Better Performers


There is a new term to label doctors and it is called “better-performers”.  Not unlike greyhounds at the dog track, administrators can now walk around us, stare at us, feel our haunches and say to each other, “This one looks like a better-performer”.  The article I found this from was called:

MGMA benchmarking report: Almost 80 percent of practices deemed ‘better-performers’ conduct patient-satisfaction surveys

Once again, the propaganda machine rolls on.  In medicine, we try to discern which studies have been rigorously tested for significance.  We look for any biases.   It seems for the bureaucrats of healthcare, however, this doesn’t matter.   They use third party companies, like the MGMA, to produce crappy surveys in order for them to further their agenda.  In fact, right at the bottom of this article it states:

Note: MGMA surveys depend on voluntary participation and may not be representative of the industry. Readers are urged to review the entire survey report when making conclusions regarding trends or other observations.

In other words, take this whole thing with a grain of salt.  It could be that only the ones who do the patient satisfactions surveys were the ones who volunteered to send information back to the MGMA.  Here are some highlights from this “advertisement”:


  • Compared with other practices, better-performers were more likely to assess patient satisfaction in their practices and did so more frequently.
  • Practices conducted satisfaction surveys to gauge, among other things, their patients’ overall experience, professionalism of the staff, availability of appointments, and quality of care.
  • More than half of better-performing medical practices indicated they used patient-satisfaction surveys to evaluate and improve practice operations and educate staff and physicians about behavior.
  • Almost 10 percent of better-performing practices cited using patient-satisfaction survey results as “part of physician compensation formula.”
  • In June, MGMA released the Physician Compensation Survey Report and results indicated that quality and patient-satisfaction measures appeared to be a small yet emerging component of total compensation for physicians.
  • MGMA member Martha Kelley, administrator, Virginia Anesthesia & Perioperative Care Specialists, Newport News, Va., developed a performance-based risk program with a hospital system and tied patient-satisfaction measures to their physicians’ compensation. “We started surveying patients for our own internal quality program several years ago, and now we’re required to meet established criteria with one of our hospitals,” Kelley said. “We share results from our patient-satisfaction survey with the hospital, and this metric now ultimately impacts physician compensation. We appreciate the feedback we receive and are continuing to explore ways in which to serve patients better.”

There you have it.  The future of medicine.  Unproven criteria like quality indicators and patient-satisfaction scores (ACTUALLY THEY ARE HAVE BEEN PROVEN NOT TO IMPROVE PATIENT CARE!) are constantly being pushed on the medical world in order to determine physician compensation.  And in the end, it will be the administrators who will determine which greyhounds to hire and which ones to put down.

Which one are you?


Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  6 comments for “Better Performers

  1. MACF
    November 20, 2013 at 2:17 pm

    The #1 rule in medicine has been trumped by “keep your patients and administrators happy”.

  2. S. Fitzgibbons MD
    November 20, 2013 at 1:39 pm

    I am OK with being called a “performer”…when I’m playing one of my cocktail piano gigs. When I am practicing medicine you can call me “doctor”.

    • Doug Farrago
      November 20, 2013 at 3:17 pm

      Sing us a song, you’re the piano doc
      Sing us a song tonight
      Well, we’re all in the mood to quit our job
      And you’ve got us feelin’ alright

  3. david bertoncini
    November 20, 2013 at 9:01 am

    “Patient satisfaction linked to higher health-care expenses and mortality” – what more needs to be said?!?

  4. Pat
    November 18, 2013 at 4:03 pm

    This story, and Lance’s comments, underscore something awful I have come to realize over the past few years: for all of our idealism, personal ethics, and a great legacy on which to draw, medicine is now a fundamentally dishonest business. We properly criticize studies funded by Big Pharma, and policies dictated by government or insurance companies as biased, and agenda-driven. But really, what are most doctors? When you document “smoking cessation counseling” for the twentieth time on the same patient, are you really doing it just for their good, or for some other reason? When I run up thousands of dollars in unnecessary tests every day in the ER, who am I working for? Only those who have had the guts/ability to go cash-only can truly claim to be honest agents for their patients alone.

  5. Sir Lance-a-lot
    November 18, 2013 at 10:40 am

    Our hospital wasted its (my) money on those stupid Press-Gaineys for a while, until it was incontestably pointed out to them that the docs with the consistently high scores were the highest narcotic and antibiotic prescribers, and those with the lowest scores prescribed narcs and abx the least.

    At a nearby hospital a few years ago, I knew that the ER docs had “regulars” who would come in for parenteral narcotics for highly suspicious “pain.” The docs said straight out, “I can’t refuse them or my Press-Gaineys will go down.”

    If you’re comfortable basing your salary on your narcotic prescription rates, then these surveys are great, but if you’re going to do that, why not just go all the way and open up a pill mill, and dole out narcotics to anyone who can push cash (or other valuables) across your desk. It’s the same thing, really.

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