Sunday, November 04, 2007

Evaluation Time

This week several evaluation requests from insurers appeared in my mailbox at work. One from UnitedHealthcare and the other from Blue Cross and Blue Shield of Illinois (BCBSIL). No doubt there will be others.

Most doctors I know ignore these surveys. I, for one, have never filled one out. Usually such notices are relegated to the circular file. Maybe a few physicians are brave enought to turf them over to their already overburdened office managers who could care less about such a survey, scribble a response if required, and move on. But no doubt a few well-meaning individuals complete these - and probably say relatively nice things like "my patients never complain" or "my hospital seems pretty good at what they do." More likely they complete them without ANY data before them, like how many of their patients have been denied payment and how long reimbursement rates for services rendered actually took. And even after the survey is completed (and, if lucky, mailed) we are left to wonder, what's riding on these rarely-completed surveys? So I spent a minute looking at them.

UnitedHealthcare wanted me to sign on to a computer with this survey address: They gave me a tip about this address:
TIP: Do not enter the survey web address into a search engine or search function on your browser, as it will not find the survey Web site. Use only the Address or Location line located at the top of your web browser window.
Thanks to web-crawlers, I added it in this little tip into my blog to be SURE to correct this problem. I wonder why they want to keep their UNITEDHEALTHCARE SURVEY so secretive in this era of "consumer empowerment" in healthcare? By the way, the server was down when I tried to log in this morning stating:
The system is unavailable at this time, please try again after 6am EST. We appologize for the inconvenience and appreciate your patience.
That was at 7 am CST (8 am EST) today - maybe because the computer clocks are screwed up due to ending Daylight Savings Time today - but I digress.

Here's a sample of the letter from Blue Cross Blue Shield of Illinois:
"The BCBSIL Quality Improvement Plans require measurement of physician satisfaction with procedures for utilization management, referrals (if applicable), appeals, claim payment, continuity and coordination of care, and various services including BCBSIL services and hospital information."
I'm not good at business double-speak. What is "utilization management?" And since when do insurers perform "referrals" or assure "continuity and coordination of care" for a patient? Is it just me or do insurers now think they are "care providers?"

And the cover letter from BCBSIL says something else:
The Hospital Information section, found on the last page of the Satisfaction Surveys, is important to BCBSIL, as results (will be) analyzed for the BCBSIL Annual Hospital Profile. We strongly encourage you to provide feedback on your primary hospital. Responses are only analyzed and presented at the aggregate level. Therefore, all the individual responses are kept strictly confidential.
The questions for the hospital survey include things like scoring the overall quality of the hospital, timeliness of imaging reports, adequacy of the number of nurses, quality of discharge plans, etc. Wow. Not only do I get to care for patients, but I can be Zagat for hospitals, too!

Or am I being asked to be a mole? Are such "hospital quality" questions really because they care about improving quality in hospitals? Or is there another motivation like: "We want to use your less-than-perfect aggregate responses against your hospital during negotiations with them." At least this would be honest and make more sense why these data are so "important." They are, after all, interested most in their bottom line as a business.

But let's not be quite so negative. No doubt the insurers take the three or four responses (not the real number, mind you, but certainly a minority of the total surveys distributed), and show their leadership and stockholders their beneficience in all things insurable. Surely they raise self-congratulatory data up their PR flagpole and to Congress and CMS as justification of their existence.

All from three or four survey responses.

Ah, the beauty (and shame) of healthcare bureaucracy...



Hope said...

I analyze surveys for a living, but not for the healthcare industry. Usually 10% responce is an excellent return and we will go with the findings if we have 5-8%. We use the surveys to determine what Point of Purchase materials we will be sending to our customers, and it is the only criterior used. Still it is emphasized when I and others are presenting the findings that the only people who answer surveys are people who either really love the materials we are asking about or really hate them. We never get responces from the vast majority of our customers who are in the middle of the bell curve. Everything has to be taken in that light. It has worked this way for every survey I have ever done for any company. I don't imagine that it changes for the healthcare industry.

Anonymous said...

Dr. Wes, Having worked inside Blue, they no longer see themselves as health insurance companies, but healthcare management companies. Hence, their focus on case/disease management, UR, and 'wellness' programs that intercede between patients and their doctors; and p4p measures determined by clinical guidelines they establish.