With the current focus on patient satisfaction and the consumer-driven healthcare economy, a number of independent websites enable patients to rate individual physicians whom they encounter. The impact of these websites on orthopaedic practice is continuing to be elucidated. Many for-profit websites compare and contrast individual physicians and surgeons. This article reviews some of the most well-known physician comparison websites and examines their implications for practice.

The most popular sites
Although many websites compare physicians, the most popular sites appear to be Healthgrades (www.healthgrades.com), Vitals (www.vitals.com), UCompareHealthCare (www.ucomparehealthcare.com), and RateMDs (www.ratemds.com). Although the amount of information included in each physician's profile varies, all include basic information regarding a physician's practice location, education and training, years of experience within their specialty, and some insurance acceptance information. HealthGrades also includes information regarding malpractice claims, something that does not appear clearly on the other websites listed. All four sites use a "star" rating system, with a 5-point rating system for each category. Although the criteria for rating physicians differs on each site, all cover similar topics (see "Rating criteria").

Another website is Physician Compare (www.Medicare.gov/physiciancompare), a site offered by the Centers for Medicare & Medicaid Services (CMS) that helps patients find and select physicians and other healthcare professionals enrolled in Medicare. The site offers information about quality programs that group practices participate in, and also displays a star rating system and percentages that illustrate performance on clinical quality of care measures, as reported by group practices.

Also worth mentioning is the Physician Quality Reporting System, established as part of the Affordable Care Act in 2010. This reporting system is based on quality measures determined by CMS, not patient feedback. However, it does include a patient reporting portion, the Consumer Assessment of Healthcare Providers & Systems, which enables patients to rate their physicians using similar measures as for-profit websites.

Are residents included?
As a resident, I wondered about inclusion on these for-profit websites. It appears that most of these websites receive their information from the National Provider Identifier (NPI) database, so as soon as an incoming resident establishes an NPI number, that resident becomes searchable. I searched my own name on all four websites and found a profile on every one except UCompareHealthCare.

However, only Vitals provided any indication of my status as a trainee. My profile included an alert stating, "Our records indicate this doctor is a student." My patients, however, could still rate me by clicking the "patient reviews" section.

I was able to find other residents on UCompareHealthCare; those I found did not have a qualifier stating that they were still in a training program.

Impact on orthopaedic practice
Until recently, the impact of profit-driven online physician rating systems on orthopaedic practice had not been well-researched. I could find only two studies in the peer-reviewed literature on the impact of these websites on orthopaedic surgeons. Both studies were conducted by Addisu Mesfin, MD, from the University of Rochester. One looked at the four for-profit websites previously mentioned and found that the vast majority of reviews of orthopaedic surgeons were positive. The aspects of care that contributed the most for overall ratings were bedside manner and proficiency/knowledge. Ease of scheduling, wait time, and time spent with the patient were all also found to be significant variables in this study.

The second study by Dr. Mesfin published in 2015 evaluated ratings on 550 orthopaedic surgeons from 30 metropolitan areas. This study found an association between being in an academic setting and higher ratings, but no significant differences with respect to gender or geographic location.

Although most orthopaedic surgeons received positive ratings, Dr. Mesfin concluded that "It is important for practices and physicians to monitor their online presence and respond to negative ratings or comments if that option exists."

At the 2016 AAOS Annual Meeting, Lewis L. Shi, MD, and colleagues reported the results of their analysis of orthopaedic surgeon reviews on Healthgrades and Vitals. Their findings reinforced the idea that interpersonal factors play a huge role in patients' ratings of orthopaedic surgeons.

What's next?
Potential topics for further study include whether and how these sites and reviews affect issues such as a patient's selection of a surgeon, primary care referral patterns, and practice decisions on new hires. The challenges associated with handling negative reviews, especially those that a physician believes may be damaging to his or her reputation, are still being defined. In addition, the issue of trainees being listed on these sites with no qualifier informing patients of their status will require further research and investigation.

The use of for-profit physician grading websites is becoming an increasingly important issue and should continue to generate research interest as these sites play an increasingly larger role in a patient's search for an orthopaedic surgeon.

Dionisio Ortiz III, MD, is a member of the AAOS Resident Assembly Health Policy Committee. He can be reached at damenis810@gmail.com

Rating criteria
HealthGrades, Vitals, UCompareHealthCare, and RateMDs all cover the following topics:

• ease of scheduling appointments
• bedside manner
• total wait time
• friendliness of staff
• assessment of the physician's knowledge and expertise
• willingness to recommend to other people

References:

1. Bakhsh W, Mesfin A: Online ratings of orthopedic surgeons: Analysis of 2185 reviews. Am J Orthop 2014;43(8):359–363.
2. Frost C, Mesfin A: Online reviews of orthopedic surgeons: An emerging trend. Orthopedics 2015;38(4):e257–262. doi: 10.3928/01477447-20150402-52.
3. Trehan SK, DeFrancesco CJ, Nguyen JT, Charalel RA, Daluiski A: Online patient ratings of hand surgeons. J Hand Surg Am 2016 Jan;41(1):98–103. doi: 10.1016/j.jhsa.2015.10.006.
4. Segal J, Sacopulos M, Sheets V, Thurston I, Brooks K, Puccia R: Online doctor reviews: Do they track surgeon volume, a proxy for quality of care? J Med Internet Res 2012;10;14(2):e50. doi: 10.2196/jmir.2005.
5. Hussain M, Hussain WM, Hussain H, Piponov HI, Dirschl DR, Shi LL: Analyses of 22,833 orthopaedic surgeons' scores from two major physician-rating websites. Presented at the 2016 AAOS Annual Meeting, Orlando, Fla.