3 ms·

When I managed a call center, we had employees that were amazing and accurate at repetitive and rapid tasks (1-2 min calls) and others that were comparatively b

When I managed a call center, we had employees that were amazing and accurate at repetitive and rapid tasks (1-2 min calls) and others that were comparatively better at slower-paced more deep-dive calls (30-40 min). We had elaborate routing rules that were matched to skill set and training. My job as a manager was to mix all of the data available to me into a plan that worked best for the collective team. Nevertheless, we still had to sometimes let people go that didn't have an effective place in the team. I did not find sufficient information in the article to determine if this was a management problem or a personnel issue. Without quantitative expectations of performance and safety trade-offs, the actual argument being made here is that a doctor can spend infinite time on a single case and never be reprimanded.

rob74 2y ago
The risk in a call center is generally that someone won't have their issue fixed and will have to call again tomorrow. I would say the risk in denying treatment to a cancer patient is a bit higher than that, so every patient should be entitled to a review of their case that is not skewed to increase the insurer's profits or rushed to meet some "productivity" metrics. Of course doctors shouldn't spend infinite time on a case, but if the only way to not fall behind is to quickly deny cases, then something is wrong...
- hermannj314 2y ago
  I did not explicitly state that call center and cancer treatment were the same. I was under the impression that management practices can provide insight across industries. There is an obsession that doctors are special and that no rules can apply to them excpet the ones they write themselves. As someone that has had two relatives die due to medical errors, I stopped drinking the cool-aid of God-complex doctors awhile ago.
crispyambulance 2y ago
> Without quantitative expectations of performance and safety trade-offs, the actual argument being made here is that a doctor can spend infinite time on a single case and never be reprimanded. Woah, hold on there, false dichotomy. It's NOT a matter of "Infinite amount of time" vs "quantified expectations with reasonable trade-offs". It's a matter of "a doctor putting in the time to be careful" vs "being pressured to take 2-5 minutes of to make LIFE-CHANGING medical decisions". At the end of the day Cigna cares about hitting their numbers to squeeze every last drop of profit while the doctors are being forced to live with the possibility of making a grave mistake being rushed at "burger-flipper" (or "call-center") time scales. I am on the side of the docs for this one.
- hermannj314 2y ago
  I didn't create a false dichotomy, you are doing the same thing as the article. You are setting absolutely no threshold for speed, except to "side with the docs" That implies your upper limit has no bounds either. I am not on either side, but this God worship of doctors in America is sickening.
JumpCrisscross 2y ago
> did not find sufficient information in the article to determine if this was a management problem or a personnel issue Dr. Day having put together the framework for IVIG “based on the scientific evidence available at the time” that “saved millions of dollars” such “that Cigna rewarded her with bonuses and stock options” seems to imply she can balance medical efficacy and speed. Given ProPublica “reproduced the [productivity] scores of 87% of the Cigna doctors listed; the scores of all but one of the rest fell within 1 to 2 percentage points” simply by “multipl[ying] the number of cases…handled by the time Cigna allotted for each type of case, then divid[ing] that total by the hours…worked that month,” and that the productivity score was used to threaten Day with termination, it would seem there is no safety factor being considered.
RyanHamilton 2y ago
>>I did not find sufficient information in the article to determine if this was a management problem or a personnel issue. She had been working at Cigna 15 years. If she was a bad employee, either she changed personality mid-life or Cigna never noticed in the previous decade plus.
- hermannj314 2y ago
  I have terminated employees with over a decade tenure. Skill decline, complacency, quiet quitting, etc. are all real. This is entirely hypothetical, but "I've worked here for 15 years" is irrelevant in a discussion of how effective you are at your job today.
acdha 2y ago
> I did not find sufficient information in the article to determine if this was a management problem or a personnel issue. It’s a management problem: she was there for 15 years and had a non-entry level position. Whatever she reported was deliberately created by Cigna’s policies – if not, they would have corrected those policies the first time she reported the problem. You can see the same pattern with the claim about being unaware of “click to close” or the refusal to clarify when their excuse about the dashboards being misunderstood was challenged. If this wasn’t intentional, someone would correct it the first time they saw patients being denied treatment and they’d easily be able to show, for example, employee training & review policies showing the opposite. We’re not talking about McDonald’s here, it would be very uncontroversial to have a policy that their medical doctors need time to get the best outcome for the patient – if that was actually their goal.
BobaFloutist 2y ago
If a doctor takes too long they shouldn't be reprimanded, the claim should be automatically approved since it's muddy enough to not be a clear and obvious denial. Health insurance companies can set the maximum time of review to whatever they want, and if the doctor doesn't decide by then, it gets approved. Doctors should also not be evaluated on % approved vs disapproved, since that provides a perverse incentive.
cmiles74 2y ago
The doctor in the article makes this point a couple of times as well: if the only metrics are "time to close" the particular file or case, that's the only metric they are being judged upon. Cigna clearly decided that they did not want to measure quality, only time-to-close.

rob74 2y ago

The risk in a call center is generally that someone won't have their issue fixed and will have to call again tomorrow. I would say the risk in denying treatment to a cancer patient is a bit higher than that, so every patient should be entitled to a review of their case that is not skewed to increase the insurer's profits or rushed to meet some "productivity" metrics. Of course doctors shouldn't spend infinite time on a case, but if the only way to not fall behind is to quickly deny cases, then something is wrong...

hermannj314 2y ago
I did not explicitly state that call center and cancer treatment were the same. I was under the impression that management practices can provide insight across industries. There is an obsession that doctors are special and that no rules can apply to them excpet the ones they write themselves. As someone that has had two relatives die due to medical errors, I stopped drinking the cool-aid of God-complex doctors awhile ago.

crispyambulance 2y ago

> Without quantitative expectations of performance and safety trade-offs, the actual argument being made here is that a doctor can spend infinite time on a single case and never be reprimanded. Woah, hold on there, false dichotomy. It's NOT a matter of "Infinite amount of time" vs "quantified expectations with reasonable trade-offs". It's a matter of "a doctor putting in the time to be careful" vs "being pressured to take 2-5 minutes of to make LIFE-CHANGING medical decisions". At the end of the day Cigna cares about hitting their numbers to squeeze every last drop of profit while the doctors are being forced to live with the possibility of making a grave mistake being rushed at "burger-flipper" (or "call-center") time scales. I am on the side of the docs for this one.

hermannj314 2y ago
I didn't create a false dichotomy, you are doing the same thing as the article. You are setting absolutely no threshold for speed, except to "side with the docs" That implies your upper limit has no bounds either. I am not on either side, but this God worship of doctors in America is sickening.

JumpCrisscross 2y ago

> did not find sufficient information in the article to determine if this was a management problem or a personnel issue Dr. Day having put together the framework for IVIG “based on the scientific evidence available at the time” that “saved millions of dollars” such “that Cigna rewarded her with bonuses and stock options” seems to imply she can balance medical efficacy and speed. Given ProPublica “reproduced the [productivity] scores of 87% of the Cigna doctors listed; the scores of all but one of the rest fell within 1 to 2 percentage points” simply by “multipl[ying] the number of cases…handled by the time Cigna allotted for each type of case, then divid[ing] that total by the hours…worked that month,” and that the productivity score was used to threaten Day with termination, it would seem there is no safety factor being considered.

RyanHamilton 2y ago

>>I did not find sufficient information in the article to determine if this was a management problem or a personnel issue. She had been working at Cigna 15 years. If she was a bad employee, either she changed personality mid-life or Cigna never noticed in the previous decade plus.

hermannj314 2y ago
I have terminated employees with over a decade tenure. Skill decline, complacency, quiet quitting, etc. are all real. This is entirely hypothetical, but "I've worked here for 15 years" is irrelevant in a discussion of how effective you are at your job today.

acdha 2y ago

> I did not find sufficient information in the article to determine if this was a management problem or a personnel issue. It’s a management problem: she was there for 15 years and had a non-entry level position. Whatever she reported was deliberately created by Cigna’s policies – if not, they would have corrected those policies the first time she reported the problem. You can see the same pattern with the claim about being unaware of “click to close” or the refusal to clarify when their excuse about the dashboards being misunderstood was challenged. If this wasn’t intentional, someone would correct it the first time they saw patients being denied treatment and they’d easily be able to show, for example, employee training & review policies showing the opposite. We’re not talking about McDonald’s here, it would be very uncontroversial to have a policy that their medical doctors need time to get the best outcome for the patient – if that was actually their goal.

BobaFloutist 2y ago

If a doctor takes too long they shouldn't be reprimanded, the claim should be automatically approved since it's muddy enough to not be a clear and obvious denial. Health insurance companies can set the maximum time of review to whatever they want, and if the doctor doesn't decide by then, it gets approved. Doctors should also not be evaluated on % approved vs disapproved, since that provides a perverse incentive.

cmiles74 2y ago

The doctor in the article makes this point a couple of times as well: if the only metrics are "time to close" the particular file or case, that's the only metric they are being judged upon. Cigna clearly decided that they did not want to measure quality, only time-to-close.