Shooting Stars


“The per patient expenditure for your assigned patient panel the last quarter was up by $XYZ, so we will be dropping your rating on our website from five to four stars. Your patient satisfaction and preventive care scores remain outstanding. We will re-evaluate your rating at next quarter.” A letter from one of the big insurance companies a few weeks ago.

You know what? Bite me. To my knowledge I am not wasting money. I take appropriate care of my patients.

But then it occurred to me, do patients even know that this is what those stars mean? How much money they and their physician cost the insurance company….


79 thoughts on “Shooting Stars

  1. I doubt it. Rediculous trying to figure out what the bottom line of a medical bill is or how much they are actually charged! Our prescriptions are finally down to a reasonable co-pay at this time of year, except for one of my husband’s generic XYZ which has been on the market FOREVER and is a very common drug used my millions of people each and every day. We still pay over $100.00 every month. Insurance “saves” us $18.88. Woo-hoo!

    Liked by 1 person

    • I try to be conscious of costs, particularly because every decision I make impacts the patient financially. But if I feel like I am doing the best I can, the only places to make cuts will have an adverse effect on patient outcomes…


  2. No. Patients don’t know. The stigma and narrative of doctors is that they are pill pushers for the pharmaceutical companies with no care for their patients
    If I did not work in the healthcare field, I might believe that too. Pharmaceutical companies and insurance companies want patients to be in the dark. So that when things go wrong, when drugs cause death or when insurance companies won’t cover needed procedures, then then the blame can be laid at the physicians feet.

    Liked by 3 people

  3. Most people, probably have no idea what those stars mean. You’d have to go on your own gut feeling about how you are caring for your patients. The insurance companies have no credibility in my opinion.

    Liked by 1 person

  4. I doubt it. They see the stars and think it’s a reflection of your standard of care. Just like everything else in healthcare right now though, it’s all driven by cost, efficiency, and absurd outcome expectations. Kinda sucks being in the field at the present.

    Liked by 1 person

  5. “The per patient expenditure for your assigned patient panel the last quarter was up by $XYZ, so we will be dropping your rating on our website from five to four stars. Your patient satisfaction and preventive care scores remain outstanding.” Soooo, even though your patient satisfaction and preventive care scores remain outstanding, you’re still going down a star? I don’t know how they figure these things, but if your patient satisfaction scores remain outstanding shouldn’t they add on a star or make your stars glittery or something? Or does money trump patient experience and care??

    Liked by 1 person

  6. I used to be confronted with internal rating scores as a temp as in “well yesterday you were a 6 but sometimes you are an 8” (on a 1 to 10 score, 10 being high).

    I always shrugged because if managers like giving score to others then why do they cover up for themselves until the cluster-fuck is too big to ignore? Everything the managers and top managers could not deal with we temps dealt with because we did our jobs. We had to get our hands dirty, they did not.

    Sometimes that put us in a bad mood or made us look at the management as if they were brainless suit wearers. Next time look the responsible management in the eye and let them know you are doing the dirty work.

    Give them that look and they shut up…

    Liked by 1 person

  7. Hey Victo,

    Lab-rats to the insurance companies are we: they play with lives at their leisure, whilst we pay them for their perfidy and pleasure.

    ‘Outstanding’ patient care reveals the true heart of your intention, and reflects reason why you practice medicine. Qualities such as integrity and passion could never be conveyed through an arbitrarily conceived statistic read on a brief by a soft-handed suit. You are priceless as an excellent Doctor! Rock on Victo!

    Statistics remove any sense of ownership from the decisions insurance companies spawn, and thus remove any sense of guilt, shame, or remorse from their myopic mind-set. It is the capitalist way of course, to always reduce humanity to an abstract value rather than considering to ever capitalise on its profound worth.

    I too enjoy the photograph, thank you. Do you recall who the statue is of, and why it is associated with the inlaid Sun of Vergina on the floor?

    Thank you for sharing insight with bite 🙂


    DN – 25/10/2016

    Liked by 2 people

      • Hey Victo,

        The truth should prevail Victo, and the public made aware of unethical and immoral business practice. If by extension, a reader escalates their thinking and appreciates the travesty of having their miraculous planet spun on an axis of fool’s gold, and their lives dictated to by a small minority who have an unwitting propensity towards greed, wealth and power, then indeed your work here is done! It is wicked self-effacement and the culture that business idolise, which ultimately permeates all facets of life to strip real worth and impose arbitrary value, and finally leave all but gravity, the air we breathe, and the imagination as the three last great bastions of freedom for all.

        As to the statue…I was hoping you may recall who it was of? I have no knowledge to offer, but a curious interest to know more. I may do a little digging unless a sharp-eyed reader might know?

        Enjoy your weekend 🙂


        DN – 30/10/2016

        Liked by 1 person

  8. We just formed a new committee, which is really just renamed from the Customer Satisfaction Committee I headed up, called Patient Experience. One of our focuses is to look at the friggin star rating.It is always some rating to beat. And no, patients do not have a clue what the stars and surveys mean and the impact they have on the providers. That’s part of what I to do….create edumacation for da patients….” l

    Liked by 1 person

  9. My husband says if there are patients who care about those stars then he may not want them for patients (and they don’t want him to be their doctor, either). Win-win. I think he has a good perspective there.

    Liked by 1 person

  10. Wow. There’s no way a patient could know that’s what those stars mean. It’s really deceitful.

    The better you care for your patients, the lower your score; patients that swear by ratings fall off; spending is dually curbed and you’re sent the message that you’ll do less and succeed more or do more and succeed less.

    This is why your blog is so powerful. I would never know what a beast the medical industry is. Keep being a great doctor and writer!😁

    Liked by 1 person

  11. Pingback: Shooting Stars — Behind the White Coat | bellasartescom

  12. At a private hospital I used to work at they tried to get the doctors to only admit cases that made lots of money . The doctors went and admit their patients elsewhere and the hospital lost. Nothing of that sort over here in Australia.
    The doctors calls the shots not the insurance companies


  13. Rating? This sounds like Uber-Med…
    I am increasingly worried by your thoughts and comments on those topics. I never thought of the insurance companies taking over the world… A threat I had not seen coming. And they are barbarians, I mean they are actuaries for Pete’s sake!

    Liked by 1 person

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