Physician-rating websites do not reflect quality, outcome of care
Benedict U. Nwachukwu
Anthony A. Romeo
Physician ratings: Within health care, there has been a greater emphasis on transparency and the improvement of the quality of care. Health care reform measures from CMS have led to the measurement and public reporting of hospital performance. Nationally organized physician-reporting initiatives have failed to gain the same momentum.
The private sector has sought to create mechanisms for similarly reporting physician quality. Physician-rating websites have become popular among patients. Some have suggested patients can be regarded as consumers of health care and services, such as surgery and perioperative care. Therefore, patients should review their physician the same way they review hotels or restaurants.
Increasing influence
Regardless of whether one agrees with the rationale, physician-rating websites have an increasing influence on physician practices and patient referrals. A survey study published in the Journal of the American Medical Association found online reviews were highly influential for patients. Among survey respondents, 65% were aware of physician-rating websites and 35% had used a physician-rating website within the past year. Among respondents seeking physician online rating websites, 35% subsequently selected a physician based on good ratings while 37% avoided a physician with bad ratings.
The physician-rating landscape constantly evolves. Online ratings generally involve an overall rating for a single surgeon. In addition to assigning their physician a certain number of stars, patients can leave written comments describing their experience. The physician is then rated with a one- to five-star system on various categories. The process of care and staff are also graded on the same scale in various categories, such as helpfulness, knowledge and punctuality.
Validity assessments
Several investigators have sought to assess the validity of these websites within orthopedic surgery. A recent study looked at online ratings for 275 sports medicine physicians across three high-traffic websites. The authors found 99% of the surgeons had online ratings and most surgeons were highly rated on average. However, scores across the three websites did not have a high degree of correlation. Scores were moderately well correlated for surgeons scoring between 4 to 5, but for surgeons scoring between 2.5 to 3.5 on any one website there was low correlation of these scores across sites. The authors suggested this finding may be explained by lack of aggregation wherein patients with a negative experience post a negative review on one website thereby impacting the surgeon’s rating on that website but not affecting the surgeon’s rating on other websites.
Another similar study of hand surgeons found positive online ratings were associated with a higher number of ratings and increased online presence. Hypothetically, surgeons with a high number of ratings and online presence may be involved in some form of marketing to elicit positive reviews.
As ratings websites have become popular, more private companies have sought to provide a mechanism for rating physicians. With many available options, physician ratings can become diluted in a large pool of offerings, thereby leading to a heterogeneity of reviews. Health policy experts have warned that physician-ratings websites based ratings on too few reviews. On the patient side, having many options does the patient a disservice as they are left scrounging through different rating websites to develop a collective grade for their intended physician.
Beyond the problematically high number of available rating websites, it is unclear if the reviews themselves are fundamentally trustworthy. For many websites, there is no requirement for reviewer identity verification. As such, physician ratings could be conceivably — both positively and negatively — skewed by paid reviewers and false reviews. “Reputation management” agencies work with surgeons to encourage satisfied patients to provide strong reviews of the surgeon across multiple websites. Similarly, patients thought to be dissatisfied are identified early in the process to provide mediation.
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For more information: Anthony A. Romeo, MD, is the Chief Medical Editor of Orthopedics Today. He can be reached at Orthopedics Today, 6900 Grove Rd., Thorofare, NJ 08086; email: orthopedics@healio.com. Benedict U. Nwachukwu, MD, MBA, is an orthopedic surgery chief resident at Hospital for Special Surgery.
