HHS Considers Mystery Patients to Evaluate PCPs

The office of the Assistant Secretary for Planning and Evaluation (ASPE) is proposing to use a mystery shopper approach to collect data from physician offices to accurately gauge availability of primary care physicians (PCPs) accepting new patients, assess the timeliness of services from PCPs, and assess the reasons that PCP availability is lacking.

Over a four-month period, 465 primary care physicians (PCPs) in nine states across the country will be contacted by a mystery shopper on two separate occasions, using two different scenarios. The scenarios will simulate requests for an appointment with the PCP from a new patient with a public or private insurance and either an urgent medical concern or routine exam appointment.

The physician offices will be contacted a third time using a direct questioning approach by an identified caller who will inform the physician of the study.

The U.S. Department of Health and Human Services (HHS) published the proposed information collection request for public comment in the Federal Register April 28.

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31 Responses to “HHS Considers Mystery Patients to Evaluate PCPs”

  1. Liz Wilson says:

    Which states? Maryland?

  2. Terry Dickhaus says:

    I think its a great idea, a good way to evaluate the physician without them knowing and you can see if they care about you as a patient.

  3. Stanley Griffiths says:

    Refrain from using the mystery shopper title; reword this article at once and do not use the words or title mystery shopper. A mystery shopper is a popular scam which robs from the person who is doing the job of mystery shopper by funding their shopping with bogus funds (bad checks, bogus money orders) and asking the shopper to wire any excess funds to another place. The shopper complies but the initial funds are bad and the shopper must repay the bank sending the funds days after the bank determines the initial funding was bogus; a loss of very much money to the person who is doing the role of mystery shopper. Mystery shopper is a scam; never use the title or words to connote otherwise.

  4. Stanley Griffiths says:

    Refrain from using the mystery shopper title; reword this article at once and do not use the words or title mystery shopper. A mystery shopper is a popular scam which robs from the person who is doing the job of mystery shopper by funding their shopping with bogus funds (bad checks, bogus money orders) and asking the shopper to wire any excess funds to another place. The shopper complies but the initial funds are bad and the shopper must repay the bank sending the funds days after the bank determines the initial funding was bogus; a loss of very much money to the person who is doing the role of mystery shopper. Mystery shopper is a scam; never use the title or words to connote otherwise.

  5. Debra Baird says:

    I hope that they call back and release the appointments or drop the idea. Having worked in a doctor’s office some specialties are hard enough to get an appointment for a patient without somebody “mystery shopping” for appointments that somebody may really need.

  6. Diane Walsh says:

    As long as it is a learning tool and used to provide feedback to an office it may be ok. Some offices have become so complacent they have forgotten what it is to be the patient who may have had a health scare or just need a routine exam. Not OK to use the mystery shopper name. It does have a negative connotation.

  7. Cindy H. says:

    I too think it’s a great idea. The mystery shopper title was used as a reference so people would understand the concept of the promgram being thought of.

  8. Susan W says:

    I, too think its a great idea. And, Stanley, you are wrong about mystery shopping being a scam. Just like any industry, I am sure there are “bad” people trying to take money from gullible people, but I have been a mystery shopper for years, am proud of my work, and really enjoy doing it. There are many reputable companies out there (including companies that already hire mystery shoppers for medical office evaluations). Obviously, one should avoid any business offer where money is required up front.

  9. Richard P says:

    I think it will backfire on them. I work in the grocery industry and they use the mystery shopper approach all the time to grade the stores on how they are doing. However, it has turned into a competition within the company with stiff penalties if you don’t “tow the line”. It ends up creating more animosity and jealous pride than it is worth. What if everyone in the office just treated everyone else how they would want to be treated? Remember the Golden Rule ” Do unto others as you would have them do unto you “? And remember, we are all patients at some time in our life; How would we want to be treated?

  10. lolsen says:

    I saw that one coming…and that is not the reason why they are doing this…if you have followed government involvement in healthcare for the past 20 years, this should be no surprise but the stated intent is not why….

  11. Kimberly says:

    I think this is a good idea.
    Please pay more attention to the idea and concept and not the words. I have been to the doctor and had to think about where I was. They made me feel like I was bother them and getting on their nerves. So much has been lost at the doctors office that need to come back and a caring staff is one of them. So many is blaming managed care, what about the person that is making the appointment smacking in your ear, or the person that is registering you and talking to some in the office (not about my registration) and dont forget the nurse/tech who takes your blood pressure with the cell phone. We desperately need this.
    not the words, the concept…

  12. cpete says:

    Does anyone know what states? Or is that a mystery too?

  13. Ashley T says:

    I’m sorry but what a joke. I have worked in an office with 2 PCP’s that worked 4 full days a week in the clinic (the rest of the time in the hospital), where one provider saw 45 patients a day and the other saw 18 (chronic, elderly,time consuming patients) and we still would try to fit in new patients as we were able. A patient, especially one that has insurance, means revenue coming in. (Im not being crass but honest here) With the overhead for running a clinic I really have a hard time believing doctors are purposely “not seeing” patients. There are also doctors in the community where I live that have been there for so many years and have built up a base of patients to the point where they cannot take anymore new patients. When you cannot establish continuety of care for your established patients, how can you take on new ones? If this is about the quality of care received once established I can understand, but this just sounds like a waste of people’s time and a waste of resources.

  14. carrie allen says:

    I have mixed feelings about this. I have worked in a walk-in clinic for eight years and we try as a team to offer our patients that personalized care that sometimes you can only get with a small practice. I have no problems with our established patients who have seen us a few times to honestly evaluate us and share their experiences, however having a “mystery shopper” evaluate us may not give the full spectrum of how we do business. For instance, we do not accept most HMO’s and that might hinder our “availability” we also do not see patients who have workers compensation cases or if they say the car insurance company will pay for the medical bills. We also screen people when they call, so if a mystery shopper calls us they may feel like we are a little instrusive. I know that I always ask questions that they are not prepared to answer and that may throw off the mystery shopper. My point is I rather have someone evaulate us who has a real medical problem than a person fishing for a problem with our services.

  15. Ashley T says:

    A quick comment about what Kimberly said, I have worked the front desk, medical records, billing and other postions for 3 separate offices. Like most places you go, there will be bad apples. Most people that work in health care really care about the people they are treating and if you run into an office that treats you badly, you can always go somewhere else. Quality of care is different then availability of care. unfortunately, when you have such a high rate of patients to doctors, it’s quality of care that will suffer. Like picking a restaurant. If you want to go to a real nice place that is in high demand, you have to make a reservation. If you want to push through the most customers you can get in….you go to McDonalds. Its not a good thing, but that is the reality.

  16. Shasha says:

    I really don’t see any problem getting the appointment, it could be that some PCP’s are in higher demand than others. Maybe data should be collected from the established patients that are actually seen by the Physicians. I had a great insurance and still waited for my name to be called just like everyone else. They overbook and it’s the waiting 2-3 hours to see a PCP or GYN for 10 minutes that gets under my skin.

  17. Penny says:

    Mixed feelings on this one. I’ve been both a patient and worked in several different medical offices. Getting those appointments depends on so many issues that in some ways it isn’t fair to the patient and they go elsewhere meaning loss of business to the doctor. Doesn’t HHS have anything better to do than “mystery shop” medical practices? What’s the point of their statistics other to show who’s not complying. If HHS isn’t going to make everyone comply, then don’t do it at all. I haven’t had a chance to look at the whole document yet, but it seems like a waste.

  18. Carol Coots says:

    I have been a mystery patient twice for a private company to help a huge medical group find out why they were losing patients. Going in from this approach you notice many more areas that need improvement. It made a difference in the practices as a whole. In these cases the physicians were not the problem. It was the poor staff that was the problem. It has a tendency to make staff nervous. I went in with a true medical advice/concern so I did not fake a problem or waste the physicians time also. If they go from this approach the outcome should be positive to find out what the problems really are for a practice. If all employees, including physicians are doing their best at a job there is nothing to worry about.

  19. Kelly says:

    I work for a doctor that actually spends time with patients, I mean we book for half hour appointments and new patient appointments are 3 hours. Our office deals patients who really need that amount of attention. As a PCP the doctor I work for really takes the time to get to know the patient, and helps them every step of the way. That being said, a new patient appointment can’t be scheduled on a moments notice, sometimes we have opening within a few weeks and other times it can be months. We also run bloodwork PRIOR to the patient being seen. This give the doctor more information in treating the patient. How can mystery shopping for an appointment benefit our practice? I have had ppl actually call our answering service wanting help right then and there. Sometimes I think ppl need to use common sense too. With no history how can you expect a doctor to truly help you. In those instances of course we refer them to their local emergency room. Is there a rule somewhere that says you have to see someone right now? Everyone should remember than Medical Practices are places of business. I can assure you no one with any business sense at all turns away paying patrons!

  20. Tina says:

    I agree “mystery shopper” is the wrong choice for words. I have worked in an office for yrs. and I disagree with this approach because for one appts. are for people who are really sick. Our Dr.’s make the choice to schedule in people who really need in fast. This is not fair to the patient. Also if a patient feels their doctor does not care for them they are smart enough to go elsewhere. We should not undermine a patients sense by using a bogus patient. Doctors time is very valuable and so is the REAL patients.

  21. Tina says:

    I also agree with Kelly. A Dr. needs time and history on a patient. No one should expect to get in as a new patient right away and have no bearings on to why they need in. If a practice is loosing patients then that is self explanatory [common sense] to the practice that they need to reevaluate their practice. I do not believe you need a bogus patient in their office wasting the doctor’s time and his or her staff’s time. Doctors are on a time constraint. Common sense is all it boils down to.

  22. Judy says:

    I wish I could apply for this position. With the knowledge and understanding that I have in the world of coding. I could save insurance companies lots of money! Pass experience in a ED with one of my children and physicians office, the providers to not document the truth. I saw my child’s record and took it to my boss to have her code it so there would be no problems with the charge. When looking at it…..the chart stated the physician was present supervising the PA….what a fib…..there was never a physician that entered that room. But documentation said differently. I pointed this out to my boss and she said that she would take care of it. (We billed for this group) The provider didn’t know me and I don’t tell providers what I do when it is necessity to go to the ED…….wow, like I said I would like to be one of those “mystery shoppers” because I could so burst them! They need to be bursted because they don’t do half the things they state that they do!

  23. Diane says:

    I am blessed with good health and rarely have to see a physician, but when I’m sick with the flu or strep throat, I can’t wait two weeks or 2 months to see my PCP – by that time I’ll either be well, or dead! But that’s what happens when I call for an appointment. No wonder so many non-emergency patients end up in the emergency room. I have a wonderful PCP who spends as much time with me as I feel I need, but getting an appointment is a pain. I don’t know what the answer is but maybe the mystery shopper will turn up some clues. I also wonder if maybe another purpose for this is to determine how many physicians refuse to see Medicare patients.

  24. Cindy H says:

    This is a bad idea in my opinion. This is a free contry and doctors are free to carve out their practice in any way they choose by limiting the number of Medicare/Medicaid patients or any other patients that they see fit. A doctors office is not an non-profit organization its a business just like Walmart or Target. It is also their responsibilty to make sure that their personnel treat their patients with dignity and respect. If my doctor’s chooses to have staff that treats me badly or like I am a bother I will find a different doctor thats my choice. If you want to know a doctors availability just call them and ask them.

  25. angela says:

    I would love to learn more about this – especially if this takes place in New York.

    I’d love to be one of these mystery patients

  26. Nancy says:

    The idea of a mystery shopper sounds risky…in that you are submitting a ? claim to
    an insurance company or carrier under false pretenses…not a good idea…anyone could
    pose as a mystery shopper…you are opening the door for crime opportunity.

  27. Lin Livingston says:

    Stanley Griffiths doesn’t have a clue what a mystery shopper is. I was one for three years before I became a coder. I mystery shopped for many fast food, grocery and electronics companies. That said, it’s just a critic of what ever is happening on any given day. I think it’s a good thing. You discover a lot of things being done wrong, but sometimes you get to tell them how right they were. I, too, would like to be a mystery patient.

  28. Sabrina Palmer says:

    Interesting idea. Both good and bad points. I would help.

  29. no-one says:

    It will work really easy with my office.

    They say they have Medicaid, we say goodbye.

  30. suzyq says:

    I agree wholeheartedly with Cindy H! A medical practice IS a business venture and decisions must be made as to how to best operate it. The coice of “customer base” should be at the the provider’s discretion. The $300,000 debt that a new doctor carries after medical school won’t get paid with a practice full of Medicaid and Medicare patients. I think all the folks who have responded in favor to this scheme need to consider how this is yet another invasion by the government. We are still a free country and our doctors should not be used as pigeons in this sting operation.

  31. Pat P says:

    I think perhaps you are missing the intent of this proposal? Perhaps the intent is not to trap individual practices, but to guage how great the need is to increase the number of available PCPs nationwide. Providing statistics on the difficulty of finding a practice willing to accept new patients, and the length of time one must wait for an appointment helps provide incentive for the government to move toward ways to encourage new PCPs to enter the field.

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