Posting doc-patient reviews pays off

When Salt Lake City residents search the Web for physician reviews, they're likely to come across a set of ratings from an unlikely source: the University of Utah Health Care's website.

Since December 2012, UUHC has been posting patient satisfaction ratings for its doctors. Other providers with a similar approach to self-publishing online ratings include the Cleveland Clinic, Northwell Health Physician Partners, Piedmont Healthcare, Wake Forrest Baptist Hospital and Geisinger Health System.

Not only did UUHC lead the way in opening access to its patient satisfaction data, the health system created a process for improving the patient experience based on the reviews. In the three years since UUHC moved to systemwide public reviews, measures of patient satisfaction have soared.

Before, only 4% of their physicians were in the top 10th percentile of Press Ganey's national patient ratings database, which combines measures for its more than 8,000 clients on Consumer Assessment of Healthcare Providers and Systems surveys for hospitals, home health, hospice, dialysis facilities and accountable care organizations. By 2014, half of UUHC doctors were scoring in the top 10% and more than a quarter ranked in the top 1% nationally.

“It's difficult to imagine this isn't going to be the default,” said Dr. Thomas Lee, chief medical officer of Press Ganey, which provides the surveys for UUHC. According to Lee, all hospitals that make patient satisfaction surveys publicly available use a process that mirrors UUHC's.

Providers have had to confront the reality of online physician reviews because of the rise of for-profit ratings companies including Healthgrades, Vitals and ZocDoc. According to a 2014 study published in JAMA, 59% of American adults consider online ratings to be “somewhat” or “very” important when choosing a physician.

Healthcare organizations such as UUHC obviously wanted some control over how they are portrayed. But they are also concerned about the validity of the data gathered by external sources. Posting reviews generated by an internal process ensures the data are scientifically sound, they say.

At UUHC, patients receive a 20-question survey after seeing a doctor. Completed surveys—the system reports a 12% response rate—are carefully screened. “We are committed to posting positive and negative feedback,” UUHC's website says. “However, we do not post comments that are libelous, slanderous, profane or those that risk the privacy of our patients.”

Physicians have seven days to appeal reckless or unfair remarks before they are posted. They can also appeal later, with a three-physician panel making a final decision about disputed comments. UUHC posts satisfaction data only when it has received at least 30 surveys per physician.

UUHC's online ratings succeeded because most physicians responded positively to patient critiques. Dr. Bernadette Kiraly, a family medicine physician and medical director of UUHC's Sugar House Health Center, learned a lot from her patients one month after they said she seemed distracted. “I didn't realize I was acting that way, but when I read the comments, they really hit home,” she said. “I was having some personal stressors that month and was feeling overwhelmed.”

At first, UUHC provided reviews only to department heads and individual physicians. But it quickly discovered they were great motivators. Physicians wanted to know how they stacked up against their colleagues. “The natural tendency toward competition began to drive improvements in patient satisfaction,” UUHC executives wrote in Academic Medicine.

Some clinicians worry patients may base reviews on issues beyond a physician's control. “I look mostly at negative comments to see where I can make changes,” said Dr. Mark Bromberg, chief of the division of diagnostic and clinical neurology at UUHC. “But most negative comments appear to be about issues that I cannot easily control.”

Patients are noticing the new system. According to another UUHC patient survey, respondents chose “patient satisfaction ratings and comments” as the second most important aspect of the provider profiles on the website after “specialty focus.”

Given the positive feedback from patients and physicians, UUHC believes there are more opportunities to use patient satisfaction data to improve quality.

“There is still much to learn by digging into our patient experience database,” said Dr. Thomas Miller, the system's chief medical officer.

“When we identify high-scoring physicians, we can learn from them and leverage their skills to motivate, educate and train faculty, especially young and recently hired physicians, in the key ingredients of a successful patient encounter,” he said. “Physicians learn best from physicians.”