Press-Ganey Hell Revisited

For those of you that follow @movinmeat's blog, as well as my own (and see me on twitter @irb123), you know about my "issues" with the unfairness of the Press-Ganey system of customer service, and how I feel it is actually undermining good patient care.

Well, irony of ironies, over the last 2 months, I am...wait for it (drumroll)...#1 in my group and in the 97.5% of all (doctors in atlanta? the US? a hypothetical sample size from the imaginings of the P-G folks?) on the list.

And guess what folks? I didn't do anything different. I told that to my medical director today when he congratulated me on a job well done, bringing up my scores. His response: pretend like you did something different if someone asks.

In other words, for the P-G to be legit, one set of behavior leads to one set of scores, but another set of behavior leads to a different set of scores. But in my world, there is one type of ER practice that leads to a rollercoaster of scores from the very bottom to the very top.

Once again, the P-G fails to indicate anything meaningful for me and for my patients. Only now, I am not in the doghouse with the CEO. Maybe this is the right time to ask for that iphone I've been wanting...

Criticisms of the Kennedy Health Plan

First let me say that whether you agree with his politics or not, he has worked tirelessly to get healthcare reform for the last thirty years. That being said, I have a lot of problems with his proposal. I'm reviewing his first since it was one of the first proposals out and it has just been evaluated by the CBO (Congressional Budget Office).

I will not review any "plans" that have not been put forth as bills (i.e. obamacare). Little snippets are not appropriate to determine the good and bad of a plan. You need the whole thing to get proper context.

This is what i don't like about the Kennedy plan:

1. Has local state exchanges (Market to buy heath insurance) rather than one large federal one. I prefer the federal exchange model as it increases the size of the risk pool which has more leverage for negotiating prices such as prescription drugs. And it requires less administration. Each state will have its own exchange with its own administrative costs and bureaucracy.
2. Undermining of employer-based insurance. According to the CBO paper, this plan will REDUCE employer coverage for 15 million people. So while 39 million will get coverage through the exchanges, 15 million or so already had coverage, and according to the CBO there are other losses of coverage in the Medicaid sector, so there is only a net gain of 16 million insured.
3. There is a fee for not being insured. In order for risk pooling to work, you need to have the whole population insured. In particular, the young healthy people who don't get employer coverage must be brought into the plan. This should be done by automatic enrollment, not by a fee. There should be some minimal catastrophic plan that you are enrolled in - if you have sufficient income, with the cost deducted by IRS filings. A $100 yearly penalty does not address the risk pooling issue and undermines the agreement with insurers to eliminate pre-existing conditions if all people under 65 are required to have coverage.
4. Rather than continue the Medicaid bureaucracy, all Medicaid enrollees should be rolled into the exchanges and receive subsidies for the cost of the policy. If we have to create one bureaucracy (i.e. health care markets/exchange), let's eliminate one also (Medicaid).

Considering this plan costs 1 trillion over 10 years, there is too high a cost for too few added coverage. There are better plans out there. We should look elsewhere.