Are Mystery Shoppers Such a Bad Idea for Health Care Quality Improvement?

The decision by the Obama administration to employ “mystery shoppers” to pose as patients to see how difficult it is to get an appointment with a physician has sparked criticism from physicians. However, access to primary care physicians is a very real public policy issue that needs to be understood if we are to successfully care for the more than 30 million Americans who receive coverage under the Affordable Care Act. Is the use of “mystery shoppers” a bad idea?

Dr. Raymond Scalettar certainly thinks it is a bad idea. “I don’t like the idea of the government snooping. It’s a pernicious practice – Big Brother tactics, which should be opposed.” (http://www.nytimes.com/2011/06/27/health/policy/27docs.html?ref=health)

Dr. George Petruncio says, “This is not the way to build trust in government. Why should I trust someone who does not correctly identify himself.” (http://www.nytimes.com/2011/06/27/health/policy/27docs.html?ref=health)

Westby Fisher, MD writes in his blog: “When information gathering trumps patient care - particularly fictitious care - we've got a problem. Is this a new quality standard we can expect from our new government health care initiative?

Just like scam-artists that phish for unsuspecting people's financial information online, governmental appointment phishing should not be tolerated in any way, shape, or form. It is fraud - plain and simple.” (http://drwes.blogspot.com/2011/06/appointment-phishing.html?utm_source=feedburner&utm_medium=twitter&utm_campaign=Feed%3A+DrWes+%28Dr.+Wes%29&utm_content=Twitter)

Several physicians on twitter retweeted Dr. Fisher’s blog post and indicated they agreed with his analysis.

A mystery shopper is a quality improvement tool that has been used in the retail and hotel industry for decades. In 2004 the health care industry accounted for 2% of mystery shopper revenue, but the use in health care is increasing.

(http://www.ncpa.org/sub/dpd/index.php?Article_ID=10273)

In health care, mystery shoppers have been used to provide feedback on every step in the patient experience: making an appointment, environment of the waiting room, encounter with nurses and office staff, and visit with the physician. There has been an increased interest in mystery shoppers by health care providers since CMS started posting patient satisfaction information on hospitals as part of the Website Hospital Compare. (http://www.boston.com/business/healthcare/articles/2007/06/13/on_sly_workers_rate_hospital_service/)

The use of mystery shoppers has been reported to lead to better patient flow and improved wait times, extension of office hours, improved telephone etiquette, better physician communication with patients, and more time with patients answering questions about surgery.

(http://www.boston.com/business/healthcare/articles/2007/06/13/on_sly_workers_rate_hospital_service/)

(http://www.pjonline.com/pdf/articles/pj_20040515_mysteryshopping.pdf.2004;272:615-617)

(http://www.ama-assn.org/amednews/2006/09/18/bise0918.htm)

The AMA Council on Ethical and Judicial Affairs studied the mystery shopper question and concluded that a sound program would include:

1) The places that unannounced visits will affect should know about the program.

2) The information should be used for improvement and not punitive actions.

3) Mystery shoppers should not be the sole source of data for evaluating clinical performance

4) The program should not adversely affect access to medical care by legitimate patients.

(http://www.ama-assn.org/ama1/pub/upload/mm/38/a08cejoreports.pdf)

I disagree with my colleagues that a properly planned and implemented mystery shopper program is a bad idea for trying to improve health care. For far too long, we in medicine have been too arrogant to learn lessons from other industries that improve quality. I think we need all the help we can get to take better care of patients.