Selected Article
Title Going Undercover as a New Patient
Date Published 01/01/2003
Author Barabra Gerber
Publication New York Times

To anyone sitting in the emergency room of the hospital, Barbara Gerber looked like any other patient. She filled out forms, chatted with the triage nurse and plopped down in a chair to wait her turn. A half-hour later, Ms. Gerber was ushered inside and left in the hands of a paramedic. While he examined Ms. Gerber’s throat for the

cause of her bad cough, she gave him a thorough looking-over, too.

“Apparently, he had just gotten out of an ambulance,” Ms. Gerber said. “His shirt tail was hanging out and there was dirt all over his shoes. You’d expect someone to be dressed in white. His appearance didn’t inspire a lot of confidence.” Minutes later, after receiving a clean bill of health from the soiled, young paramedic, Ms. Gerber drove home, her work having just begun. She then dictated into her tape recorder, noting not only the paramedic’s appearance

but how long she had to wait in the emergency room of the hospital, which was in a small Northeastern town. The emergency room receptionist had been friendly, and the desk neat and tidy, she recalled. But on her way to meet the doctor, she was sent down a dark hallway. “I thought, ‘What is going on here?’ “ she

said. “ ‘Is this place closed or something?’ That could have been very frightening.” That emergency room may never be the same after her visit. Shortly thereafter, she filed a written report to the hospital. “I’m sure the staff was told to keep the lights on in the

hallways after that,” she said. While doctors are used to hearing patients grumble, few complaints carry more weight than Ms. Gerber’s. Rare in the health care industry, Ms. Gerber is a consultant hired by doctors and hospitals to rate their services by posing as a patient. Undercover consumers have long been used by retailers and hotel chains to improve customer service, but they

are gaining favor in the health care industry, as

more hospitals, health maintenance organizations and doctor’s offices try to improve reputations

and attract patients. “These sleuths are keeping the health care

providers on their toes,” said Diane Archer, executive director of the Medicare Rights Center, a health care consumer rights group in

New York. “We need more of them. And more power to them. They are uncovering important information ‘that helps to promote a more

accountable health care marketplace.” Ms. Gerber fell into the profession. Admitted to a hospital six years ago, she was

amazed at the attitudes and the services, good and bad. At the time, she was working as a hospital administrator and thought how easily

patient service could be improved by listening

to patient’s suggestions. As the owner of Devon Hill Associates, a

company based in San Diego that conducts health care marketing and sales training, Ms. Gerber soon added mystery’ shopping to her

repertoire. Since 1991, she has made undercover visits for 15 long-term care companies and has picked up three hospitals and a doctor’s

office as clients in the last three years. VISITS from Ms. Gerber are thorough and expensive. She encourages doctors

and hospitals to sign up for one or two inspections to try out the service. One visit costs as little as $400, but the price climbs

quickly to $5,000 for a regular inspection, which usually involves three or four visits. Clients who want Ms. Gerber long term, which

usually includes monthly inspections at 20 to

30 sites each year, can expect to pay about $60,000 a year.

The fee buys an inspection that almost

always exposes a few hospital flaws. Three

years ago, Ms. Gerber visited Chesapeake

General Hospital in Chesapeake, Va., inspecting

the mammography clinic as well as longterm

care facilities and the gym.

“Barbara actually came in and had a mammogram,”

said Becky Maples, vice president

for planning and marketing at Chesapeake

General. “None of the staff complained about

being fooled, but in a way Barbara was a real

patient.” While Chesapeake’s mammography clinic

met with Ms. Gerber’s approval, the hospital’s

gym did not. Because the hospital wanted to

attract people from the community to exercise,

Ms. Gerber was alarmed by what she saw as a

lack of enthusiasm among some of the hospital’s

sales staff. “Apparently, our sales people would show

people around the health facility, and they

would be good at giving information but

wouldn’t try to close the sale,” Ms. Maples

said. “It was something easy to correct, but we

may have not known about it had we not had

the viewpoint of someone who had actually

been through it as a shopper.” Some visits have provided a few surprises. Unstoppable in her critiques, Ms. Gerber once

From the front desk to the examining room, Barbara Gerber of

Devon Hill Associates in San Diego checks out how patients are

treated in health care facilities that hire her.

Sometimes she has a routine procedure, like a mammogram, and

sometimes she fakes an illness. made it all the way to the operating table to inspect an outpatient surgical unit. She

brought the procedure to a halt by telling the

surgeon, who was in on the ruse, that she

drank orange juice a few hours before, a disqualification

for anyone scheduled to receive

anesthesia. Afterward, Ms. Gerber dressed and went

home, but not before she noted that the surgical

staff had behaved professionally.

The operating room may appear to be

daunting territory, but Ms. Gerber said she has

little trouble getting inside. Because Ms.

Gerber has an inside contact at the companies

that hire her, she can arrange to have procedures

bent to allow her to complete her inspection

quietly. Usually, the extra hand isn’t necessary.

“Sometimes the client may give us a script

of what they want us to say to get in,” Ms.

Gerber said. “But getting inside the emergency

room is relatively easy. People come in there

with all kind of complaints that aren’t emergencies.

I can say that I have a shoulder injury

or a bad cough. They treat me as an outpatient.”

On most visits, she wears street clothes,

though sometimes she also dons a wig to avoid

being recognized. To be fair, Ms. Gerber and two of her

employees often visit a site three times before

writing a report, taking care each time to note

the good with the bad. One emergency room

receptionist was written up for repeatedly turning

her back while quizzing one of Ms. Gerber’s colleagues

about her health history.

If the hospital staff cannot make enough

mistakes on their own, Ms. Gerber joyously

provides some ample opportunities. One of her

favorite ploys is to refuse to give her birth date

to emergency room registrars, Few hospital

employees are willing to accept no for an

answer and spend as much as a half hour badgering

her for it. “Not giving your birth date can sometimes

be a real problem for them,” Ms. Gerber said.

“The computer may not print the form out if

all the blanks aren’t filled in. it’s interesting to

note how upset the hospital staff person gets.

The goal is to make the patient feel comfortable,

not hound him.” WHILE patient posing may be new to

the health care industry, other forms

of consumer inspection are also at

work. Elizabeth Moore, 75, a retiree from

Denver, started shopping last April for a

Medicare H.M.O. for herself and her 88-yearold

husband, Thornton, and was appalled by

what she found. After sending questionnaires

to five H.M.O.’s seeking details

on their coverage, two refused to respond,

and she later discovered that the other three

had given inaccurate answers.

Roiled, Mrs. Moore became one of the

worst enemies of H.M.O.’s in Colorado. To

warn the elderly about problems of Medicare

H.M.O.’s, she developed her “10

Commandments,” a set of questions that consumers

should ask before buying a policy. And

she is setting up a Web site (http:// Last summer,

she sent the list to Colorado legislators, who

are considering a bill that would require

H.M.O.’s to make their policies easily comparable

so the elderly can understand them.

Mrs. Moore has made her commandments

available to anyone in the United States who

wants them. As of last week, she had mailed

out 320 copies in Colorado alone.

“The point is that if you don’t do this kind

of shopping, then consumers can’t make good

decisions,” Mrs. Moore said. “Some of these

facilities don’t want consumers to shop. That’s

all the more reason to do it.”