Over the past decade, consumer information has been revolutionized by the explosion of websites that provide ratings and customer feedback on nearly everything, including physicians. With a few clicks, potential patients can look up a doctor and find a variety of “star” gradings, feedback posts, and biographical information, often without the physician’s submitting any data or providing permission to the website.

These developments have been met with justifiable skepticism by the medical community, based on personal experiences with online information that misrepresents background information or professional performance. However, this new medium for researching physicians is not going away. In fact, as health insurers and the federal government increase their quality data gathering and distribution, patients will have even more sources of information. The first step to maintaining an excellent online quality profile is to understand what sites are most popular, and how they create grades for physicians and their hospitals.

HealthGrades
Founded in 1998, HealthGrades is a leader in online medical scores, with an estimated 7 million views monthly. They generate ratings for both physicians and hospitals. Physician ratings consist of patient satisfaction scores and a Recognized Doctor “Honor Roll” designation.

The satisfaction scores, with five stars being a perfect score, are created from online survey responses that evaluate patients’ experiences with the physician and the office staff, including wait time. The physician’s standing (above, at, or below the national average for this category) is also shown.

The Recognized Doctor designation is displayed under “Awards and Recognitions” in the doctor’s biographical information section. To achieve this designation, a physician must meet the following criteria:

• never had his or her medical license revoked
• in the past 5 years, have no malpractice judgments or legal settlements and be free of state or federal disciplinary actions
• be board-certified

HealthGrades uses several data sources to collect this information, including state medical boards, the Centers for Medicare & Medicaid Services (CMS), the American Board of Medical Specialties, and the American Osteopathic Association. Disciplinary actions are collected from all 50 states; malpractice data are available from only 14 states (listed on the website).

HealthGrades’ hospital scores consist of three categories: patient safety, clinical quality (mortality and complications), and patient experience. High-performing hospitals are recognized with a variety of awards. The primary data source for hospital scores comes from the Medicare Provider Analysis and Review, purchased from CMS. Four orthopaedic-related measures are included in the score calculations: mortality from pulmonary emboli, complications after neck/back surgery, complications after hip fracture care, and complications after total hip/total knee replacement.

HealthGrades’ prominent role has not been achieved without criticism. Surveys posted by site users are not vetted; anyone can post a review of a physician, even if he or she never actually was a patient or is mistakenly reviewing a physician with a similar name. Physician satisfaction scores are frequently based on very few reviews; a 2013 study found that the combined physician score was based on an average of only 2.4 completed patient reviews.

ZocDoc
Started in 2007, ZocDoc seeks to improve both health provider information and access to physician offices. Unlike other physician ranking sites, ZocDoc reviews every comment posted about physicians by users, allowing only patients who have seen that physician to comment.

Each physician is scored on a five-star scale, with three components: overall experience, bedside manner, and wait time. Patients searching for physicians in their area can book an appointment online with the doctor they choose.

Physicians must register on ZocDoc to be included in search results. ZocDoc may be an increasingly useful tool to recruit new patients as its popularity increases; currently, the site has 2.5 million users monthly and has registered physicians in nearly 2,000 U.S. cities.

Consumer Reports
Consumer Reports (CR), long known for publishing information on manufactured product quality, has begun rating hospitals and currently scores more than 1,100 hospitals in 44 states. CR calculates ratings by tracking infections, hospital readmissions, complications, mortality, use of electronic health records, appropriate use of imaging, and patient experience. Information sources include CMS data, publicly available state healthcare data, and the American Hospital Association (AHA). In 2012, CR started publishing special reports focusing on individual physician practice performance in several states, including Massachusetts, Minnesota, and Wisconsin.

Although early efforts to report physician metrics focus more on primary care, CR does report quality scores for cardiac bypass surgeons on its website. The Society of Thoracic Surgeons has made these data available from their self-reported outcomes database. CR is seeking similar partnerships with other medical specialty societies to make more physician-specific information available. The advantage of this arrangement is that physicians have a great deal of control over what data are collected and how they are reported, helping to maintain a higher level of reliability and fairness.

U.S. News & World Report
The annual U.S. News & World Report rankings of medical schools and hospitals are perhaps the best known to physicians. Hospitals are ranked in 16 specialties, including orthopaedic surgery. Although nearly 5,000 hospitals are assessed, only 3 percent achieve a ranking in even one specialty. Eighteen hospitals made the 2013 Honor Roll by ranking in six or more specialties.

To be ranked, a hospital must be a teaching hospital or have at least 100 beds. Hospitals meeting these qualifications then must meet volume thresholds, varying by specialty. To be ranked for orthopaedics, a hospital needs 303 Medicare admissions, 275 of which must involve a surgical procedure. Qualifying hospitals then receive a four-part score:

1. reputation (32.5 percent of score), based on rankings of 200 randomly selected physicians in each specialty
2. survival score (32.5 percent of score), calculated based on mortality of Medicare inpatients, adjusted for patient condition, for the prior 3 years
3. care-related indicators (30 percent of score), primarily based on AHA survey data.
4. patient safety score (5 percent of score)

One important aspect of the U.S. News & World Report rankings is the relative weight of hospital reputation compared to patient safety. Most other quality measurement systems put a greater emphasis on patient safety.

Suggestions
The following suggestions may help orthopaedic surgeons turn this emerging aspect of healthcare marketing to their advantage.

First, create an accurate and updated profile on a few of the most popular physician ratings sites (in addition to those described above, look at WebMD.com, Vitals.com, and RateMDs.com). A biographical profile may already exist, but contain inaccuracies. Patients who search should at least find correct information about training, specialty, and office locations.

Recent studies have shown that patient reviews are more often positive than negative. This may surprise many physicians, but treating patients well will result in positive online reviews.

Finally, a key component in most patient-reported online rankings is office wait time. If your online scores are lower than you like, try to shorten patient wait times.

David B. Bumpass, MD, and Julie Balch Samora, MD, PhD, MPH, are the 2012–2013 AAOS Washington Health Policy Fellows.

References

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