Online consumer ratings of healthcare services are a reality. On sites like Yelp!, Angie’s List, and RateMDs, a growing number of patients can (and do) rate their physicians and hospitals on a variety of factors related to service and treatment. Other patients place a very high value on individually-reported experiences, so much so that researchers found that a single, emailed anecdote from a relative held as much weight as ten quality ratings graphs from the validated quality tool, HCAHPS (1).
What influence will online ratings have on healthcare? At this early stage, there is both great enthusiasm for and great resistance to their use in decision making.
Not all providers welcome consumer ratings.
It seems a significant subset of physicians believe that patients are incapable of assessing the quality of their healthcare services. Some doctors have even tried to prevent their patients from doing so by requiring patients to sign a “no negative review” agreement – restricting online reviews (2). One company actually specializes in creating contract language allowing physicians to legally remove any patient reviews from websites, preventing a forum for what some might call honest feedback (3).
What does it mean when an industry tries to block efforts to gather consumer input about services? Would we understand if airlines claimed that travelers should not be allowed to rate their travel experience because the average consumer cannot understand the complexity of aviation? Or if cell phone providers claimed that consumers are not qualified to judge technology because telecommunications is beyond their comprehension? Doubtful.
Is it because doctors have never been scrutinized in this way?
It’s interesting that doctors have been largely sheltered from public customer reviews. Consider how commonly all of us consult some sort of consumer report before making major (and even minor) purchases on just about everything!
When I shop on Amazon for a book or a product, I always glance at the buyer reviews. If there are only one or two, I may not pay much attention. But if there are a lot, I look at the typical rating and then also read a few of the most negative and most positive lowest. Sometimes the outliers seem too extreme to be real, other times they have useful information. Regardless, I do realize that I am reviewing opinions based on individual experience, and that I am still at liberty to buy the product or not.
In most industries, sellers actually desire and encourage consumer reviews, because they improve the overall exposure of their product, and in the case of great products and services, they capture free testimonials that draw more customers.
So why are some healthcare providers so deeply opposed to public ratings?
It seems that many fear they will be rated on waiting time or bed-side manner instead of their professional and clinical skills. Others presume that only extreme reviews (positive or negative) will get posted, leading to biased results. In one article, a gynecologist confessed that she read several positive patient reviews on a fellow doctor that she personally “wouldn’t trust to deliver her mail, let alone her baby” (2). Yet, the doctor did not suggest she would help patients by publically identifying this untrustworthy colleague.
So sure, consumer reviews may endorse doctors who haven’t the clinical expertise to deserve it, but isn’t this exactly the reason we need more information? How are patients supposed to identify the terrible docs if the medical profession doesn’t share this information with the public? It is hard to argue that patients reporting their honest experiences is somehow worse than doctors keeping quiet about fellow physicians they don’t trust.
In a marketplace where consumers are increasingly being held accountable to make healthcare decisions, the lack of reliable, accessible, and understandable information has created a vacuum that is being filled. Rather than try to maintain the vacuum, providers should fill it with better information. Either patients will get it from other sources, or they will begin to rely on each other.
What about trained reviewers instead of consumers?
Recently, government-sponsored researchers announced plans to use fake patients to determine how many physicians will be available to take on the coming influx of Medicaid-eligible patients (4). According to researchers, when asked by officials in phone interviews, more doctors report an intention to accept new patients than actually do so when new patients come to the office. Further, there are anecdotal reports that Medicaid patients are treated differently by staff. Thus, fake patients were trained to gather the information. However, one day after media coverage of the fake-patient study, the department for Health and Human Services called it off, citing complaints from physicians about spying on unsuspecting doctors (5).
Once again, some physicians were outraged about being observed (this time in secret by trained individuals), yet this approach differs little from many industries where unidentified reviewers provide useful objective feedback (for example about university professors).
Evidence that consumer feedback is surprisingly representative of other quality ratings.
It may be easy to dismiss patient ratings, as one doctor commented, as tabloid journalism not relevant to actual medical quality. But, not so fast. At a recent Academy Health presentation, researchers reported that patient ratings on Yelp! have a similar distribution as official HCAHPS scores. In other words, relatively the same portion rate hospitals highly and poorly in both measures—refuting popular opinion that only extreme views are shared online. Further, for hospitals with sufficient numbers of posted ratings (at least 5), Yelp! ratings correlate strongly (+0.5) with formal HCAHPS scores (6).
Why this matters: With the exponential growth of social media sites that include ratings of virtually every type of product or service, we can expect more consumer commentary about healthcare in the future, not less. Because patients want and need better information, we can also expect rating systems to improve in both volume and validity. Regardless of how strongly some providers object, one has to believe that more transparency about safety, quality, price, and – yes – service will help the entire system improve. That is, as long as we solicit and receive honest feedback.
1. Huppertz JW, Carlson JP: Consumers’ use of HCAHPS ratings and word-of-mouth in hospital choice. Health Serv Res 2010;45:1602-13.20698896
2. Tanner, L. Doctors seek gag orders to stop patients’ online reviews. USA Today, Mar 5, 2009; (accessed Jul 18, 2011).
3. Medical Justice.com. (accessed Jul 18, 2011).
4. Goldberg, C. Mystery Medicaid Shoppers Coming To Massachusetts? Common Health wbur.org , May 5, 2011; (accessed Jul 19, 2011).
5. Government won’t use ‘mystery shoppers’ to investigate physicians. The Patient Life, Messenger-Inquirer, Jul 1, 2011; (accessed Jul 19, 2011).
6. Academy Health. 2011 ARM: Consumer Engagement, Choices and Decision-Making Theme Sessions. (accessed Jul 18, 2011).