The Secret Shopper

The "secret shopper" is one of several methods used to monitor access to care by the National Committee for Quality Assurance (NCQA). It was listed as a recommended example in Surveyor Guidelines for the Accreditation of Managed Behavioral Healthcare Organizations and was removed in 2001 from NCQA’s list of examples because of concerns raised by NASW and other behavioral health provider groups. Although it is no longer recommended by NCQA, it continues to be an "accepted" practice.

To monitor access to care, a secret shopper calls a behavioral health care provider and requests an appointment under an assumed name. The appointment time is documented to assess whether the provider met the contract specifications for providing an appointment. Many clinical social workers object to such practices because it is done under false pretenses. NASW Board of Directors (BOD) opposes "secret shopper" as a way of monitoring contracts with managed care providers.

Some clinical social workers have reported that social workers are being utilized as secret shoppers. Managed care companies (MCCs) denied this when NASW inquired about it.

Apparently, administrative assistants are hired and trained to work as secret shoppers. NASW BOD advises that social workers who pose as patients to monitor their peers on behalf of MCCs may be in violation of the NASW Code of Ethics.

NCQA has reported that some organizations may need to continue the secret shopper throughout the remainder of their accreditation cycle to comply with NCQA’s requirement to measure their effectiveness in providing accessible care to patients. Other organizations that are not in an accreditation cycle are free to select another method without penalty. Some social workers are unhappy with NCQA’s position with the secret shopper and prefer that it be replaced during a managed care company’s accreditation cycle. However, many MCCs are reluctant to jeopardize their accreditation status during an accreditation cycle.

NASW BOD also urges social workers entering into contracts with MCCs to be familiar with the mechanisms used to evaluate their practice so they can comply appropriately. Social workers who disagree with the secret shopper methodology may not renew their managed care contracts or initiate new ones.

Social workers from the northeastern region of the country have expressed dissatisfaction with the secret shopper. It is unknown at this time whether social workers from other areas are also affected. NASW would like to hear about secret shopper experiences from social workers across the country to determine the extent and effect of this practice on clinical social workers. Therefore, NASW has established a designated hotline voicemail at 1-800-638-8799, ext. 450, and an e-mail address, sshopper@naswdc.org., to gather additional information.

Doc# 929