So Zagats, which is the best known old world ratings guide in the restaurant business, is making a move into health care. And it’s doing it with the biggest blues plan Wellpoint.
So there’s likely to be quite a bit of cynicism about this. After all, why should anyone use a health plan site to rate doctors rather than an independent one, and for that matter is Wellpoint going to let its customers rate it? I can think of a few who won’t rate it so highly!
But beyond the cynicism, it’s clear that some form of ratings is coming fast. And plans might as well get into the game somehow, although given the lack of trust they have in the market, my guess is that an independent ratings company is more likely to succeed. And there are lots of those around. Perhaps the question is whether it’ll be a guide known best for restaurants like Yelp, a general health care site which allows ratings like Revolution or Vimo, or whether a specialist one that just rates doctors like RateMDs or CareSeek.
Quick add: On the panel at Connected Health, Henry DePhillips, ex MedDecision now with Medem says– consumers not going to
rate costs or quality—so that Wellpoint/Zagats are missing the point!
I read somewhere that Well Point offered mdnationwide.org 3.8 million (cash) for it databases, and proprietary software. Yet, MDNationwide Inc turn”ed down the offer. Here’s what the founder “Hugo Gallegos said in a statement, “Our organization is so far ahead as far as technologies implemented into our Infrastructure, we have been developing our specialization since 2000.” It’s fairly inexpensive to put a site together, and string some doctor credential information databases, and rely on traffic so that you can charge for advertisement space. Thus, you allow patients to rate doctors based on how (bedside manner) nice they are, that’s what you call cheap information, that ultimately get “distorted” by accessing these databases and rating a physician.
Consumers need to take back control of their patient satisfaction, and as in other industries, only the consumer can effect change. So in the case of MyDocHub.com, patients rate their doctor based on waiting room times, total wait time including the time in the patient room with the doctor, and a simple rating of 1 to 5, 5 being the highest on how satisfied they were with that appointment. The ratings are averaged out, so one poor score does not hurt the doctor, but on the other hand, various poor ratings may indicate poor performance by the doctor, since the wisdom of crowds determine a more accurate assessment of the doctor.
It’s not surprising that physicians are uncomfortable with the idea of others “rating” them. After all, what do others know about how well they provide healthcare?
This, actually, is very similar to the reactions professors first had on RateMyProfessors, where professors protested that students only cared about whether their tests were fair, and scoffed saying that the “kids” knew nothing about the professors’ degrees, research projects, etc. In the minds of those who stood at the lectern, it was about academic qualifications; for those in the seats, it was about staying awake. Today, professors are much more comfortable with the fact that they can be listed on a website and reviewed, and in fact, are somewhat insulted if no student has taken the time to list them. Secretly they even hope to receive a few “chili peppers”, meaning that they are “hot” professors!
Ultimately, a few professors responded in kind and created Rateyourstudents.blogspot.com, a sort of RateMyStudents site. By now it has turned into a cynical professorial rant about teaching.
So with new physician rating and review sites coming online nearly every week, how are doctors going to handle being rated by their patients? Physicians also complain “What does a patient know about how well I practice medicine?…Patients don’t know about my years in school, my research, my etc.” Will doctors ultimately create a site called RateMyPatients, where they can rant over the injustices of healthcare and the assaults they take daily from their patients? Or will they praise these sites as a place to learn how to improve their practices or as sources of patient testimonials to their excellence?
The latest twist on who rates whom is eliminating the issue of reviewer qualification, namely NursesRecommendDoctors.com. No one will deny that this population of over 3,000,000 trained medical professionals has a keen insight into the practices of physicians, their bedside manners and clinical competence. It will be interesting to see if this trusted group of patient advocates will have the willingness to share what everyone wants to know…who are the best doctors?
Patient satisfaction is only one element– albeit an important one– of medical quality. I asked a group of doctors what they thought the average doctor’s patient satisfaction score would be. On a scale of 0-10, they gave answers in the range of 4-6. The actual median score of doctors (with 20 or more ratings) on the http://www.DrScore.com online patient satisfaction survey website is 9.5 out of 10! Even doctors don’t realize what a great job we are doing, tending to see each others’ failures and rarely each others’ happy patients.
Doctors don’t need to try to prohibit patients from rating doctors on the Internet. What are we trying to hide—the greatest collection of physicians of all time?! Instead, we ought to be encouraging all our patients to rate us on the Internet. For one, the public would get to see a more representative picture of the great job U.S. physicians are doing every day (we certainly aren’t going to see that picture in our newspapers or TV news broadcasts). And two, getting feedback from patients can only help us achieve our goals of giving our patients the best possible medical care.
Steven R. Feldman, M.D., Ph.D.
This rating has been going on for years in the UK, specifically in regards laser eye surgeons and clinics. Have a look at http://www.lasik-eyes.co.uk The site is composed of thousands of comments, associated with 1 to 5 star ratings, and average price per procedure paid.
I have some thoughts on this whole scoring business from the patient perspective. See http://www.diabetesmine.com/2007/10/the-zagats-guid.html .
I’m not so quick to dismiss the Wellpoint/Zagat’s initiative. Look at it from the average consumer’s perspective – is the doctor accessible, does he or she communicate, is the office a comfortable place to visit, and do people TRUST the doctor?
Those are all things that would resonate with the average consumer (they certainly do with me), and they are all things that the patient is able to pass judgement on. And in some ways they’re not all that different that what CAHPS asks about physicians.
How is a patient able to evaluate cost when rates are set by payors and seeing a physician for anything non-routine is (hopefully) not a frequent event? It’s not like buying tomatoes where I see one store always has hard flavorless baseballs that happen to be red and I see the price at check-out, and I can go to another store next week to see the difference.
Before we turn up our noses at this initiative, we should take off our respective versions on the white coat of healthcare regulars, and put ourselves in the average patient’s shoes. I think there’s some credit due to Wellpoint and Zagat’s for trying to bring the “voice of the customer” into the dialog.
“Quick add: On the panel at Connected Health, Henry DePhillips, ex MedDecision now with Medem says– consumers not going to rate costs or quality—so that Wellpoint/Zagats are missing the point!”
This comment is kind of misguided. The point of the Wellpoint/Zagats survey is to solely focus on elements of patient satisfaction related to their physician. According the press release, it will consist of a 30-point scale in which patients evaluate their physician on trustworthiness, communication skills, availability and medical office environment. Not a single measure where customers directly attempt to measure quality or cost.
Just go to the AHRQ website and read the progress on the CAHPS survey development process to see what is going on with patient satisfaction. Here is the link:
CAHPS development is currently in its third phase and well-validated instruments with sound psychometric properties already exist for health plans (incorporated into health plan accreditation process by NCQA for several years now), physicians, and hospitals.
The interesting part is that AHRQ is now trying focus on two main things:
1. Spur the adoption of the CAHPS survey instruments.
2. Finding how improving patient satisfaction can improve quality
AHRQ is making strides on the first part and Medicare is already going to post HCAHPS survey for all hospitals starting in 2009 I think (maybe 2008).
Either way the two biggest challenges remain:
1. Getting customers to actually use this data and
2. Figuring out how constructs of patient satisfaction are actually tied to quality (which is actually a lot of more difficult than you would think because patient satisfaction is a varied construct and many attributes including socialdemographic, institutional, and timing attributes have been shown to statistically significant effects on patient satisfaction ratings.)
While I think this is a fantastic babystep, it is just a babystep and it isn’t in step with the direction of the web as a whole (increasingly open systems). The ratings are only available within a closed system, accesible only to Wellpoint members. This doesn’t help folks who are choosing their physician before they actually have an insurance card (and can actually get into the plan website) and it certainly doesn’t help anyone else.
All that aside, while not showing any data until there are at least 10 ratings is good data practice, it isn’t necessarily good web practice. Based on the experience of RateMDs and other rating websites, it can take years before ratings have any critical mass. So, consumers will only have access to ratings on a select few providers for possibly an extended period of time (unless physicians decide to buy in and encourage consumers to rate their practice).
I really do think this is a step for a health plan. It is a risk for them and I know that. However, I think the actual progress that this represents is significantly less than they would have us believe. It’s simply taking the surveys they already do, replacing them with Zagat’s (although they’ll probably still ask us to do the old ones), and making that data available online (in a locked system) when it hits a certain point. The only risk here is making the data available online to members. The commenting aspect is relatively easily managed; so, I’m not going to count that as a risk.
I am absolutely not discounting the value of what Wellpoint and Zagat’s have developed. It is important and it’s an improvement, but it’s a far cry from “bright.” It still doesn’t give consumers the public voice that they really should have and *do* have in other venues.
I totally agree with Henry DePhillips from the Connected Health panel.