"Secret Shopper" Patients Improve Medical Care, Documentation, and Spending

CHICAGO - July 8, 2020 - PRLog -- Actors working for the Institute for Practice and Provider Performance Improvement, Inc. (I3PI) made undercover visits to 59 New Jersey doctor's offices to gather information about how doctors treated common conditions. I3PI provided feedback between rounds of visits. Doctors substantially improved in the care they provided for smoking cessation, back pain, and depression, wrote more accurate notes, and, compared with nonparticipating practices, spent less in treating diabetes and depression in their actual patients.

According to Alan Schwartz, PhD, I3PI principal and lead author, the study, published in the Journal of General Internal Medicine and conducted in partnership with the American College of Physicians and Horizon Healthcare Services, Inc., is the first to demonstrate that medical secret shoppers (also known as "unannounced standardized patients") can not only identify areas to improve care but can have impacts on insurance claim patterns among real patients of practices visited.

The doctors agreed to participate in the program, not knowing when they would receive visits from actors over about 12 months. The actors carried used the same scripts for each doctor they visited, so feedback could show doctors how they performed compared with many others. Horizon helped I3PI compare changes over time in insurance claims between the participating practices and a similar group that did not participate. "The secret shopper program yielded tremendous insights for the clinicians that participated. We were delighted by the level of commitment by the practices, the quality of the information gathered by the actors, and the openness to feedback among our clinicians," said Steven Peskin, MD, MBA, Executive Medical Director Population Health and Transformation at Horizon and a study co-author.

Doctors performed 53% more recommended clinical practices in the post-feedback visits than the pre-feedback visits, Notes from post-feedback visits were also 26% less likely to report physician behaviors that had not actually occurred. Office visit claims by actual patients of participating practices in periods before and after the visits compared with nonparticipating practices showed slower spending increases for patients with diabetes and depression (where better management leads to fewer office visits) and and increased cancer screenings and physical therapy claims for back pain (consistent with reduced use of opioids).

"One of the best things about secret shopper studies is that they don't require doctors do anything but provide usual best care," explained Saul Weiner, MD, I3PI principal and study co-author. "The unannounced standardized patient approach is the only one that measures quality through direct observation of the patient-doctor interaction," added Alan Spiro, MD, MBA, I3PI principal and study co-author.