Help! I’m On

James A Colbert MDNewton-Wellesley Hospital

Brigham & Women’s Hospital

Bradley H Crotty MD MPH FACPBeth Israel Deaconess Medical Center

How Online Ratings are affecting Physicians

@jcolbertMD

@bradcrotty

2Department of

Medicine

Agenda• Introduction & Framing Questions

• Landscape

• Framework

• Practical Approach

• Discussion

3Department of

Medicine

15 YEARS AGO…

44%+

of web users search the web aboutdoctors or other health professionals

Fox S. Health Topics. A Report of Pew Internet & American Life Project. 2/11/2011Fox S, Jones S. The Social Life of Health Information. Pew Internet & American Life Project. 6/11/2009.

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Questions• Am I being rated? How do patients rate me?

• Are online ratings correlated with actual quality?

• Do online ratings matter?

• Do online ratings change clinician behavior?

• How do I engage with this new trend?º (How) Do I address negative reviews?º Can reviews help my practice?

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The Landscape of Physician Rating Sites

Physician Evaluation Websites

Health Websites with Physician Evaluation Functionality

General Rating Websites

Healthgrades.com Doctor.com Angies List

Findadoc.com Everydayhealth.com Insiderpages.com

Ratemds.com Healthtap.com Yelp

Zocdoc.com Wellness.com Yahoo

Drscore.com

Ucomparehealthcare.comVitals.com

Docspot.com

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Physician Online Ratings WebsitesPros:

• Provide healthcare consumers with information to help them make better decisions about where to receive care

• A way to share personal experiences regarding quality of patient experience with others

Cons:

• Ratings and comments can be left anonymously

• Patients may value customer service more than healthcare quality

• Small number of ratings could harm a physician’s reputation

• Reviewer anonymity – can be subject to manipulation by patients or providers

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Gao JMIR 2012• As of 2010 approx. 1 in 10 US physicians had an

online review

• OB/GYN most likely to be rated

• Mean score of 3.93 on 1-5 scale

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Gao 2012 JMIR

Breakdown of physicians rated online

Primary Care41%

Medical Specialties

16%

Sugeons20%

OB/GYN12%

Other Specialties

12%

Primary

Care

40%

Medical Specialties

10%

Sugeons16%

OB/GYN6%

Other Special-ties28%

National Physician Population

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Specialists Are More Likely To Be Rated Than Generalists

Gao 2012 JMIR

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Online Sample of 250 MA Physicians

Physicia

ns liste

d on websit

e

Physicia

ns with

a rating or r

eview

1–4 Reviews

5–9 Reviews

10+ Reviews

060

120180

Healthgrades RateMD Wellness

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Online reviews of 500 urologists

• 80% had an online review

• 86% of reviews were positive

• 45% had written patient comments onlineº 25% negativeº 22% neutralº 53% positive

Ellimoottil, Journal of Urology 2013

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Distribution of Online Ratings across Physicians

Gao 2012 JMIR

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Quality of Ratings by Physician Characteristics

Primary

care

Medica

l specia

lties

Surg

eons

Obstetri

cs/gyn

ecology

Other specia

lties

4.04

3.953.9

4.04

3.63

Chart Title

Before 1980

1980–1989

1990–1999

2000–2009

3.85

3.953.99

4.22

Specialty* Medical School Graduation Year*

Gao 2012 JMIR* p < 0.05

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Quality of Ratings by Physician Characteristics

Board Certification Status*

Medical School Ranking*

Board ce

rtified

Not board

certi

fied

3.96

3.86

Ranked top 50

Ranked below top 50

4.08

3.91

No malpracti

ce cla

ims

At least

one malpracti

ce cla

im

3.97

3.82

Malpractice Claims#

Gao 2012 JMIR

* p < 0.05 # p > 0.05

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National Patient Survey Data

Hanauer, JAMA 2014

Aware of Rating Websites

Sought Ratings In Last Year

Found Reviews Useful

*Only 5% had written online ratings

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Medicine

National Patient Survey Data• 59% thought ratings to be important when selecting a

physician

• 35% reported selecting a physician based on good ratings and 37% avoided a physician based on bad ratings

• 34% had concerns about their identify being disclosed

• 26% were concerned about their physician taking action against them

Hanauer, JAMA 2014

25Department of

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To Summarize…• Patients are frequently rating their clinicians,

though to date any one clinician generally has a low number of ratings.

• Patients are variably (but increasingly) using these ratings to drive decisions

• Ratings tend to be positive

• What are the implications for me?

• How do I think about this?

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Probiotic• Indications:

º Proactive identity managementº Building practice

• Dosing:º Spectrum of engagement

• Alternate Dosing:º Outsource reputation management

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Do Nothing

EncourageReviews

SelfReviews

Non-DisclosureAgreements

ProactiveIdentity

Management

EngageReviews

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Antibiotic• Indications

º Misinformationº Slander

• Mechanism of Actionº Request of Siteº Legal Action

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Implications• Patient Volume and Referrals

• Patient-Doctor Relationship

• Ethical Considerations

• Patient Privacy

• Time & Resources

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Dual Online Identities

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• Systematic web searching using search engines

• List professional information, rating sites, and what personal information is available

• Note erroneous information

• Inventory your personal information

º Social Networking Sites

º Online Contactsº Picture Sharing

Sites• Adjust privacy

settings to match your comfort

The Digital Audit

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Practical Steps• Separate personal from professional identities

• Perform digital audits or create automated searches

• Plan goals

• Decide how best to engageº At a minimum, have an online bio or contact information for your

practice available for patients

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Medicine

Make An Individualized Plan…• What are your needs?

• What are your goals?

• How much time do you want to invest?

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Rx• Goals• Practice Type• Referral Source• Time / Resources