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Mystery shoppers help medical professionals examine service quality

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As dentist Alexander Sabet poked around Lynn Tobias' mouth during a recent examination, his patient took extra care to note his every word and action.

"He looked me in the eyes and listened to what I had to say, and he spoke in clear, easy-to-understand terms," Tobias later recalled.

That was good news for Sabet, who's spent the last few months working to soften his "strictly business" bedside manner.

Tobias wasn't your run-of-the-mill patient, and her exam was anything but routine. She's a mystery shopper, someone hired to patronize a business undercover and evaluate everything from the workers' politeness to building cleanliness and the caregiver's bedside manner.

Mystery shoppers have visited restaurants, clothing stores, banks and other retail businesses for years, but an increasing number are now showing up at offices run by dentists, optometrists, chiropractors and family physicians.

With Americans paying more of their medical bills out of their own pockets and health care costs continuing to soar, patients are comparing prices, service quality and convenience. That's putting more pressure on health care professionals - particularly those who rely on referrals - to make sure their patients are happy with the care they receive.

These changes prompted Jodi Manfredi to launch Examine Your Practice, a San Diego-based mystery shopper service that caters to medical offices.

Manfredi, a former dental supply company sales representative, relocated to Southern California earlier this year after starting the business in Las Vegas.

An evaluation by Examine Your Practice can cost from $300 to $3,500, depending on the number of visits made by secret patients. A typical medical practice will schedule six visits over the course of six months.

In order to comply with privacy laws, such as the federal government's Health Insurance Portability and Accountability Act, health care mystery shoppers typically sign confidentiality agreements that bar them from disclosing information about their shopping experience outside of the evaluation process unless they receive permission from the client.

"This is not about getting staff members fired," Manfredi said. "It's not about what they are doing wrong. It's really about recognizing training needs and catching (staff members) doing something right."

On a visit to a doctor's office in the San Diego area recently, one of Manfredi's shoppers encountered an inattentive receptionist at the front desk.

"She barely looked at me, and then finally said, 'Sign in,' and went back to working on the computer and talking," the shopper wrote in a report on the visit. "The front office staff and medical assistants should be friendlier, more attentive and professional. They do not reflect the same caring and friendly attitude that (the doctor) displays."

Such observations can be revelations for medical practice owners.

Doctors who spend most of their workday in examination rooms often are unaware of what is happening in the front office, said Dr. James Loden, a Nashville, Tenn., ophthalmologist who has used Examine Your Practice.

"The only way to know exactly how (staff members) are performing is to have someone actually evaluate how they are performing," he said.

Sabet was more interested in evaluating his own dealings with patients when he hired Manfredi's firm a few months ago.

The Vista, Calif., dentist started warming up his button-down approach to work after his wife told him that he needed to be friendlier with his patients.

"Before, I was more focused on the teeth. But you need to get to know the person a little bit before you treat them," he said. "Now, I sit down with them at eye level. I talk to them and spend a little time with them."

Tobias, who has worked as a mystery shopper for several years, appreciated the changes.

"I would highly recommend this dentist. I would actually go to him," she said.

The mystery shopping industry racked up $600 million in revenue in 2004, according to the latest figures from the Mystery Shopping Providers Association, the industry's Dallas-based trade group. Most of the 8 million mystery shopping trips made in that year involved retail stores, banks, fast food restaurants and convenience stores.

Health care mystery shopping accounted for 2 percent of industry revenue in 2004, more than double the previous year when health care mystery shopping accounted for less than 1 percent of industry revenue.

"That's a pretty hefty jump," said John Swinburn, executive director of the association.

While about one-third of the group's 150 U.S. members say they provide mystery shoppers to health care clients, only a handful make it their primary focus, Swinburn said. Those that do mainly work with hospitals.

Devon Hill Associates of San Diego, for example, has been conducting mystery shopping visits to hospitals since the late 1990s. Last year the firm sent mystery shoppers posing as uninsured patients to 64 California hospitals. The shoppers were seeking price information on elective procedures, part of a study by the nonprofit California HealthCare Foundation looking into the difficulty of comparing costs among hospitals.

Health care companies are just starting to warm to the idea of using mystery shopper services to gauge customer satisfaction, said Devon President Barbara Gerber, who conducts long-term evaluations for two or three hospital clients each year.

"You are going to find in the future that there is more of it," she said. "It's still a very new field for them."

Neither Devon Hill Associates nor Examine Your Practice would divulge sales figures. Examine Your Practice currently has six clients.

San Diego chiropractor Danny Song decided last fall to hire Examine Your Practice to evaluate his pain care clinic after reading about a recent report that indicated San Diego physicians rank lower than doctors in many other large U.S. cities when it comes to patient satisfaction.

"We understand that patients have a choice of where they can go," he said. "Even though we give patients the best medical service that we can, we wanted to make sure that the customer service part is good as well."

Mystery shoppers who visited Pain Care San Diego gave practice workers high marks for scheduling appointments quickly and limiting time spent in the waiting room, but the shoppers complained about the office's confusing automated telephone system and said that some patients weren't immediately greeted after arriving for appointments.

Song said those weaknesses now are regularly discussed during staff meetings, and a suggestion box has been placed in the waiting room to collect more consumer input.

Though pay for mystery shopper work is relatively low - ranging from $10 to $30 for several hours of work - other perks make the job attractive.

Since shoppers are reimbursed for the cost of the exams they receive, a mystery shopping trip amounts to free health care. An undercover trip to a dental office, for example, could mean a free dental cleaning, X-rays and an exam that normally would cost about $250.

Tobias, who doesn't have dental insurance, said her recent trip to the dentist for Examine Your Practice provided valuable advice on procedures that she has been considering for some time. "I had a very nice teeth cleaning and got some good information," she said.

Tobias, who has worked for years as a mystery shopper outside of the health care industry, said the part-time job serves as a public service as much as anything else.

"There is a lot of satisfaction to it, and I do it because I enjoy shopping," she said.

"This isn't a 'get rich quick' thing. It's not a 'get rich' thing at all."
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 healthcare professionals  family physicians  pockets  Las Vegas  California HealthCare Foundation  executive director  exams  costs  workers  patients

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