Physician satisfaction sites: It's time to tell patients not to use them as a single source of information

Physician satisfaction scores on online third-party review sites tend to be skewed and can easily mislead patients. At the same time, however, more and more people are turning to them when choosing a physician and this distortion may have significant consequences for both parties. 

The real issue arises when consumers trust these ratings as a sole source of information. 

That's unwelcome news for hospitals and other healthcare providers, as healthcare in the U.S. is still relatively new to operating under a consumer-centric framework. Hospital ratings can make or break revenue, and providers are increasingly adopting tactics commonly employed by the retail industry. 

But there's a limit to how effective those tactics can be if a third-party site, such as Yelp, rates a hospital or physician poorly. And sometimes positive reviews are misleading as well, making a provider look better than they actually are.

Researchers conducting a new Cedars-Sinai study pulled reviews from October 2014 to March 2017 on Healthgrades, a consumer ratings website that ranks medical providers from 1-5 stars. The investigators linked this data to providers listed in the Centers for Medicare and Medicaid Services' Physician Compare tool. They narrowed the field to 212,933 providers, who had at least four reviews evaluating overall patient satisfaction. They grouped the providers by medical, surgical and allied health specialties, and performed a statistical analysis to examine the distribution of the providers' average satisfaction scores.

The results showed overall satisfaction ratings that consistently skewed positively, fell within narrow ranges and had different distributions across specialties. As a result, scores that appear high might actually be comparatively average or low, effectively misleading patients. For example, if 90 percent of physicians in a particular specialty are rated higher than four stars, patients could be misled into thinking the physician they select is at the top of their field.

Providers' satisfaction ratings also differed significantly by specialty group. Median scores for allied health providers -- physical therapists, optometrists and the like -- were much higher than those of physicians in medical and surgical specialties.

Some of the differences in rankings between specialties might be related to the nature of the work, the authors said. That may explain why psychiatrists, who field emotional trauma, get lower ratings than chiropractors, who provide physical relief and lots of one-on-one interaction. But the authors think review sites should flag such statistical quirks and caveats.

The study comes at a time when consumers increasingly are turning to third-party websites to post reviews of physicians and comments about a wide variety of healthcare services and experiences. Although there has been a proliferation of these third-party sites -- Healthgrades, Zocdoc, and Yelp, to name a few -- they often present information based on a small number of reviews and incomplete or unverified information. As a result, many health systems (such as Stanford, Cleveland Clinic and University of Utah) have begun posting more complete ratings and comments from their own outpatient satisfaction surveys.

These hospital-driven tools measure satisfaction with providers for attributes such as communication, friendliness and time spent with patients. They don't measure healthcare quality. Providers are giving consumers access to this information to offer greater transparency and visibility into feedback from real patients.

The findings suggest that third-party online review sites can do better by posting median star ratings for each medical provider and noting where they rank among peers in their specialty. 

Patients do not likely know this so it's up to providers to explain it.

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com