I'm (a little) Sorry, Press Ganey
So recently I threw some shade at Press Ganey in a technical blog post about integrating their patient satisfaction survey data into Epic's data warehouse. In this post I'd like to clarify and expand on those criticisms.
First off, it's very likely I don't understand many of the nuances behind why they do business the way they do. In fact, I'm positive I don't.
Before we get started, let it be clear that my criticisms are:
- Solely my own and should be taken with a grain of salt.
- Aimed at Press Ganey's management and application IT staff, who I believe have the money, vision, and capacity to fix these shortcomings.
Let's start with an analogy.
Pretend you just bought a new iPhone. Now imagine there's a federal mandate to protect your phone from damage with a case, and the only case available is a one-size-fits-all generic case with curt instructions to "work with your device manufacturer" to get it to fit properly.
Wouldn't it make sense for the case company to just work with the 100-odd device manufacturers directly? Rather than have 1 billion iPhone-wielding Joes carefully measure and develop case-fitting specs to send to Apple on their own?
Clearly not every Joe wants to or has the tools for case-fitting, so it would seem natural for specialists to arise and fill that niche.
Now should Apple pay for these case-fitting specialist services? Or Joe?
How much money (and time) would have been saved, for everyone, if the case company had just worked with the damn the device manufacturers from the start?
It's About the Money (and Time)
At the health system I work for, we wrote our Press Ganey-to-Epic-Warehouse integration software in ~2 weeks, with 1.5 people, costing ~$10k USD. Let's also add ~$20k in Epic-specific software development "brain-equity." Another $10k for a year's maintenance of the software. And for now, we'll ignore the benefits of having access/control of the data in-house for research, analytics, and process improvement purposes.
So for a 5-year Total-Cost-of-Ownership type number, we're looking at $40k + ($10k + 4 ) = ~$80,000 for my hospital to make Press Ganey patient satisfaction data play nicely in Epic's Warehouse.
This .gov report from July 2016 shows that 3 companies (Cerner, Meditech, Epic) constitute 2851 (60%) of the 4,474 hospitals using a certified electronic medical record (96% of ALL hospitals).
According to this Emergency Physicians Monthly article from 2010, approximately 40% of hospitals use Press Ganey services. We'll use that number b/c it sounds reasonable and really doesn't matter, as you'll soon see.
Using the same development costs as their customer hospitals, it would cost Press Ganey just 3 x ($40k + ($10k x 4)) = ~$240,000 to develop and maintain patient satisfaction data integrations for 60% of their customers for 5 years.
Instead, however, by pushing the burden of integration development costs onto hospitals and vendors, it ends up costing those same hospitals that are both Press Ganey customers and use one of those EHRs (2851 * 0.4) x ($40k + ($10k + 4)) = ~$91,232,000 to integrate patient satisfaction data with Press Ganey over 5 years.
These back-of-the-napkin calculations could be grossly imprecise, but they're fairly accurate on orders of magnitude, so I hope you see my point.
Fixing Healthcare is Like a Mandatory Group Fitness Class
With all the talk about managing the cost of care through value-based and all-payer reimbursement models, Press Ganey's decision to ignore interoperability begins to feel strategic -- a consultancy-fee cash-grab fundamentally incompatible with our industry's goals and initiatives.
One of the main takeaways from the 2015 National Impact Assessment of the Centers for Medicare & Medicaid Services (CMS) Quality Measures Report reads as follows:
Action to Consider: Strengthen efforts to make quality data collection easier and less expensive for physician practices by emphasizing EHR-based reporting and measure alignment between quality measurement programs.
If we truly need our hospitals and clinicians to step up -- provide more services, with higher quality, at a lower cost -- why aren't we asking the same from other players in the industry?