Patient Satisfaction Scores and Narcotics

We have written here before about the Candy Man, who got in trouble for handing out opioids like they were mints and how his patient satisfaction scores were great. Well, here is a story about a doctor who got hammered on her scores because she didn’t hand out narcotics but then also got less pay because of it:

“Kaiser’s management denied Dr. Alpert shareholder status at least in part on the basis of financial concerns that advancing Dr. Alpert would result in reduced revenues and that other physicians would follow her example and refuse to prescribe or provide medications that were not medically indicated, further reducing the profitability of Kaiser Permanente’s business operations in the northwest region and nationally,” the complaint alleges.

The way Kaiser used patient scores “systematically incentivized its physician employees (especially its urgent care physicians) to overprescribe opioids to vulnerable populations,” the complaint says. “Kaiser’s system penalized those physicians who refused to prescribe opioids where it was not medically indicated.”

I hope she wins this lawsuit. I also hope some administrators lose their jobs over this. The perverse use of patient satisfaction scores, when used without forethought, has always been a disgusting way to bonus doctors. Yes, we want doctors to care, to listen and to be human but this job can put you in the difficult situation of saying no now and then and those patients are the ones who will try to hurt you on these surveys.

When is the last time an administrator had a “physician satisfaction survey” about their job and their pay reflected it?

Yeah, I didn’t think so.

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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] 

  5 comments for “Patient Satisfaction Scores and Narcotics

  1. Aaron M Levine
    November 6, 2019 at 9:46 pm

    I was recently on the staff of a hospital that received low ratings by a survey done by the county medical society. It reached the newspaper (only one is left). The hospital someone knew who the leaders were. Suddenly, several were listed as disruptive physicians and were removed from the staff. Their spots were then filled by doctors employed by the hospital system. The scores improved.

  2. Benjamin Van Raalte
    November 4, 2019 at 12:38 pm

    Actually when I worked in the wound care unit, and before I was let go because I was not making patients happy with narcotics and asking them to lose weight , I was told the hospital got Medicare bonuses based on satisfaction score (the diabolical Press Ganey who along with Perdue and Joint Commission and the pain scale were collaborators). The administrators got bonuses based on this, as non profit, means you bonus out all the leftover money to the administrators. I was told their bonus was dependent on the satisfaction score on Medicare patients. Thus the government is also to blame. I was pushed out since I refused to write for narcotics for chronic wounds knowing it would lead to addiction.

  3. Steve Roberts
    November 4, 2019 at 10:52 am

    Now that physicians are employees, they can organize for collective bargaining.
    Let’s show those “administrators” what the results of their actions will lead to.

  4. Rick
    November 4, 2019 at 10:08 am

    Whenever I receive my own request to rate my physician/practice, I always write comments about how demeaning this is for physicians and then refuse to participate.
    This is the most bizarre element of today’s medicine. I have an idea—we rate them when we leave their practice. What ever happened to voting with our feet? God but I loathe the nanny state.

  5. November 4, 2019 at 10:07 am

    They will settle. The doc will get a ton of money and walk away. Administrators will not lose their jobs because they are making money. Back to work for the status quo.

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