One of the few Republican ideas brought up at Thursday's Health Care Reform summit that seemed to be really popular with both parties was suggested by Senator Tom Coburn. The idea basically is to have people go and visit doctors, and try to get them to break Medicare rules. I presume that if they created such a program for Medicare they would try to see to it that it was applied to Medicaid as well. It has been compared to the practice that many fast food restaurants and retail clothing stores have been employing for a while now, commonly known as "Mystery Shopping". This is a horrible idea for several reasons, and the comparison to the Mystery Shopper, is frankly weak and ultimately inaccurate. More importantly I have a suggestion that contains none of the yuck factor of Under Cover Patients, and could potentially play a significant role in changing the way that doctors and patients relate to one another.
WHY UNDERCOVER PATIENTS ARE A HORRIBLE IDEA....
The primary reason is that the practice will create a climate of fear in doctors. They will be looking at every new patient wondering, "Is this person sincere or are they here with a hidden agenda?" Further more it runs the risk of warping the doctors focus. Instead of focusing on how well they are treating the patient, they will instead be more likely to focus on whether or not they are following all the rules so as to not risk getting in trouble. In short order doctors will come to resent their patients and it will increase the likelihood that more doctors will be unwilling to go through the hassle of seeing Medicare or Medicaid patients. The idea is also a terrible one, because it is highly unlikely to be all that effective. Good doctors will either try to continue to focus on doing what is best for their patients, and so might be caught because of not having an encyclopedic knowledge of Medicare rules. Bad doctors, will be in a state of heightened alert and will most likely mind their P's and Q's around new patients until they feel they have weeded out the undercover agents. It is also massively disrespectful to doctors. It says that essentially they are not to be trusted and that their time is not valuable, since every time they have to see one of these undercover patients is time they will not be spending with someone who truly needs to be seen. And finally on the list of reasons why this is a piss poor idea, is the fact that it seems like ultimately it would expend money on hiring, training, and employing these agents, some of whom would just about have to be sent on long term missions to have even the slightest hope of effectiveness, without there being much hope of the expense really being justified by what ever slight "savings" there might be from the relatively low number of doctors that you might catch. And even if you did catch some it would not surprise me if a high proportion of cases were thrown out of court for breaking laws against entrapment.
UNDER COVER PATIENTS AND MYSTERY SHOPPERS ARE VERY DIFFERENT THINGS....
One of the things that is being used to sell the undercover patient idea, is comparing to the practice of employing "Mystery Shoppers" engaged in by many in the retail and service industry. The mystery shopper idea in brief is to take an ordinary person, give them a check list to fill out, and then send them to a store or restaurant to act as a customer, fill out the form and report their impressions. It can be an effective tool to help a business discover areas in which they could be performing better. But the undercover patient idea is similar in only the most minimal of ways, and there is one very important difference. Mystery shoppers are not attempting to get anyone to break the law. Whereas the undercover patients would be.
MAYBE I’M PARANOID BUT....
I honestly have to wonder how sincere the Republicans even are with this suggestion. Frankly it sounds like something that they came up with figuring that it would so outrage the Democrats that they would reject it immediately and so they could continue to push their, "The Democrats won't listen to any of our ideas." meme. Further more, what better way if such an idea was put into practice, to continue their campaign of destroying people's confidence in government as the legitimate organ of managing the people's well being. How much do you want to bet that if the undercover patient program came to be, that the Republicans would quickly denounce it and demonize it as "Your government spying on you!", making certain of course to distance themselves from being the ones to originally suggest it. Obfuscating the fact that they are part of that very same government.
THERE IS HOWEVER A BETTER POSSIBLE WAY....
I am not unaware of the need to not only ferret out actual fraud, and other misdeeds, but also to make it easier for patients voices to be heard. So instead of doing it in a way that breeds fear and suspicion, let’s do it in a way that is honest and open, while still protecting patient privacy.
We can use websites designed for customer reviews as a model. The idea behind such sites is that people go and rate on a scale (usually one to ten) how the service they received, and they leave messages discussing what was good or bad. A similar site attached to the main White House site could be created. Furthermore doctors and hospitals who take Medicare patients could be required to distribute surveys that could be sent postage paid to a department tasked with collecting, reading them and tabulating the results. There could also be an 800 number available. Then if a pattern was noticed there could be a follow up investigation. But why just use it to weed out the bad? It could also be used to reward the good. Doctors who were consistently getting excellent ratings could be rewarded some way.
This would be totally above board since doctors would know that all patients were empowered to utilize the PERN (Patient Experience Reporting Network) they would strive to give excellent service to all patients, but would not have to live in perpetual fear that new patients were in reality undercover government stoolies. Any wrong doing on the part of doctors that was discovered would be a great deal more likely to stand up in a court of law since there would not be the taint of entrapment. The cost to benefit ratio would be considerably higher I suspect than if one attempted to maintain a network of what are to put it bluntly spies. Plus it would help patients feel like they truly had a channel for sharing their experiences both good and bad, and that their voice was being heard. I myself would call that a win for doctors, a win for patients, and a win for the bottom line.
Keep The Faith My Brothers And Sisters!
(This article originally appeared at The One About...)