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Physicians are now being reviewed online, like restaurants and hotels. What's the right way to react to this trend?
Anytime Andy Pasternak, a family medicine physician in Reno, Nev., needs a slice of humble pie, he turns to one source.
"Usually if I am feeling good about myself and want to keep myself hungry, I'll Google my reviews," Pasternak says.
Indeed, some of the reviews on Pasternak's Yelp page (bit.ly/silver-sage-yelp) are downright mean: "Limited and narrow-minded way of thinking," "distracted from his job as a primary-care doctor," and he has an attitude that is "dismissive."
Not all of them are bad, and overall, his Silver Sage Center for Family Medicine has more positive ratings than negative ones. He has a three-star rating on Yelp and Vitals, and three-and-a-half stars on HealthGrades. Top-end restaurants in New York have been ranked worse.
For many docs though, the negative reviews stick out. While some may be warranted, physicians feel many come from people with grudges. "I've found them to be a little frustrating because for most of the online review sites, there was no way for me to be sure people writing the reviews had actually seen me in the office," says Ira Nash, an internal medicine physician and senior vice president of the North Shore-LIJ Medical Group, with various locations in New York.
These sentiments are echoed by a number of doctors not exactly enthralled with the idea of their professional expertise being judged on Yelp, HealthGrades, Vitals, or any other website. Yet for better or worse, research shows that online reviews are how they're increasingly being discovered and judged.
A survey of approximately 3,000 patients, from Boston-based health tech company Nuance, discovered that more than half of millennials (the generation of patients in their mid- to late-30s and younger) say they use online reviews to shop for a doctor. Another survey, from Austin-based consulting firm, Software Advice, found that 42 percent of all patients said they used online reviews in 2014, which was up from just 25 percent in 2013. "We're starting to see the shift in online access to individual provider information becoming more real, and more real to individual providers," says Anthony Oliva, the national medical director at Nuance.
Driving this demand is a conglomeration of consumerism and technology, according to experts. Patients expect it, says Nash, as part of a larger culture where all forms of decision making (from going to a restaurant to picking a pair of shoes) can be crowdsourced. Furthermore, consumerism has been integrated into healthcare, as part of the shift from volume to value. While the government isn't using a physician's Yelp score to determine Medicare reimbursement, there are the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and Clinician & Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) surveys. The HCAHPS is given to patients at discharge and can have an impact on a provider's Medicare total reimbursement, while CG-CAHPS is required as part of the Physician Quality Reporting System.
Moreover, thanks to the Internet and other technological innovations of the last 20 years, patients are more empowered than ever to make healthcare-related decisions. It doesn't just stop at picking a provider. The Nuance survey reflects how younger patients are coming to the doctor's office armed with health information they found online. A survey from the Pew Research Center found that 72 percent of Internet users (87 percent of people surveyed) looked online for health information.
"There is pressure from marketplace to perform and meet patients' needs in ways there haven't been in the past," says Tom Lee, the chief medical officer of Press Ganey, a South Bend, Ind.-based software vendor that allows providers to survey patient satisfaction. "Meeting patients' needs hasn't exactly been front and center in eras past."
FAIR OR NOT?
Docs have differing opinions on whether or not online reviews help or hurt them. While he is an advocate of patients being involved in the decision-making process, Pasternak notes that providing someone with healthcare isn't exactly the same as providing them with a good meal.
"Healthcare is definitely a service industry and we're here to make patients and their families happy … but in many ways, it's a different model than having a restaurant or hotel. Oftentimes, a patient may request something … and it may not [be] appropriate or needed. It puts us in a situation where we know we will be judged, you kind of have to balance what the patient wants with what they really need," Pasternak says.
Nash adds that physicians are committed to excellent customer service, but there is a lot of skepticism that this is a valid way to check how they are doing. Lee says that in some cases, physicians have every right to be irked. "Who wouldn't be angry with ratings based on a small number of patients, many of whom weren't their patients in the first place or were biased toward negativity," Lee says.
Despite the flaws and an overall weariness toward online reviews, some physicians are embracing the change. Braun says many providers welcome the opportunity, as long as it's a fair dialogue. "As physicians, our first and foremost concern is the patient's well-being and this will trump the concern of getting a fantastic online review or avoiding a less than ideal one," he says.
Tod Baker, CEO of MDValuate, which provides physician performance analytics based on consumer-facing data, sees a generational divide between the providers who are OK with online reviews and the ones who are against it. "In my experiences, younger docs seem to be more acclimated to consumerism … It's easier for them to swallow. Some older docs have embraced it, but some are still fighting, kicking, and screaming. The ones closer to retirement … they think they can ride it out. Younger than that … they realize this is here to stay and part of their career," he says.
Baker adds that most physicians would prefer to be rated on quality outcomes, rather than something that could be construed as arbitrary. In that regard, Yelp announced it is teaming up with ProPublica, a non-profit, research journalism organization, to provide statistics-based care information, compiled through CMS databases, on a care facility's website.
HERE TO STAY
So how should physicians treat this emerging phenomenon? Whether they accept it or not, all experts agree that it is here to stay. Other than those in Baker's scenario who are close to retirement, the physician of the future will have to deal with being judged through a computer screen moving forward.
Many, like Aaron Braun, the medical director at SignatureCare Emergency in Dallas, advocate for a simple solution: "Every provider and their staff should strive to provide a great patient medical experience by being compassionate, empathetic, and delivering great care. This should usually result in positive online reviews," he says.
Pasternak tries to take the extra step. If someone seems agitated, he'll make sure he takes more time to figure out what he can do to make the experience better. "I've been trying to be just a little more proactive with patients, especially if I sense they may not be satisfied, so we can just avoid the whole issue to begin with," he says.
He also has used bad online reviews to improve his processes. He had a bad review with the way a referral process was done and implemented changes to ensure it wouldn't happen again.
Taking a proactive approach is one that many believe in, even if it's something a little simpler, as in 'Pasternak's case, or something more aggressive.
"Providers should take ownership and take control of this and do it right," says Press Ganey's Lee. "By doing it right I mean, they should be trying to survey as many patients as possible."
Nash's organization has gone down that path. The medical group electronically surveys patients on their experience and posts each physician's ratings on their page. Nash says NorthShore-LIJ's process, unlike Yelp, HealthGrades, or Vitals, ensures that the patient was actually seen by that physician. The group is using these surveys to motivate physicians (see related sidebar).
Oliva at Nuance says there is something to the motivational benefits of being reviewed in this manner. "Physicians are motivated by reputation even stronger than most professions. Making this information transparent to them will get them to move, more than throwing dollars at them," he says.
THE OLD FASHIONED WAY
For organizations like NorthShore-LIJ Medical Group, which is owned by a large health system, embracing transparency is a matter of delineating the right resources. For smaller physician practices, those kinds of resources are not available. They have no choice but to live with Yelp, HealthGrades, Vitals or some other website as their source of being reviewed.
For those practices, they can conquer their pages with, as Braun implied, good old-fashioned care. Baker says he believes that 90 percent of the issues on those sites come down to better interpersonal skills. "If you actually make eye contact, smile, walk people to their room … it's [basic] patient/human-being interaction. If you do those things, you can manage [most] of this," Baker says.
* Physicians Practice readers, we have more articles and guides on physician review sites at PhysiciansPractice.com. Read a “How-To” guide on dealing with a bad review here. Also, Tod Baker, CEO of MDValuate, shares more tips for physicians.
Gabriel Perna is managing editor for Physicians Practice. He can be reached at firstname.lastname@example.org.
This article was originally published in the January 2016 issue of Physicians Practice.