CAHPS CHAPS Us All (at least it should)
In the never ceasing desire to make healthcare worthless in America, CMS has chimed in on a trend that everyone seems to be doing – and that is caring at all what strangers think. The country has gone nuts with the need to have perfect Google reviews and a 5 Star perpetually; A Yelp review from Slothbutt69 seems to carry more weight than personal experience. Strangers can make or break a company and entire industries have sprung up in the “review fixing” genre. You can pay someone to cater your Google review up and work to challenge the bad reviews off.
I have two ideas on how to fix this wacky issue, and the first one has been alluded to. Stop caring. Have the guts to make an opinion on your own. I have seen in the “NextDoor” App which does similar ratings and seeking of opinions phrases such as, “I have always had good luck and good service there, but after reading this I’ll be more careful \ I’ll quit using them \ etc.”
So, someone is willing to care SO MUCH about what a stranger thinks that they will discount even their own experience. Someone writes about a cricket leg in their sandwich and you stop going forever? Even though they brought the cricket leg in with the intent of sabotaging the Google Yelp ratings for their own reasons? Quit reading the reviews and businesses will quit caring which means quit paying fees to them – and quick as a wink Yelp goes the way of Ask Jeeves – gone gone gone.
The second idea is a fixer for sure – stop allowing it. For this I mean into the healthcare sector – I think these review businesses that do nothing but judge companies that actually do something should be allowed to exist for other entities – but not healthcare. I am in fact suggesting a law be passed to stop online reviews of healthcare – be it a medical assistant all the way to hospitals and insurance companies. Certainly, clinics and doctors and other providers should be exempt.
My reasons for blocking any and all rating systems from existing in the healthcare world are two-fold. First, what if a good or even great rating is received? I can speak to doctors most directly on this issue, but everyone is the same – we like to hear nice things about us. We hear a lot of negative, we heard next to never praise from Parents or spouses, we live in a rushed and almost entirely thankless world. A glowing review makes us feel good and validated – and we are going to want that feeling to continue. So when that patient comes in the next time and really wants an MRI they don’t need, or a pain med refill that is just a few days early – you may do the right thing, but you will at least think about it. And that is when we will all lose our objectivity and that is why all reviews are bad and reviews in healthcare need to be banned – reviews change behavior. They work.
The other reason for banning them for us is the flip side – what if the review blasts you personally and destroys the clinic’s well-earned reputation? WE CANNOT RESPOND. HIPAA steps in and makes it actionable to respond in any way. You just are dying to send in your own review – “they were drug seeking idiots that left screaming because you felt like 8 mg of Xanax a day was too much.” You just got sued and likely will be brought up before the board.
So, we are absolutely helpless to this review issue. I suppose that if posting any review about a healthcare entity waived any and all HIPAA protection I would be happy enough.
BUT
Now CMS is on the act. They have decided in their wisdom to base a percentage of YOUR Medicare advantage bonuses on – reviews! Not from peers but from your patients! It is called: Consumer Assessment of Healthcare Providers and Systems or CAHPS.
My understanding is that this is no small potato number either. It’s 30%!
So, in the spirit of the Placebo Journal, I would like to make a list of reasonable and actionable ways for doctors to increase their CAHPS score. Feel free to add comments about your own ways to help this nonsense.
Increase your healthcare reviews!
- Beer in the waiting room
- Vibrating toilet seats
- R – rated movies in the waiting room
- Topless Tuesdays (seeing me topless would at least give a laugh)
- 10 Percocet with every 5-star review
- And yes, for the Karens out there – actually doing my job and never having a negative outcome
We can rate physician employers. We can only change who we choose to work for by rating our employers. RYHE.org, Glassdoor.com and others allow you to rate and view reviews. RYHE.org (full disclosure – my website) is the only one dedicated to professional prescriber reviews.
As an actual Karen, I give Dr. LeCroy a 5/5!!!!
The question of – why CAHPS? is a small part of a much longer social problem. I see American society in 2023 so full of frustration and resentment that is is barely able to keep stability. We notice that there are multiple daily shootings in America, often seemingly pointless, most culminating in the death of the perpetrator. This is the most obvious eruption of frustration and resentment, but most of the problem remains invisible.
Under Stalinism, resentment and petty revenge were fostered. Go ahead, snitch on your neighbor for anything – make it up! – and you might get their larger apartment. Left the bathroom light on? Snitch on them for espionage. Go ahead – the State loves a heavy stream of tattletale, even if it’s mostly nonsense. Just give us a reason to snoop and snatch, they said.
There’s a false illusion of achievement of a crumb of control over your desperate situation. The modern-day Karens, those most immersed in self-pity, hubris and ressentiment are ignored in free societies; they are given five minutes of importance by the Authorities for their snitching. Remember, if you resolve a problem on your own, you are acting as a free adult. If you snitch to Authority, you assume the legitimacy of the Authority over your life.
CMS wants control, for control is the dark side of every bureaucracy. Control requires tales with name, date and place that the resented activity took place – and CAHPS pays out big-time in the currency of revenge.
Remember, the CMS Quality Inspector who comes back with too many positive evaluations merely provokes disdain, and the funding source dries up. Exciting atrocities are all the rage, and those few events cover up and justify the enormous bulk of nonsense that most investigations result in.
I was recently accused in a Protected Peer Review of not reporting a finding to a patient within seven days. Any abnormal finding needs to be reported within a week, even if it is degenerative disk disease on an x-ray. The rules of Peer Review require the committee to consider such things as blatant surgical misadventures, such as enucleation of the wrong eye. (oops). And not reporting a finding of mild knee arthritis on an x-ray. I was interested in offering my opinion on simple common sense, but they were not having it. They wanted a guilty verdict, embedded in the nonsense of process improvement. Disobedience, even inadvertent disobedience, is a medical error.
We are a small corner of society where such authoritarianism is too thinly covered to remain undetected, and we are granted the expectation of using our minds in the care of the patient – or at least, that used to be the bargain. If you say one thing, and the patient says another based on Googling something, well – who is to say what is true and false? That’s absurd in our world, but not so much in the many other mechanisms for paralyzing the human mind that exist everywhere today.
That was not a reply – but a blog. Come over to the dark side!
Ken, THANK YOU for this. SO on point. EVERY time I am asked to review a health care entity or individual, I merely rip the hell out of them for DARING to rate folks in this way. Done.
It is really a sick concept. IF I don’t like someone or something, I DONT GO BACK! Simple.
Absolutely.
Reviews in health care are wrong.
Doctors do what is best for outcomes, not what the patient demands.
A review can destroy you yet it is not verified, accurate and cannot be responded.
Medical reviews should be required
1. To post a verified name with ID and not be published until the person has 15 reviews.
2. Automatically waive HIPAA and pictures and facts are allowed to be published.
BTW inaccurate reviews are hate speech and trigger me, so why should they be allowed?
Remember, this is no accident. There is a trap that the rational elite thinkers fall into – that if only the truth be known, things will change. So inaccurate reviews are hate speech – isn’t that why they are useful? They have a chilling effect on what is seen as physicians’ hubris – the authority to make informed decisions without fear of criticism. We do not respect uninformed or irrational opinions. But they are useful in silencing us, making us look over our shoulder. They are like the AI bots which are rapidly improving every year, those which scan bad charts for meaningless data that can be used to affirm our incompetence. If everyone is free to disagree, the quality of medical decisions made drops to the level of the most incompetent patient. But control and power is reinforced. The trap for the rational is imagining that this is not the intended consequence.