The Patient Side of Healthcare

At the Health Care Summit yesterday, Senator Tom Coburn of Oklahoma (Coburn transcript) took an approach that I thought had left the healthcare reform debate. In addition to the tremendous waste associated with preventive medicine and fear of litigation, his time was spent discussing the extraordinary waste caused by fraud.

Coburn quoted experts who believe that 15-20% of all government healthcare is fraud. This, he said, equates to at least $150 billion a year. He said that instead of a “bunch of new government programs” to detect fraud, the best thing is to use undercover patients to verify that patients are being charged fairly. President Obama later agreed with the concept. And we do too.

As healthcare mystery shoppers, we believe that there is no better way to independently assess process and behavior than mystery shopping or using Dr. Coburn’s phrase, undercover patients. Senator Coburn’s point is that there is no better way to put the fear of God into the cheaters than to let them know someone is watching. Will doctors like it? Absolutely not. But will it prevent some from bilking the system that we all pay for? Yes it will.

A hospital administrator once informed me that a mystery shopping program we had concluded two years prior was still paying dividends because employees continued to comment on the mystery shoppers they had encountered. A well-run undercover patient program will have the same impact.

We intend to reach out to Senator Coburn to share our expertise in any way possible.

From the very beginning of our mystery shopping business, we have used two evaluation standards that for us have said so much about the discrepancy between healthcare employees and their constituents. The first standard is “The employee showed respect for the customer.” The second is “Employees showed respect for one another.” Now, granted, the scores associated with these standards are from the mystery shopper’s perspective and it is possible some of them may be more sensitive to the outward show of respect toward them. However, based on thousands of encounters, most healthcare organizations are biased in favor of interactions amongst themselves. In fact, the difference is 18 points on a five-point Likert Scale – 4.75 versus 4.57.

I have always found this statistic somewhat troubling, but understandable. The odds of recognizing and showing respect toward another individual with a name badge on are high. The closer an organization gets to having the customer respect standard equal to the employee respect standard, the more positive and responsive constituents will be.

What will it take? In a DVD presentation we recently did for a client, we asked employees to “hold their heads high.” It is often too easy for healthcare employees to become complacent about their roles as ambassadors. They need to see what is going on around them – find opportunities to assist visitors or reach out to people who are hurting or lost in the hospital maze. It’s part of their job and it shows pride in their workplace. Walking with your head up and a smile on your face says you are “of” the organization and not apart from it. The message of saying something as simple as hello is that it tells patient and visitors they are not strangers.

I found the article published today on MSNBC.com by Bill Dedman a perfect fit to this discussion of the patient side of healthcare. However, despite the fact that “Clinic with two doors, a Symbol of Two-Tier Care” makes one think about where he or she fits in the world of concierge healthcare and what is important to them as consumers, it just focuses attention on what money can buy. So what else is new?

Don’t get more wrong, I doubt if anyone reading this article thinks they should be getting premier healthcare service for a mammogram where the insurance company picks up the $140 tab. But the perception is that consumers are not entitled to great service unless they are paying top dollar. My concern is that we are being lulled into believing that that is going to be the case going forward. My sincere hope is that consumers don’t buy it and healthcare providers don’t perpetuate it.