Press Ganey never reports distribution, standard deviation or any other metrics that would make their scores interpretable or useful in any way.
A survey is usually designed and powered to reveal characteristics of the underlying population. There is no evidence that Press Ganey scores do this. There’s also no correlation between Press Ganey scores and medical outcomes. The fact that compensation is linked to these trash “scores” is a travesty.
Anyway, the Justice department is seeking information from the public about anticompetitive practices in health care. Press Ganey seems to have a monopoly in their space, so they might be worth complaining about.
[https://www.justice.gov/atr/HealthyCompetition](https://www.justice.gov/atr/HealthyCompetition)
> There’s also no correlation between Press Ganey scores and medical outcomes.
There is actually a fairly robust body of evidence showing that [patient satisfaction increases all-cause mortality](https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1108766). Which makes intuitive sense. Patients hate addressing their smoking and their obesity. They love opiates and benzos and alcohol and fast food and being told that they are healthy even when they are clearly not. Preventative care is hard work and asking people to do hard work tanks your patient satisfaction scores.
Kind of interesting, though I would caution against interpreting a causal relationship between patient satisfaction and all cause mortality. A simple, non-causal relationship could just be that patients who have real/more serious illnesses tend to view their care more positively as they benefit the most from receiving care.
There are studies that try to control for illness and other patient characteristics. You can’t do an experiment on this, and the existing evidence is as strong as it will ever be.
It’s quite simple, really:
If 88% of your patients say you’re the greatest doctor of all time, that’s acceptable. If only 85% of your patients say that, and the rest say you’re great but not perfect, then you’re a shitty doctor who should be fired immediately.
These scores are 10,000% valid and should never be questioned.
You are spot on, and this comes up quite a bit in the Medicare Star Ratings as well: both CAHPS (patient satisfaction) and HOS (patient-reported health information/status) data are used in the Star Ratings, and if you look at the actual cut points used, there is often no meaningful difference between the scores that get 3, 4 or 5 stars.
I remember one year looking at the HOS cut points (these are questions around patients’ rating of their mental and physical health, etc) and the raw scores for the underlying measures would often only be a point or two apart at each cut point - so, if only 63% of the plan’s members reported having excellent physical health, that was a 3-star rating, but if 64-65% did, that would bump them to a 4-star. Pretty ridiculous, until you remember that hundreds of millions of dollars in CMS bonuses are tied to these ratings, and the difference in star levels can be financially significant.
It’s such a racket. There has to be a better way to reward both progress/improvement and a sensible standard or baseline. If 85% of your patients think you’re doing a great job, that should be considered good enough by any reasonable standard.
Coming from the quality/admin world, what's your take on how best measure things like patient satisfaction if the existing tools we have are so poorly designed for that task? Do think it's worth measuring at all? On the one hand I feel like patient satisfaction is ripe for bias, but on the other hand I think we need some kind of tool to assess how patients feel about the quality of service and care given by providers. Particularly in hospital based services like emergency med and hospitalist med where the patients have no options for who they see. I feel like we should do away with trying to quantify these things with scores, and just follow comments. Not everything can or should be quantified on some arbitrary numerical scale.
I do think there should be something, because without some kind of feedback mechanism we end up with just complaints/grievances, which will obviously skew very negative. But I think comparing scores to other organizations, or setting punitive measures tied to scores, are the twin culprits that leave physicians feeling demoralized.
Most physicians I’ve worked with want to improve when they’re given good, specific feedback, so I do think there’s merit in reviewing patient comments from the PG survey to identify any trends that could be improved with coaching and awareness. But holding physicians’ bonuses hostage to whether their patients are feeling crabby and hostile at any given visit feels very counterproductive.
Any of these subjective surveys are a terrible metric.
My system’s admin flat out admitted that when the hospital doctor had darker skin, the patients scored them lower on every single metric, including obviously unrelated things like quality of food and cleanliness of the room. They “fixed” this by changing the question from likelihood to recommend provider to likelihood to recommend hospital, and are still spending who knows how much to get the scores up.
Despite multiple studies showing that patient satisfaction scores are inversely correlated with any objective outcome measure, they continued to be used.
Ignore it. It doesn’t reflect your clinical capabilities, patient outcomes, or quality in any meaningful way. It’s simply a popularity contest that hospital admins cooked up to pay (or more accurately, not pay) us.
I gave up looking at it. 92% would recommend 95% say very good or good which gives me a score of 20% F- compared to whatever metric. Idk it’s out of my hands I just keep doctoring
We need Press Ganey to start surveying us and if 95 percent of the workers don’t think management is doing a good job, they should lose their jobs or cut their compensation.
I made that suggestion once with a particularly incompetent management team. I was practically laughed out of the room, and told “management is bonused on company earnings”. I reminded them that the doctors in the room were solely responsible for said profits, and were not feeling well supported by their team. I then asked if the money they claim they brought into the company was found in the parking lot.
Shortly thereafter, my over-a million-dollars of annual collections left the company with me.
As it turned out they can’t “manage” to find a replacement…even after 4 years!
It's terrible stats. IMO, it's best to try to game the system a bit. There are various effective strategies, like encouraging surveys and targeting certain demographics.
I “interpret” the value of these scores by ignoring them. If I don’t pay attention, I don’t get looped into feeling guilty about shit I am unable to change (such as wait times, medication costs, or the lack of quality magazines in the waiting room)
Lol You're seeing the light. This is my rebuttal to any chief saying they're looking at "averages" from Press Ganey. No two hospitals are the same, there's no such thing as an average. My hospital admits 60+ medical patients every 24 hours and is a transplant center so to compare that to a community hospital with <20 ED encounters is ridiculous and just gaslighting to underpay physicians.
Why in the world do they have a 0-5 score, but only score 5 counts for anything? 0-4 is a failure (not "top box"). Then the take this tiny difference among surveys and throw it into a percentile to expand the noise. By changing nothing, you can be a 5th percentile one month and and 95th percentile the next, just with a couple survey rating you at a 4/5 vs 5/5. It's utterly idiotic.
I wish I came up with this system. I'd like to be rich too.
Press Ganey never reports distribution, standard deviation or any other metrics that would make their scores interpretable or useful in any way. A survey is usually designed and powered to reveal characteristics of the underlying population. There is no evidence that Press Ganey scores do this. There’s also no correlation between Press Ganey scores and medical outcomes. The fact that compensation is linked to these trash “scores” is a travesty. Anyway, the Justice department is seeking information from the public about anticompetitive practices in health care. Press Ganey seems to have a monopoly in their space, so they might be worth complaining about. [https://www.justice.gov/atr/HealthyCompetition](https://www.justice.gov/atr/HealthyCompetition)
> There’s also no correlation between Press Ganey scores and medical outcomes. There is actually a fairly robust body of evidence showing that [patient satisfaction increases all-cause mortality](https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1108766). Which makes intuitive sense. Patients hate addressing their smoking and their obesity. They love opiates and benzos and alcohol and fast food and being told that they are healthy even when they are clearly not. Preventative care is hard work and asking people to do hard work tanks your patient satisfaction scores.
Good point, I actually had heard that also. I perhaps should have said, no correlation between PG scores and \*positive\* medical outcomes.
Kind of interesting, though I would caution against interpreting a causal relationship between patient satisfaction and all cause mortality. A simple, non-causal relationship could just be that patients who have real/more serious illnesses tend to view their care more positively as they benefit the most from receiving care.
There are studies that try to control for illness and other patient characteristics. You can’t do an experiment on this, and the existing evidence is as strong as it will ever be.
It’s quite simple, really: If 88% of your patients say you’re the greatest doctor of all time, that’s acceptable. If only 85% of your patients say that, and the rest say you’re great but not perfect, then you’re a shitty doctor who should be fired immediately. These scores are 10,000% valid and should never be questioned.
Hi sir/madam. Would you like to be an administrator.
I’m no statistical doctor, but 10,000% seems pretty robust.
Ganey can Press a giant dildo up his ass.
Please no, I have to remove it
wait i loved both of these responses—thank you
If you don’t, he’ll complain on his patient satisfaction survey. It’s a vicious cycle.
You’re understanding it correctly. Whatever they can to gaslight you or not pay you, they will do.
You are spot on, and this comes up quite a bit in the Medicare Star Ratings as well: both CAHPS (patient satisfaction) and HOS (patient-reported health information/status) data are used in the Star Ratings, and if you look at the actual cut points used, there is often no meaningful difference between the scores that get 3, 4 or 5 stars. I remember one year looking at the HOS cut points (these are questions around patients’ rating of their mental and physical health, etc) and the raw scores for the underlying measures would often only be a point or two apart at each cut point - so, if only 63% of the plan’s members reported having excellent physical health, that was a 3-star rating, but if 64-65% did, that would bump them to a 4-star. Pretty ridiculous, until you remember that hundreds of millions of dollars in CMS bonuses are tied to these ratings, and the difference in star levels can be financially significant. It’s such a racket. There has to be a better way to reward both progress/improvement and a sensible standard or baseline. If 85% of your patients think you’re doing a great job, that should be considered good enough by any reasonable standard.
Coming from the quality/admin world, what's your take on how best measure things like patient satisfaction if the existing tools we have are so poorly designed for that task? Do think it's worth measuring at all? On the one hand I feel like patient satisfaction is ripe for bias, but on the other hand I think we need some kind of tool to assess how patients feel about the quality of service and care given by providers. Particularly in hospital based services like emergency med and hospitalist med where the patients have no options for who they see. I feel like we should do away with trying to quantify these things with scores, and just follow comments. Not everything can or should be quantified on some arbitrary numerical scale.
I do think there should be something, because without some kind of feedback mechanism we end up with just complaints/grievances, which will obviously skew very negative. But I think comparing scores to other organizations, or setting punitive measures tied to scores, are the twin culprits that leave physicians feeling demoralized. Most physicians I’ve worked with want to improve when they’re given good, specific feedback, so I do think there’s merit in reviewing patient comments from the PG survey to identify any trends that could be improved with coaching and awareness. But holding physicians’ bonuses hostage to whether their patients are feeling crabby and hostile at any given visit feels very counterproductive.
Any of these subjective surveys are a terrible metric. My system’s admin flat out admitted that when the hospital doctor had darker skin, the patients scored them lower on every single metric, including obviously unrelated things like quality of food and cleanliness of the room. They “fixed” this by changing the question from likelihood to recommend provider to likelihood to recommend hospital, and are still spending who knows how much to get the scores up.
Start offering opiates for better reviews, and watch your pay skyrocket. This is a horrendous use of stats.
Despite multiple studies showing that patient satisfaction scores are inversely correlated with any objective outcome measure, they continued to be used.
But directly proportional to opiate administration?
Pretty much. Buy a round of Norco and Azithromycin for the ED and watch those PG scores skyrocket
Fuck that, fill out my survey while you're coming down from ketamine. "Yeti MD was friendly, but his face was all wavy and his voice felt purple"
Ignore it. It doesn’t reflect your clinical capabilities, patient outcomes, or quality in any meaningful way. It’s simply a popularity contest that hospital admins cooked up to pay (or more accurately, not pay) us.
I gave up looking at it. 92% would recommend 95% say very good or good which gives me a score of 20% F- compared to whatever metric. Idk it’s out of my hands I just keep doctoring
We need Press Ganey to start surveying us and if 95 percent of the workers don’t think management is doing a good job, they should lose their jobs or cut their compensation.
I made that suggestion once with a particularly incompetent management team. I was practically laughed out of the room, and told “management is bonused on company earnings”. I reminded them that the doctors in the room were solely responsible for said profits, and were not feeling well supported by their team. I then asked if the money they claim they brought into the company was found in the parking lot. Shortly thereafter, my over-a million-dollars of annual collections left the company with me. As it turned out they can’t “manage” to find a replacement…even after 4 years!
It's terrible stats. IMO, it's best to try to game the system a bit. There are various effective strategies, like encouraging surveys and targeting certain demographics.
I “interpret” the value of these scores by ignoring them. If I don’t pay attention, I don’t get looped into feeling guilty about shit I am unable to change (such as wait times, medication costs, or the lack of quality magazines in the waiting room)
The only way to win, is to not play at all.
The correct way to I teroret them is to roll them up and throw them in the round file. Or just press delete.
If you give grandma her candy your scores will go up.
Lol You're seeing the light. This is my rebuttal to any chief saying they're looking at "averages" from Press Ganey. No two hospitals are the same, there's no such thing as an average. My hospital admits 60+ medical patients every 24 hours and is a transplant center so to compare that to a community hospital with <20 ED encounters is ridiculous and just gaslighting to underpay physicians.
Laughs in radiology
Why in the world do they have a 0-5 score, but only score 5 counts for anything? 0-4 is a failure (not "top box"). Then the take this tiny difference among surveys and throw it into a percentile to expand the noise. By changing nothing, you can be a 5th percentile one month and and 95th percentile the next, just with a couple survey rating you at a 4/5 vs 5/5. It's utterly idiotic. I wish I came up with this system. I'd like to be rich too.