Secret Shoppers to Improve Your Healthcare Business

Any health care business can benefit from implementing a secret shopper program. Hospitals, nursing homes, assisted living facilities, medical clinics and doctors' offices can improve not only patient satisfaction, but also quality, efficiency and profitability.

A healthcare secret shopper program is unique from retail programs in that the shoppers may have to undergo clinical testing to gain the full experience. Some programs go so far as to subject the shopper to diagnostic tests such as MRIs and blood draws, but rarely further than that. Your program need not go quite that far to reap the rewards of a secret shopper program; that's a choice you can make and depends on how far into the patient experience you want to evaluate.

Obviously, you'll have to weigh the cost of unnecessary procedures against the knowledge you'll gain from delving into those experiences from a patient perspective. If you're evaluating an imaging center's patient satisfaction, undergoing an exam is a major part of the patient experience. You should take that into consideration before you decide. On the other hand, if you're evaluating an emergency room, undergoing clinical procedures and exams might not be your primary concern (and they are more costly in this setting). You might prefer to evaluate just the triage experience and ask your shoppers to refuse treatment once they're sent to the back.

Whatever you decide, we've compiled a few tips to get you started on designing a successful healthcare secret shopper program.

1. Involve employees from the beginning. Secret shopper programs can be devastating to employee morale if executed poorly. Avoid this by simply keeping them informed. Better yet, involve them in the design process. For more information, read our previous post about getting your team invested in a project.

2. Set measurable goals and make them clear. Before you design your secret shopper program, identify your organization's goals. And don't pick goals like "improve patient satisfaction" or "reduce wait time." Make them specific and measurable so you'll know if the program is working. "Improve ER patient survey scores by 15%" is a good start. Make sure you clearly communicate your goals to employees before the program starts.

3. Evaluate strategically. Think carefully about what you measure and how you measure it. Include the visitor's perspective as well as the patient's. Establish a consistent grading system so you can compare units and departments. Measure on the same scale and use standard dimensions like "service," "process," "friendliness" and "professionalism." Don't use employees as secret shoppers. You run the risk that they'll be recognized and perhaps more importantly, you don't want to allow bias in the evaluation (or even the perception of bias). Finally, consider measuring process as well as experiential data. Have your shopper track wait times and how long it takes to accomplish key tasks like registration.

4. Analyze, report and share the results with employees. Post the results of every secret shopper encounter for all employees to see and to learn from. Consider creating friendly competition with contests and always reward positive outcomes.

5. Make improvements and educate staff. When outcomes aren't so positive, learn from the results, make improvements and educate staff. Do not make it punitive. Again, involving staff is very important and this is another opportunity to do that. Gather your team and identify solutions together.

6. Publicize your work. Let the public know what you're up to; it's a great way to show your commitment to your patients and visitors. Plus you could win over some new fans and increase your market share.

Our healthcare consultants can help you design and implement a successful secret shopper program. Contact us to learn more.

Update: Pay-For-Performance Coming to Nursing Homes

Nursing homes in AZ, MS, NY and WI had until May 1, 2009 to apply for participation in the Nursing Home Value-Based Purchasing demonstration project. Award letters are expected to be sent out around June 1st 2009 to 50 selected nursing homes in each state. Each nursing home then has 30 days from the date on their acceptance letter to accept. The project will begin in the summer and last for three years.

Even if your nursing home is not participating in CMS's demonstration project, you can still benefit by learning more about it. If the program is successful, it will be expanded to more states and participation will likely eventually become mandatory. Understand the quality measures used in the project and identify areas of improvement for your facility now so you'll be ready. This will give you the advantage of extra time that your competitors might not have had.

For more information about the demonstration or the quality measures used, visit http://www.nhvbp.com or contact Enovasis Healthcare Solutions.

National Hospital Week Giveaway May 10-16

The week of May 10-16 was designated as National Hospital Week to recognize hospitals and their employees and volunteers for all the good that they do for their communities.

Enovasis Healthcare Solutions is celebrating by giving away consulting hours and a WhereToFindCare.com Premium Home Page to one lucky hospital.

For the free consulting hours, we'll analyze a data set (up to 1,000 patients) and identify areas to improve revenue, cost or quality. These projects typically yield a return of $250,000 to $500,000 in opportunities.

The free Premium Home Page is a 1-yr subscription and is a great way to share testimonials of satisfied patients and display your marketing message to consumers choosing a hospital and comparing hospital quality/satisfaction performance.

To enter the drawing, just contact us or DM @bjoconnell by 5pm Friday 5/15/09 and mention the Hospital Week Giveaway. We'll draw one winner Monday 5/18.

Good luck and happy hospital week!

Pay-For-Performance Coming To Nursing Homes

CMS is kicking off a five state pay-for-performance (P4P) demonstration project that will help them design incentives for quality improvement in nursing homes. They're calling it Nursing Home Value-Based Purchasing.

Arizona, Mississippi, New York and Wisconsin have been chosen to be the host states. Nursing homes in these states are invited to participate.

Basically how the demonstration project will work is over the next couple years CMS will collect quality data on participating nursing homes, assign scores based on performance and compare those scores to other nursing homes in the state overall and over time.

CMS will determine how much money is saved as a result of nursing homes' improvements and then allocate those cost savings to the best-performers in the form of incentive payments.

However if it is determined that nursing homes in a particular state did not improve overall, no incentive payments will be disbursed...no matter how well a particular nursing home performed.

If you're considering participating in the demonstration and would like assistance, Enovasis can guide you through it. Enovasis can also identify and implement improvements to increase the likelihood of receiving incentive payments. Contact us today.

For more information about the demonstration or to apply for participation visit www.nhvbp.com.

Lean Healthcare, Simplified

Applying lean concepts to health care is all the rage these days, but you don't necessarily need to hire high-priced consultants to get started. The essence of "lean" is finding and eliminating "non-value added" work, or "waste." To get started, just follow these five simple steps:

1. Look closely at each of the tasks performed in a particular process (drawing blood, processing an MRI order, etc.) This is done by carefully documenting each step either in flowchart or list form. Your goal is to have a list of steps that is so complete that a new employee could use it as a guide. Sometimes the best way to accomplish this is to have someone unfamiliar with the process do it. They are unable to make assumptions and tend to ask more questions, resulting in fewer missed steps and more detail. Also, estimate the amount of time and/or cost is associated with each step.

2. Once each step is documented, ask this question of each: Does this task directly contribute to the service being performed or the patient being treated? In other words, does it add value to the patient? For example, if you're looking at a lab draw process ask, "is this directly related to testing the patient's blood? Does the patient care about it?" Indicate whether the task is value added or not next to each.

3. Now that you've identified the non-value-added steps in your process, your goal is to eliminate or reduce the amount of time spent on each. Think creatively and approach each step with an open mind. Are each of these steps absolutely required? Are they essential to the entire process? Is there a way to perform them more efficiently? Is there improved technology that can help you perform the task faster and more efficiently? Can you automate the task? Cross out all the steps you can eliminate and note changes next to steps that can be improved.

4. Document your new, highly-efficient process and compare it to the old. Determine how many steps, how much time and how much cost you saved by eliminating the waste.

5. Implement the new process and monitor the results. Check periodically to make sure the process is working and that staff are adhering to it. If there are problems, reassess the process and make corrections.

See, lean isn't so complicated! Sure, some complex processes can be daunting, but break them down into smaller processes whenever possible. Follow these basic steps and you'll be on your way to improving your organization's bottom line in no time.

If you need any help, our process improvement experts can guide you or tackle the project for you. Contact Enovasis Healthcare Solutions to boost your profitability.

Reduce Readmissions by Discharging to Better Nursing Homes

In our experience, a common cause of hospital readmission is urinary tract infection (UTI) associated with catheter placement. This is especially true in the elderly and stroke populations discharged to nursing homes.

The belief is that a hospital treats a patient, sends her back to the nursing home from which she came, only for that nursing home to leave her catheter in too long which subsequently causes a UTI and associated symptoms such as "dizziness and giddiness" that look like they could be stroke related. Thus, the patient is admitted to the hospital, treated and the cycle continues.

Meanwhile, the hospital is unable to cover the cost of the admissions for various reasons: failure to document "present on admission," too many resources were used to diagnose the problem and rule out a stroke, the patient didn't meet admission criteria or payment for the billing DRG simply was less than the cost of the admission.

You can prevent these admissions quite simply by knowing more about the nursing homes to which you're discharging patients. We recommend looking at two pieces of quality information and sharing with families when choosing a nursing home:

1. Percent of long-stay residents who have/had a catheter inserted and left in their bladder (the national average is 5%)
2. Percent of long stay patients who had a UTI (the national average is 9%)

A quick search on nursing homes in our neighborhood yielded surprising results. We found one in Taylor, MI where 20% of long stay patients had a UTI. That's 11% above the national average! One might find that hospitals in that area discharging to this nursing home have higher than average readmission rates and are losing needless amounts of money.

If that is the case, these hospitals should quickly implement a procedure to present these simple pieces of information to families as they are making long term care choices. Armed with the right information, families can find better care for their loved ones and help you improve your bottom line.


Both of these indicators can be found on nursing homes across the country at WhereToFindCare.com. Simply search for nursing homes, click on the nursing home desired, click the Quality tab, then "See Details..." next to the Long Stay condition.

WhereToFindCare.com is working on a free tool to help you with this process. Join our mailing list to receive an update as soon as it is available.

Expediting Payment of Insurance Claims

by Jeff Smolen

If you are reading this, you don’t need to be told that the bulk of your revenue is dependent on the major insurance companies, BCBS, HAP, Aetna, etc… Millions of dollars are spent by practices and hospitals on software to “scrub” the claims before they are submitted to insurance companies, but they don’t get you paid. Now tens of millions more are spent on FTEs to follow up and find out why these claims haven’t been paid.

Usually these FTEs are overworked, inexperienced, and turn over frequently. They also tend to be the lowest paid member of any practice. They spend a lot of time on hold, following up on these unresolved claims which are parked in the 90day+ column. Yet these employees fill a need since they try to get money on the 10%-20% of claims which are rejected, lost or “held in review.”

There is, however, another way to effectively handle the follow up on non responsive insurance companies…harness the power of third party impact.

The reason this approach works for hospitals and practices is that Insurance carrier by-laws and internal policies typically require immediate response to licensed third party contacts. In addition, third party demands move the responsibility for the claim from a clerk to a supervisor, who generally settles the claim more quickly. Even if the claim is rejected, the practice can more quickly move the bill to patient responsibility and resolve the balance issue. Bringing in a licensed 3rd party to pursue delinquent claims leads to a quicker resolution of claims, reduced FTE expenses, increased cash flow/profitability and lower office stress.

Jeff Smolen represents GreenFlag Profit Recovery by Transworld Systems. TSI has been providing medical practices, clinics and hospitals with cost effective A/R solutions for over 38 years. TSI has achieved Peer Reviewed status with HFMA, and has been an Adminiserve Partner with MGMA for 10 years. Jeff can be reached at 313-617-7360 or at jeff.smolen@transworldsystems.com.