Post­ing doc-pa­tient re­views pays off

Modern Healthcare - - BEST PARTICLES - By Ja­clyn Schiff

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 com- ments. 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.”

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