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    What "mystery patients" can do for you

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    Kathleen Barry, MD, couldn't believe what she saw on an evaluation of one of her physicians.




    "The young woman took a cell phone call in the exam room with the [patient] right there. Can you imagine? " says Barry, medical director for Bright Health Physicians, an 11-office primary care and multispecialty practice in Southern California. Two years after the incident, she still speaks of it with exasperated gasps. "She took a personal call—and spoke a foreign language!"

    The evaluation was created by a paid observer or "mystery patient," the healthcare world's version of the mystery-shopper customer service programs used by retailers and corporations for years. A typical evaluation involves "shoppers" who pose as potential patients, then critique every phase of the encounter, from the first phone call for an appointment to the departure after completing a consultation.

    A practicing family physician for 25 years, Barry sought mystery patients in 2007 to improve patient satisfaction and retention at Bright Health. She knows that many practices rely on patient surveys for similar feedback, but Barry prefers mystery patients for their lack of bias. "Patient satisfaction surveys are not very helpful to physicians," she says. "Patients are mad when they fill those out, and the mad ones write down things and they're very disheartening. I find them obnoxious, for the most part."

    From 2003 to 2004 (the most recent years for which information is available), mystery shopping doubled into a $900 million industry, according to the Mystery Shopping Providers Association. Most mystery shoppers still serve restaurants, retail, and banking, but healthcare is on the rise.

    Examine Your Practice, a San Diego-based mystery-patient firm founded by Jodi Manfredi, reported a 40 percent increase in clients from 2007 to 2008. The firm was acquired in February by the mystery-shopping company TrendSource, and Manfredi now heads up its new healthcare division.

    "When we first started this in the late '80s, there were a number of physicians out there who still believed that clinical quality was all that mattered—and God forbid should we use the words 'customer service,' " says Meryl Luallin, co-founder of SullivanLuallin Healthcare Consulting in San Diego. "That attitude is all but dead now."

    Perhaps you've considered mystery patients for your practice, but were unsure of the costs or likely benefits of such a service. Following is a guide to mystery patients, including an inside look at a typical visit and information about what an unbiased observer in your waiting room can reveal about your practice.

    UNLOCK YOUR OWN MYSTERIES

    Mystery patients often reveal facets of your practice that you can't see.

    When Perception Strategies Inc. of Indianapolis evaluated a 170-physician, 50-office outpatient division of the St. Vincent Health System, it revealed a desperate need to streamline the process of establishing new patients.

    "In one office, [becoming a new patient] required a number of calls back and forth," says Richard Hansen, director of operations for the St. Vincent Physician Network. "After a couple calls, you or I would've looked for a physician elsewhere." (For help developing your own strategy for dealing with new patients, read "First things first," in this issue.)

    Brooke Billingsley, vice president of Perception Strategies, recalls a physician who thanked his efficient staff for allowing him to leave his practice by 5 p.m. every day. Then he learned from his mystery patients that his staff never accepted appointments past 3:30 p.m.

    "There was a disconnect between what the front-line people were doing and back office is doing," Billingsley says. "You don't always know how you're being represented."

    At Jackson Siegelbaum Gastroenterology, a six-physician practice in Harrisburg, Pennsylvania, an evaluation warned of a potential HIPAA violation. "Our paperwork at the front desk was not as covered up as it should've been," says practice administrator Lisa Scicchitano, RN. "It really took someone coming in from outside and looking at that. It was a whole different perspective."

    But it often doesn't come cheap. Mystery patient services range from around $1,150 to $5,000, based on the complexity and length of the evaluation. Some firms offer to simply make appointments, ask questions, and evaluate your phone system, which can cost less than $500. Though the major firms are centered in large cities, they hire independent shadow patients throughout the country. At least three or four visits per physician over several weeks are recommended to ensure a valid evaluation—but as the number of calls and visits increases, so does the price.

    Available services vary considerably: Some programs consist only of walk-ins, for which the mystery patient interacts with office staff, asks questions about the practice and how long it will take to be seen, and evaluates the waiting area. If mystery patients are satisfied with their visit—and some have even switched doctors based on their evaluations—chances are good that your real patients are satisfied too.

    Fed up with the limited perspective offered by Bright Health's own patient surveys, Kathleen Barry hired Luallin's firm in 2007 to make approximately 50 visits and at least that many phone calls over several months. Everyone was notified that there would be mystery visits and were told what would be evaluated. The office staff was concerned such evaluations would lead to reprimands or termination, but Barry's physicians were eager for the program.

    "They all expected to do well," she says.

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