Do Online Ratings Matter?

Larry Schlesinger doesn’t much care for online rating services that let patients bash their physicians under the veil of an anonymous post. So he’s taken matters into his own hands.

Starting in 2007, the plastic surgeon in Maui, Hawaii, who has practiced medicine for 28 years, began asking his new and existing patients to sign a legal contract that precludes them from posting online ratings (either rants or raves) about the treatment they receive at his office. Any statements they do post about his services become his property under copyright law.

To date, says Schlesinger, 100 percent of the nearly 12,000 patients he has asked to sign the contract, which was created by malpractice defense firm Medical Justice in Greensboro, N.C., have done so without hesitation. Why? In return for their discretion, he grants each patient additional privacy protection beyond that mandated by HIPAA or state confidentiality laws.

“Physicians in all specialties are very honorable, hard-working people, and we live or die on our reputations,” he says. “If someone assaults your reputation - internationally - by spewing venom on the Internet, that’s unhealthy for the person putting it up and for the doctor, and it’s a really mean thing to do. Patients who demand their right to do so should probably not be your patients.”

Patient contracts are but one of the many responses by the medical community to the proliferation of Web-based rating services. Feeling suddenly vulnerable to consumer review, physicians across the country are grappling with how best to respond- whether it makes more sense to maintain a low professional profile or harness the power of the Internet to their advantage.

New to consumer review

More than 30 such doctor rating sites exist today, including pioneers RateMDs.com and Healthgrades.com, and their ranks continue to swell. In 2008, for example, national health plan Anthem and the nation’s largest health benefits company, WellPoint, both partnered with restaurant- and hotel-rating guide Zagat to let consumers share their physician experiences with others online. Angieslist.com and Yelp.com are also gaining ground in the MD rating space.

Advocates, of course, say rating sites are a plus for healthcare consumers who previously had few tools with which to compare physicians on everything from communication skills to waiting room cleanliness - and even fewer opportunities to evaluate their doctors using patient-to-patient review. It’s a high-tech, modern day equivalent of chatting with your neighbor over the backyard fence.

Many physicians, however, contend that consumer review Web sites perform a disservice to patients because their sample sizes (of respondents versus the patient population) are statistically insignificant, and they may actually encourage patients to pick physicians based on factors less significant than quality of care.

“We think these Web sites are a little ahead of their time,” says Jeffrey Segal, a neurosurgeon and chief executive officer of Medical Justice. “If you’re trying to pick a surgeon, most people would choose to see a highly competent jerk versus someone less qualified with wonderful bedside manners. The bottom line is that we’re not going to marry our doctors. Not all things are equal.”

Another criticism of MD rating sites is that many allow registered users to post anonymously, giving not just unhappy patients a forum to sully your reputation but disgruntled former employees, embittered ex-spouses, and unscrupulous competitors as well.

Online rating services, of course, aren’t exclusive to physicians. Most service providers and product manufacturers have been subject to consumer reviews for decades. But Stewart Gandolf, founding partner of healthcare marketing firm Healthcare Success Strategies in Irvine, Calif., says the trend has been a harder pill to swallow for doctors who have had little exposure to the “dirty world of business marketing.”

“No one in corporate American likes ratings sites, but healthcare is really the deer in headlights because they’ve been so isolated,” says Gandolf, noting that marketing of professional health services was illegal until 1977. “There are a lot of doctors who are very uncomfortable with this thing they can’t control and think, ‘You’ve got to be kidding me. I had enough to worry about before.’”

The only thing we have to fear…

Yet, Steve Feldman, a practicing dermatologist, professor of dermatology, pathology, and public health sciences at Wake Forest University in Winston-Salem, N.C., and founder of physician rating site Drscore.com, says his colleagues have nothing to fear. “These Web sites are actually one of the best things ever to happen to American medicine,” he says. “Think of it this way. When you give the right diagnosis [which happens the majority of the time] no one ever hears about it, but God forbid if one of your patients has an unfavorable outcome or is harmed in some way - you can believe that’s front page news.”

Web sites such as his, he says, give satisfied patients an opportunity to sing your praises. Indeed, the median score of a doctor with 20 or more ratings on his Web site is 9.3 out of 10. “Patients love their doctors,” says Feldman. “It’s amazing how good doctors are in the United States and no one knows it.”

How to raise your score

If you find your name in lights on an online rating site, and eventually you will, don’t despair. The important thing to remember is that your score isn’t set in stone. There are ways to bring up your rating and at least a strategy or two to combat negative posts as well.

Gandolf says the best way to boost your score is to encourage your patients to counter negative posts with positive ones. “The genie is out of the bottle,” he says. “You can’t control it. The only thing you can do is to have legitimate patients put up posts on their own.”

That means asking some of your patients after your exam, especially those with whom you’ve established rapport, to share their thoughts on the online rating sites that are most popular in your area. “A lot of doctors feel really uncomfortable about this, but that’s what their more business savvy competitors are hoping for,” says Gandolf. “It makes it easier for them. Very few doctors do this so the ones who do will have a huge advantage.”

It may seem counter intuitive, says Feldman of Drscore.com, but it can also be helpful to ask your disillusioned patients to rate you as well. “Some patients I see are clearly unhappy,” he says. “Maybe they waited a long time, or are suffering from some disease and have seen multiple doctors without resolution. I just say, ‘Listen, I know things weren’t perfect today. Please go to this Web site and give me an anonymous rating so I can do better the next time.” That alone, he says, gives them a sense of release “so they don’t have to call a lawyer to take it out on me.” Equally important, Feldman notes, it communicates to his patients that he truly cares about his performance and values their opinion.

According to Gandolf, the proactive approach of asking your patients to rate you has one other distinct advantage: “It’s huge in helping your practice get ranked in the search engines,” he says. If you type in “family physician” and “Cleveland” in the Google search engine, for example, you’ll pull up a seemingly random collection of the top 10 practice listings on Google Maps. That search engine, along with Yahoo! Local, uses a number of criteria to determine which of hundreds of physicians to call out. “They decide who makes that top 10 list out of the entire area based on a number of factors, not just ratings, but it really helps,” says Gandolf.

When the comments aren’t true

Where damaging or patently false comments are concerned, you also have some (limited) recourse. For its part, RateMDs.com notes on its Web site that doctors who disagree with a rating can either create a free account on their site, then click the “registered users can respond to this rating” link just below the rating to write a reply. “If you think the rating is incorrect and should be removed, click the red flag icon next to the rating and tell us why it should be removed,” the Web site states.

You can also, of course, follow Schlesinger’s lead and hire a company like Medical Justice to provide written contracts that preclude your patients from rating you online without your permission. As part of its service, which costs $495 for the first year and $350 each subsequent year, Medical Justice monitors the posts on physician rating Web sites. If any negative comments pop up pertaining to the physician they write to the Internet Service Provider (ISP) and demand it be removed. “Asking patients to sign a contract won’t increase or decrease their level of trust in you,” says Segal. “Ultimately that’s something you establish as their physician. a contract in place just gives you a tool to control the destiny of that content.”

Segal notes that it’s important to emphasize to patients that the contract is “not a gag order.” “The patient is still free to discuss their treatment with friends and family, their hospital, the medical licensing board, and an attorney so they can use any number of venues, but because the stakes are so high online we want to foreclose that opportunity to post online,” he says.

Listen and learn

The upside to all these online rating sites, of course, is that they can also help your practice grow, highlighting areas in which your practice performs well and calling out those that need improvement. Call it a free focus group.

“I always say there’s no psychiatric screening for the people who fill out these forms, but that should not in any way mean we should disregard them or think they are worthless,” says Jay Kaplan, an emergency physician and medical director of the Gulf Breeze, Fla.-based healthcare consulting firm Studer Group. “None of us wants to give our patients anything less than the best care we can, but sometimes it has to do with a patient’s perception. We should try to learn from them rather than dismissing them.”

Examples? If you see multiple comments about your humorless front-desk clerk, inadequate parking, or untidy exam rooms, it’s time to make some changes.

To tap the marketing potential of this new online frontier, of course, you should also educate yourself about the various Web sites that exist and the types of questions your patients are being asked.

Healthgrades.com, for example, asks patients to score you on a scale from “poor” to “excellent” on a range of topics including ease of scheduling urgent appointments, office environment, staff friendliness, and wait times. It also asks them the degree to which they would recommend you to family and friends and whether you spend an adequate amount of time with them in the exam room.

RateMDs.com, meanwhile, uses a 5-point rating system (5 being the best) to create a scorecard for every doctor that patients review. Its three ratings categories include:

Punctuality - How long do you make your patients wait? Are you usually on time for your appointment?

Helpfulness - Are you generally approachable? How’s your bedside manner?

Knowledge - Did the treatment you prescribed help your patient? Did you seem to understand their symptoms, and how clear were you in explaining their diagnosis?

Your “overall quality” rating is derived from the average of your helpfulness and knowledge ratings, and the RateMDs.com Web site notes it is used to determine the type of “smiley face” you ultimately receive.

Drscore.com, meanwhile, takes its rating service one step further, creating a tool for both consumers and physicians alike. For $149 a year per physician, the company provides physicians a survey service that allows them to conduct year-long patient satisfaction surveys in-house. It also provides doctors a quarterly analysis of how they are being rated, how they’re performing relative to their peers, and a breakdown of the areas within their office that could use improvement. “We ask patients to let doctors know about anything that was really good and things that could have been better,” says Feldman. “If a patient has a way of telling us how to do a better job, that’s truly a gift.”

A better tomorrow

In the brave new world of online rating sites, where consumers have the upper hand, it remains to be seen whether practices that try to limit their patient’s right to post or those that encourage their patients to rant or rave will meet the most success.

One thing, however, is clear: The growing volume of feedback on the patient experience means doctors will increasingly be forced to compete on both service and quality of care. That’s good for everyone, says Gandolf. “In the long run, it’ll make the experience of medicine that much better,” he says. “Even if [doctors] go kicking and screaming.”

Shelly K. Schwartz, a freelance writer in Maplewood, N.J., has covered personal finance, technology, and healthcare for 12 years. Her work has appeared on CNN-Money.com, Bankrate.com, and Healthy Family magazine. She can be reached via physicianspractice@cmpmedica.com.

This article originally appeared in the April 2009 issue of Physicians Practice.