: Until 2007 Clark was in charge of Press Ganey’s patient-satisfaction improvement group. The response rates, he says, are now “too low to produce reliable results.” Insiders have known this for a decade. “This is a dirty little secret in our industry,” a senior Gallup executive wrote in a 2002 letter to the CMS chief. “At those levels the standard rules of probability don’t exist. … This means you may or may not be tracking real patient attitudes.”

The article also states that “flawed survey methods and the decisions they induce, produce billions more in waste.” That’s $280 billion in waste according to estimates in the article. Wasted money so that hospitals don’t lose a percentage of their Medicare payments – government cuts which will total $1 – 2 billion under government mandates geared to save money. The thing is that a substantial portion of the $280 billion will be paid for care to Medicare and Medicaid patients. So the government is paying out a large percentage of $280 billion for increased medical care … to improve patient satisfaction … so that it can save $2 billion. They don’t call it the Affordable Care Act for nothing.

Oh, and when the government was asked for its comments to the Forbes article, it “declined several requests to comment on the record.” Imagine that … refusing to comment on wasteful spending using an unreliable process which is associated with increased patient deaths.

Press Ganey’s CEO, Patrick Ryan’s answer to this stinging criticism of his company’s methods? “Suck it up.”

Patrick Ryan - Suck it UP

However, when you look at reviews of Press Ganey by its employees on GlassDoor.com, it is difficult to tell whether or not “suck it up” is advice for physicians who are the brunt of inaccurate statistics or whether it is a directive on how Press Ganey should run its business. Out of 16 Press Ganey employee ratings, only 25% would approve of Mr. Ryan as CEO.
Let’s put this into perspective. The average doctor approval rating in Press Ganey’s surveys is in the 85% range – more than a 4 on a 1-5 scale. Mr. Ryan’s approval rating is in the 25% range — 0.25 on a 0-1 scale. Doctors get chastised for scoring more than 4 on a 1-5 scale while Patrick Ryan smugly smiles with his rating of about 1 on a 1-5 scale. If a doctor had a 25% approval rating in a hospital setting, that doctor would be fired. Done. And the doctor would have trouble finding another job, too. Patrick Ryan? He’s still working his magic at Press Ganey.

But that’s not all. On GlassDoor.com, employees have repeatedly stated that Press Ganey management is “sucking up” the entire company.
For example, one employee review notes that “The current senior managment comes accross as clueless. They have exciting visions with no ablitiy to execute on them.”
Another employee review states that “Press Ganey sells a product that it doesn’t even believe in enough to use internally.” That’s right, folks, Patrick Ryan wants everyone else to “suck it up” and to believe his company’s surveys are statistically accurate, but he allegedly won’t even use those same surveys for his own company. Kind of like Congress exempting itself from the requirements in the Affordable Care Act. This same employee suggests that Mr. Ryan’s approval rating is “generous” and likely from “lemmings of the new leadership” adding high survey marks to “boost the numbers” and skew the survey results.
Anot her employee states “It’s disheartening to be lied to on a daily basis by a group of individuals” at Press Ganey. If Press Ganey’s management lies to its employees, does anyone expect that Press Ganey will be telling hospital administrators the truth when trying to sell its product?
Yet another employee review states that upper management is “unethical” and that there have been 4 CEOs at Press Ganey in three years. Wonder why.
I could keep going on, but you can click on the link above and read the company reviews yourself. It’s actually entertaining to read how many people think that Press Ganey is a poor company.
Suck it up, indeed.

The emperor’s clothes are gone. Everyone sees it yet few are willing to admit it. Patient satisfaction metrics are associated with higher costs, higher death rates, and a former Press Ganey executive has admitted that survey response rates are too low to produce reliable results.

Why are we still using them? One reason might be that the hospital administrators encourage the surveys because the surveys are associated with higher medical spending … to the tune of $280 billion dollars.
It’s OK that satisfied patients are more likely to die.
It’s OK that survey statistics are unreliable.
Hospital administrators know that they can drive doctors to perform more expensive and discretionary testing at their hospitals by catering to patients with satisfaction surveys.
Think about this next time you or a family member has a bad outcome from your hospital care … or the next time you get a resistant infection from discretionary antibiotics prescribed to make you more satisfied … or the next time that a family member dies from an overdose of pain medication that was prescribed to increase patient satisfaction.

You or your family member might just be satisfied to death.

If that happens, you can always take the advice of Press Ganey CEO Patrick Ryan — “suck it up.”

Heck, he and his company are still making money.

25 Responses to “Press Ganey Mantra: Suck It Up”

  1. LC says:

    On the other note – my prior hospital was often criticized for times when my ID doc and I (pharmacist) would educate the ED docs on prudent use of abx – they then would decrease utilization (where it should be) and refused patients abx when it was not indicated to use them – and our scores of course suffered. What a terrible ED we were. We didn’t give the patient abx for a rash that was not cellulitis! didn’t give abx for that sniffle and cough that was a cold! How horrid of us.

    On the inpatient side, we’d change patients from IV to PO abx and help them get out sooner – how terrible of us!! this little old 80y old doesn’t want to go home yet and we can keep her as long as we keep her on IV levoflox, and pip/tazo… but she had NEGATIVE blood culture, negative urine culture, negative EVERYTHING. but she had great nurses who brought her food and water and helped her to the bathroom… so just keep her there.. on abx… so we get better survey scores.

  2. Matt says:

    He’s got a point though. If you want to get clear of them, drop out of the current “healthcare system”. Return to being the independent professionals you should be. It’s a risk, sure, but everything is.

    Or you can suck it up and embrace the ever creeping bureaucracy.

  3. No, but thank you for asking. says:

    As the result of a severe injury in late 2011, I’ve been a heavier-than-average healthcare consumer over the last 14 months. As a result, I receive several of these surveys every month. I usually discard them, as I recognize that they’re effectively random number generators for small practices. Is there a better way of dealing with them? Should I write hospital or practice management with my concerns? Tell my doc I think the surveys are worthless? Send a glowing review of the docs I like to their higher-ups? How, as a healthcare consumer, can I help end this satisfaction metric B.S.? I’ve grown weary of defensive medicine since I was injured, and I see the P.G. surveys as one of the primary causes. Tell us, your customers, how we can help you.

    • WhiteCoat says:

      This is a great question and I appreciate the offer to help.
      One of my goals is to get people to realize that the data are flawed and should not be trusted. Hopefully I’m having an effect.
      How do we effect change?
      Throwing out the surveys only gives more influence to those surveyees with an agenda. Filling out the surveys gives the companies more leverage by having more “numbers.”
      There are three entities at play in this system: the survey companies, the hospital administrators, and the patients.
      Survey companies have a vested interest in perpetuating their existence and maximizing their profits. Not too much we can do to change their tactics other than to call them on their questionable business methods. Evil WhiteCoat might tell you to go outside, scoop up a handful of gravel, and send that back in the postage paid survey envelope. I would never tell you that. Doing so would cost the survey companies way too much money in first class postage fees.
      Administrators have been fooled by the survey companies. Administrators think that they will get more patients to come to their hospitals with high satisfaction ratings created by statistical hocus pocus. Personally, I’d rather have a social misfit physician who diagnoses my cancer rather than having an empathetic doctor who holds my hand as I die from the cancer he misdiagnosed. Writing to the administrator and stating that you believe the hospital is demeaning its medical staff by using satisfaction scores and you will no longer go there as a patient because of it may change the administrators’ minds – especially if the same letter was sent to the emergency department staff. You might also mention that you believe that your privacy rights are being violated since the hospital is sending your identifying information and the fact that you were receiving medical care to a third party without your permission. Sending the same complaint to the Office of the Inspector General as a HIPAA complaint would raise eyebrows.
      Patients are stuck in the middle. Most want to help the medical staff and have a great health care experience. They fill out surveys to try to help. Administrators generally care only about the good surveys in aggregate. My experience is that the focus is on the numerical comparisons. A few patients have agendas and use the surveys as weapons. Because there is such little variability in satisfaction scores, those patients with an agenda can have a tremendous impact on the data. Get a low score and rest assured that someone will be pulling up the medical records and questioning you about what you did wrong with the patient – even if the satisfaction feedback is untrue. Not much we can do about that yet.
      However, there is enough evidence linking satisfaction scores to poorer medical outcomes in patients. If anyone who had a bad outcome at a hospital that used satisfaction scores such as these were to allege that the damages were caused in part by an administrator’s willful ignorance of the detrimental effects of satisfaction scores, then a jury would likely get to decide whether or not the administrator was at least partly responsible for the patient’s damages. And since the suit against the administrator would not be medical malpractice, there wouldn’t be malpractice caps or medical expert testimony involved in those allegations.
      If doctors have been fired because of untrue satisfaction feedback, a defamation suit against the patients or even against the feedback company could be filed. That would likely cause other issues with the doctor’s employment, so it isn’t likely that a doctor would pursue such a path.
      This is all just hypothetical, of course, but interesting to think about, isn’t it?

  4. throckmorton says:

    IVDAr in severe cardio/resp failure secondary to endocarditis plus two new valves (life saved)but did not get the 120 Oxycontin tabs he wanted equals bad Press Ganey survey.

  5. Eric Reines says:

    Thank you for this information! I left hospitalist work five years ago. The group’s compensation was tied to Press Ganey scores. I got remedial education from a hospital VP because of my low scores. I puzzled at the Lake Wobegon fantasy that we could all strive to be above average and that 80% satisfaction wasn’t good enough. Nurses, patients, and partners often asked me to take over difficult cases; the difficulty was usually behavioral as well as medical.
    I now work for PACE. CMS requires us to keep records of all patient complaints. We asked the CMS rep how to handle a complaint of cold soup. We were instructed to fill out a form as well as heating the soup. We asked how to handle a demented patient who demands to be brought to PACE, even though they are already at PACE. We were instructed to fill out a complaint form.

  6. Long Time E.D. Doc says:

    I keep forwarding easily readable articles such as this to hospital administrators. Do they read them? Probably not. Why read anything when you already know everything. Still, my hope remains eternal that one day one of these forwards actually gets read and becomes a point of rational discussion. However, I am not holding my breath.

    I would write more but am going to heat up some hot soup (but not too hot) for a patient, her family, a visitor…

  7. SeaSpray says:

    Reminds me of our past election …Oh the futility. :(

    That being said …never give up. I too was thinking this post and related articles should be given to CEOs everywhere. Wouldn’t it SAVE money if Press Ganey services weren’t used?

    It’s just crazy and wrong to let go of good doctors because of poor press ganeys if it can be determined it was not because of bad doctoring but rather for doing their jobs correctly and for the patients own good. And how will belligerent or misinformed patients ever learn if they are not educated about the error of their expectations? And how will society be protected from consequences of perpetuating this misinformation by giving the patients what they want – even if wrong …for the sake of good Press ganeys and whatever gain comes from them?

    I just want good doctors who will do what is right by the patients ..and what they know to do and should NOT have to be afraid of losing their jobs,etc. They should be respectful and explain …but do what they know is right. To heck with press ganey.

    Too bad physicians can’t just break away from government control, over regulating and all the stupid stuff. Just imagine all you could accomplish with bureaucracy out of the way.

    Helloooo Dr Welby. :) Wouldn’t it be great to have all the advantages of today’s advancements in technology, etc,. and yet the simplicity of the Dr Welby days where you didn’t have the *over* regulations and other bureaucratic interference with the treatment of your patients? And more time?

    I was floored a few yrs ago when after meeting Mom at the ER, one of the docs I had worked with told me how administration was keeping track of their time with patients and how every patient had to be seen within a first few minutes of arrival. (I forget now – but it wasn’t realistic if emergent situations going on) He was feeling stressed about it. And he said he couldn’t spend as much time with patients as he wanted to. That just is not right. Hopefully they pushed back and it changed. What is wrong with management and some people in other areas today? Seriously!

    I wonder …do doctors ever push back against these things? You’re doctors. You work in the trenches and you must have clout. ?

    • Matt says:

      “I wonder …do doctors ever push back against these things? You’re doctors. You work in the trenches and you must have clout. ?”

      The only clout they have is walking away. And most are paid just a little too well to do it. For all they’re complaints, they’re still 1%ers, maybe even 1/2 of 1%ers, and it’s damn near guaranteed they’ll stay that way under this system. If, like most people, their lifestyle cannot survive the risk of a dip in income that comes with leaving the “system”, they’ll never do a thing but complain.

      • Dina says:

        Wrong.

        http://www.healthleadersmedia.com/page-1/PHY-282762/1-in-3-Physicians-Plans-to-Quit-Within-10-Years

        Speaking from personal experience, husband and I were 1%er MDs and made the decision to downsize our lives so we could walk away from patient care. And, we have. I’d rather go work in a mall than ever go back to it. Husband would rather farm.

      • Matt says:

        Dina,

        Talk is cheap. And I have a hard time believing that 33% of any profession could walk away. After all where are they all going to go and make anywhere near what they make now? 1 in 3 physicians have a low enough debt load to do that? Have sufficient savings to do that? Are willing to give up the lifestyle their present income affords? Maybe you’re right but I doubt it. Surveys like that are more likely to reflect wishes than plans. I am happy for you that you have though. Sounds like you’ve done some smart planning.

  8. Doc99 says:

    Quis custodiet ipsos custodes?

  9. Ricardo says:

    Sorry, gang. I find all of this simply whining about being judged by our patients. Yes, it is a terrible plot and any judgement of physicians is a terrible insult and injustice.

    On the other hand, most all of us know that the doctor-patient relationship needs to improve and a satisfaction survey is simply a start. Yes, it is imperfect, and yes, too much is made of it. But there is a huge opportunity for physician leadership, and yet we whine. The survey is bad, its just people with an agenda, it’s the drug abusers. Gosh, really?

    The ED experience, for the most part is pretty bad; in fact, its infamous. Many of the patients are unhappy because the system, not the doc, is the issue. Why not take a leadership and patient advocate role? Aren’t they our patients? Oh, that’s right. It’s easier for us to be the victims. Please.

    I had many medical directors who barely ran their ED’s and the patient sats were a clear signal that all was not well, but those medical directors spent more time on what was wrong with the survey than on what they might do to make things better. An unfortunately typical response.

    Forget the patient satisfaction survey stuff. You will be all over the web with patient feedback on Yelp for Docs, Facebook, etc. Learn to provide great patient experience and the world is your oyster. They didn’t teach it to us in medical school, but you are all more than smart enough to learn it now and knock it out of the park.

    • Long Time E.D. Doc says:

      Advocate for the patient? What a truly excellent idea! Thank you, Ricardo, for those extremely wise words. I am glad you posted so that we could learn from something as profound as what you were kind enough to provide for us. Thank you again, sir. I can only promise to try and do better in the future, “advocate” more for the patient, and will encourage my fellow E.D. physicians to do the same. We will come up with a plan, a powerpoint presentation to demonstrate the plan, an implementation schedule/strategy, and a full course of meetings to integrate it as we roll the plan out. I don’t want to be one of those so many E.D. directors you “had” who “barely ran their E.D.” I am sure they were stupid and lazy and we, on the other hand, will do much better and most definitely “knock it out of the park.”

      (I am practicing the same response all E.D. docs give to admin types who like to spout well-worn platitudes. And congrats to whoever scored today in Ricardo’s round of cliche Bingo.)

      • Matt says:

        We are a consumer society. In a consumer society the customer is always right (or at least should be convinced he/she is). With the creeping corporatization/nationalization of healthcare, pleasing the customer will soon be far more important than it is even now. Medical professionals have three options:

        1. They can improve their patient relations, and recognize how Americans now expect to be marketed to.

        2. They can take the sarcastic attitude of the above, in which case the new normal will only embitter them more.

        3. They can drop out of the third party payment model and go toward the independent professional model. In the latter, you can be as cranky and eccentric as you want, so long as you’re good. And you need to be prepared to show WHY you’re better than the other guy. Right now the average person has no way of knowing why Dr. A is any better than Dr. B, outside of the way they’re treated.

        In the new model, customer service on a mass scale will be increasingly important. And no matter how much you may feel your product is superior, the customer has to believe it as well.

        No need to give me a lecture on the uniqueness of medicine, how comparing it to the sale of a product is ridiculous, etc. I know you believe that. I just think you’re wrong if you do.

      • Dina says:

        Fine, Matt. Medicine is like any other product. In what other industry can the customer always demand the very best, but never pay any more for it? It’s like if our car insurance also included the ability to purchase cars and we all chose Ferraris – w/o having to pay any increase in premium to do so over if say, we chose a Corolla.

      • Matt says:

        Dina,

        I’m not saying it’s a GOOD system. I think it’s crazy. But docs keep signing up for it, so they have to live with it. Heck, their biggest lobbying organization backed Obamacare.

      • Dina says:

        Matt – I look forward to continuing this discussion with you on future WC posts. But for now (and future discussions), I’m going to assume by your stating it’s a crazy system (and one, may I presume based on your last comment to me, that you agree isn’t replicated in other industries) that you’re agreeing medicine is actually NOT like other industries/consumer products. If not, what other industry/consumer product is anywhere near as crazy as this?

      • Matt says:

        Dina,

        I am not agreeing that the practice of medicine is not like other industries. It’s a profession, which is a distinction that has become lost, and I wonder if it’s lost even among physicians these days.

        Physicians have more in common with lawyers than they do any other profession, despite what they’ve been marketed into thinking. But this payment system they’ve embraced, and has compensated them very well, has eroded the profession, rendering it in many cases merely a gateway to drugs or machinery.

        Now, that’s me speaking from what I read here and what I see as an occasional consumer. I acknowledge that this may be a venting site and that people don’t necessarily post the good things about being a physician.

    • DallasEDdoc says:

      Ricardo, you know why the ED experience is bad for most people, because it is overcrowded and slow. Why is it overcrowded, because it really is not the emergency room, it is the convenience room. Nowhere else in the world can you call a big red cabulance to bring you to the hospital, be seen for free, demand a TV, a sandwich, and a taxi ride home. (Yes, we see over 300 patients/day this actually happens about 50 times a day in my ED, often for just a med refill but EMS feels compelled to transport b/c they utter the words “chest pain” or their blood pressure is high) Many of the people want to order their medical care off a menu. Since most of our patients are not doctors, they are not qualified to place such orders. So if I fail to live up to a patient’s treatment expectations by practicing standard of care medicine, and I fail to give them that free meal and a taxi ride home, then I am potentially subject to a bad survey result, regardless of how much time I sit down and politely listen to their symptoms, and then explain to them about the medicine of what’s wrong and what needs to happen. And because this is so “convenient,” the volume is high, wait times are long and satisfaction suffers from this as well. Just imagine if the ED had a $10 mandatory co-pay for everyone, how many of the frequent users of this “convenience” would stay home, leaving more time and resources to take care of actual sick, and thankful patients?

      • Ricado says:

        I truly agree with your comments. The ED is “all things to all people” and surely easier to get into than most physicians office, who by the way, aren’t on the patient satisfaction train yet, and simply refer everyone to us. My point is that the constant complaining about the validity of the surveys is really a waste of time in this digital age. Throw the surveys out and you will still have people providing whatever feedback they want on Twitter, Facebook etc. We aren’t powerless in all of this. We are smart people and I believe we should start with a plan about what we want the experience to be, taking into account these other factors. I have worked with great docs who have done that for years. And as for the number of people who come to the ED for convenience, that will not likely go away for another 5-10 years simply because the private slicks just aren’t ready, willing or able to add more patients.
        Let’s be honest. Its a bit of a cluster. But I am sure that simply complaining about it will be a big game changer. :)

  10. No comment says:

    I am going to keep my thoughts to myself. You would not want to hear my opinion.

    • Phillip says:

      What if this was a study someone was trying to conduct at an academic teaching hospital? Do you think Press Ganey’s materials and methods and their statistical analysis they use would pass through an IRB approval process? “Yes, well we have a study that we’d like to do where we randomly select patients to give feedback on their physicians care. We’d like to be able to have the surveys influence the physicans’ employment and part of their salary. We did not look at whether or not these surveys will influence how physicians practice, we want to bypass that and just penalize them. No, the physician cannot refute any of the surveys. And yes, we’d like to make a ton of money by doing this and not listen to physicians genuine concerns.” Just doesn’t make sense does it?

  11. [...] need to “suck it up” – kind of like Press Ganey is doing with its business model, but that was the subject of another post. It shouldn’t matter that the statistics are unreliable and that the methods are biased. [...]

  12. […] at Press Ganey, the consulting firm whose surveys were, before HCAHPS, the number one (but much criticized) source for evaluating hospitals.  He was previously network president for Partners HealthCare, […]

Leave a Reply


× five = 40

Popular Authors

  • Greg Henry
  • Rick Bukata
  • Mark Plaster
  • Kevin Klauer
  • Jesse Pines
  • David Newman
  • Rich Levitan
  • Ghazala Sharieff
  • Nicholas Genes
  • Jeannette Wolfe
  • William Sullivan
  • Michael Silverman

Subscribe to EPM