How Doctor-grading Websites Can Impact Your Practice

“Her MA is very rude, uncompassionate. Dr. ABCD doesn’t return phone calls. They’re not helpful and not good with following up with the care plan for patients. We’re new seeing this doctor, but will never go back. I would not recommend this practice at all!!!!!!”

How would you handle a comment like this when found on your patient satisfaction surveys? What if, even worse, this comment was found about you on the Internet. This is an actual comment about a physician found on a website that rates physicians. So, what is doctor grading, how have things changed recently, and what can you do about it?

Doctor grades Rating physicians has been part of the “business” for years. In the past, the grading was done formally by utilization review or quality assurance committees at the hospital. It has also been “controlled” by lawsuits and by the various state medical boards. This type of information was maintained “internally” to the medical community.

The other method of rating was via word of mouth. This has been the most effective way to market a practice, but it also has been equally effective in losing patients. It has often been stated that one bad experience will be heard by 10 others, whereas one good experience will only be heard by one.

As we move into the new decade, the era of public rankings is moving full speed ahead, and the real issue is the online rating sites and what they can do for, or against, you.

Online

A recent survey in New York returned results from physicians who said 27% of their patients find their providers online, that 46% of them use a health plan website to do so, and that 31% of them are commercial (From MGMA presentation; reference coming). Making matters worse is that Americans can now go to any of at least 10 websites to find out how well you are doing in taking care of your patients. These sites use questionnaires or allow for posting comments. You may find yourself with stars by your name, a smile or sad face, or a numerical score. If you do a survey and 95% of your patients are satisfied, what are the other 5% doing? They could be writing poor reviews on such sites. In any event, consumers are being encouraged to forgo what their neighbors have to say and instead check you out on the Web. Let’s look at a few sites:

• With 7 million visitors to its site each month, Healthgrades.com is probably the most utilized and sophisticated site. It offers free reports, but more often than not, interested parties must pay a fee of $12.95 per physician to get a complete report.

• Angieslist.com: Yes you, along with the local plumber and painter, can now be found on Angie’s list. This site allows for posting of comments about you from anyone and rates you based on beside manor. There is a membership fee to join, but comments can be posted without membership on selected items. The patient is required to sign their name, giving you an opportunity to respond or follow up with him or her.

• RateMDs.com uses patient comments and marks with a smile, neutral, or sad face in measuring four categories: punctuality, helpfulness, knowledge, and a five-point quality scale.

• Additional sites, such as physicianreports.com, vitals.com, bookofdoctors.com, mydochub.com, drscore.com, healthcarereivews.com, and doctorscorecard.com, provide rating information as well.

• Patients can also find “grades” posted on managed care-sponsored websites.

These sites do not offer sophisticated opportunities to review actual medical outcomes or quality measures. They are measuring the importance of bedside manner, wait times, and other non-quality measures.

What happens on these sites, and why

There are several options from which you may choose to reactively, proactively, realistically, or unrealistically deal with physician rating sites.

First, it is important to recognize the role of the patient in this digital era and what you can do with the information that is discovered. The Google search engine folks indicate that they get 60,000 hits per second on health- and healthcare-related topics [need reference]. So, from where do these 60,000 hits come? They’re from people who:

• Search sites like HealthGrades.com to find out about you. Search results can reveal your education, training, and in some cases, your malpractice history.

• Report on their doctor’s office visits, which more often than not represent the extremes; either they are very happy or very unhappy. Of these, most are unhappy and can be related to delays in being seen or unfriendly staff.

• Search the Web for information on their symptoms and come prepared with a diagnosis and treatment plan for you to endorse.

• Go to their insurance carrier website to either find you or to find out about you and their insurance company’s ranking.

How do you deal with the Internet?

The time and effort put in by you or your staff is significant in dealing with this issue. Following is what one practice chose to post on a website in response to negative comments:

“We at the [Doctors office] would like to make it clear that the poor reviews listed on this site over the last several weeks are written by a single woman who is logging on under "shadow" alias' which are easily obtained through yahoo and leaving slanderous emails. Please note the use of capitalized letters in all e-mails and the truly disparaging remarks which are a common theme in all of the emails. They should not be interpreted as being legitimate in any way. We have reported her to the correct department at yahoo and an investigation is underway. We encourage anyone to talk to a legitimate patient or family member at our clinics if one takes her comments seriously. Please feel free to call our clinic and ask for a patient or patients’ family to discuss options with. Many have volunteered after seeing these statements. They do not reflect our clinic or our clinic’s goals.”

Others have asked patients to pledge that they would not post anything on a website, even going so far as asking patients to sign a document. But could this make it appear that they are hiding something?

Several key approaches should be considered when dealing with Internet grading or “gossiping” sites, all of which should be done in a realistic and proactive manner. Reaction to a negative comment on a website will be taken as defensive and will not have the desired outcome.

Instead, we recommend that you do several things:

1. Be aware. Simply being aware of these sites is a key step. The best way to find out what is on the Internet about you and your practice is to search online for your name and/or the name of the practice. You will likely find sites with comments and rankings that you were not aware of. In some cases, it may be beneficial to pay the fee to join these sites in order to be able to continuously monitor what is being said, so that your patients don’t start dropping off and you don’t know why. This activity should be assigned to a staff member.

2. Understand what each site is measuring and how they are determining the rankings. Often, there may be only one comment posted, which results in a low grade. While this may not be statistically significant, to the reader, it will not make any difference. Understanding the metrics and measurement formula will be important. If you find a site that has a negative rating based upon one report, you may choose to print and post it in your reception area (we don’t have waiting rooms) as an educational tool for your patients.

3. Take action. Once you are aware and understand what is behind the grading systems, it is time to act, similarly to how you (hopefully) do with your patient satisfaction information, when you discover the findings. It is not bad to hear negative comments if you learn from them and use them to improve the practice. If you choose a defensive response and do not recognize that what is being said may be a legitimate response, you are missing the boat. A thoughtful and truthful analysis of your practice will yield positive results for your patients and for you.

4. Develop a practice website, or update the one you have had for three years. If patients are searching for you online, it helps for your website to be one of the first page options they see. You control the information and can send positive messages about who you really are, what services you offer, and key policies that affect the patient. And, you can offer secure logins for appointment and patient registration, links to other key websites, and more.

It is important that at your next practice board or management meeting that you review how you can and will respond to the Internet grading and gossip system. We believe a positive, thoughtful plan will bring more benefit than a defensive, negative response that may be your first reaction to the perceived negativity that is on the Web.

From HCPLive blogger KevinMD.com

How Doctors Should Deal with Physician Rating Sites

Stuff the ballot box. The value of these sites, previously exposed as pretty useless…, is mainly due to the anonymous nature of the comments. Indeed, even if a doctor wanted to genuinely improve from this form of patient feedback, “posting anonymously on the Web (on sites a doctor does not regularly monitor) is probably the least effective way to accomplish that goal.” So, physicians are fighting back by skewing the reviews… in their favor. A couple of good ideas: i ) Have patients fill out comment cards in the office that can later be posted on physician-ratings Websites; and, ii) Direct satisfied patients to these sites and encourage them to comment. A doctor utilizing these techniques can skew their positive to negative comment ratio 50-to-1, so that, “The bad ones are totally ignored since they look so petty.” The lack of regulation works both ways.

Poll: What Should Doctors Do if Patients Give a Negative Online Review? Patient reviews can be manipulated. It’s easy for a doctor or his staff to counter negative reviews by posting numerous positive ones. And how can one be sure that the reviewer is even actually a patient? Or just someone with an ax to grind against the physician? Doctors are bound by patient privacy laws that prevent them from issuing specific rebuttals. Also, a physician typically has only a handful of reviews — hardly a representative sample. So patients should be cautioned against making judgments based on such little data. But online physician ratings can have value. We don’t have our own system for getting feedback from our patients. These unfiltered patient voices provide a window into what patients look for in a medical provider and can help doctors constructively improve their practice. Doctors who dismiss online reviews do so at their peril. Reviews are indexed by search engines, and patients will find them when they type your name into Google. Physician review websites aren’t going away any time soon. It makes sense to find a way to work with these sites. The medical profession can help improve the reliability of online ratings by ensuring they’re written by actual patients, and are based on real encounters.

[Results of the poll show that 56% of physicians have searched for patient ratings of themselves online]

The Big Doctor-grading Sites

ABMS.org

Free search to see whether a doctor is board certified.

Angieslist.com Members to this site submit 40,000 new reviews each month, some of them under the “Health” category, which covers pediatricians, primary care physicians, psychiatrists, and more.

ConsumerHealthRatings.com Links to many state sites that collect performance data on hospitals and doctors.

DoctorScorecard.com Patients search by state to find doctor ratings on a scale from 1-10. Comments can also be read.

HealthGrades.com Complication and mortality rates for 28 kinds of care at 5,000 hospitals (free); reports on doctors, including board certification and disciplinary actions ($13).

RateMDs.com

Nearly 880,000 ratings on nearly 215,000 doctors, with just under 1,000 added on February 5, 2010. Patients can search by zip code or specialty.

DrScore.com Patients can complete an anonymous, free, patient satisfaction survey in 3-5 minutes.

Mr. Dahl is the founder of Owen Dahl Consulting (www.owendahlconsulting.com), The Woodlands, TX. Mr. Rahman is an assistant administrator and pharmacoeconomic specialist for Oncology Consultants, PA, Houston, TX.