How Much Do Physician-Rating Web Sites Tell You about Anesthesiologists and Pain Physicians?
If anesthesiologists and pain specialists are like other physicians, at least as far as this question goes, online rating web sites like HealthGrades and Vitals do not provide much useful information on provider quality.
A recent study funded by the American Board of Internal Medicine (ABIM) found that there is little to no association between physicians’ online ratings and how well they score on performance measures or on patient-experience surveys conducted by their own practices. Researchers led by Bradley M. Gray, PhD looked at 1,299 physicians who completed an ABIM Practice Improvement Module® (PIM) in diabetes or hypertension between July 2011 and November 2012. These modules guide physicians through a review of patient data and support quality improvement work and reporting in their practices. PIM patient survey responses and chart abstractions were compared against the ratings physicians received on eight leading, publicly available and free rating websites. Sites were selected from Internet searches in which each physician’s name, specialty and city were entered into the Google search engine. The websites with the largest numbers of reviews of the physicians studied were HealthGrades (613), CompareHealthCare (466), and Vitals (207). Star ratings were converted into percentages, so that a rating of four out of five stars equaled 80 percent. Ratings were found for 61 percent of the researched doctors. They had an average of 5.6 ratings each, and an average rating of 81.6 percent.
The results: the association between quality measures such as clinical outcomes and blood-pressure control was considered not statistically significant. The relation between patient-experience survey scores and online ratings was significant, but just barely. Of the physicians who received an online rating of only one star, for example, 79 percent of their surveyed patients rated their care as “very good” or “excellent.” In comparison, physicians who had perfect five-star ratings were rated “very good” or “excellent” by a marginally larger 82 percent of their surveyed patients.
The weak correlation between the website ratings and quality scores could have resulted from the low number of website ratings per physician (median number: 4 ratings) or from an unrepresentative sample of patients providing the ratings, according to Dr. Gray, who also pointed out that the associations might have been stronger had patient comments from the websites been used in the evaluation.
The ABIM conclusion, that online physician rating services provide little reliable physician quality information, is unfortunate given the strong consumer interest in such information. In a study published in the Journal of the American Medical Association last year (Hanauer, DA, Zheng, K., Singer, DC, Gebremariam, A, & Davis, MM (2014). Public awareness, perception, and use of online physician rating sites. JAMA, 311(7), 734-735), another team of researchers determined that 59 percent of American adults find online ratings to be an important consideration when choosing a physician. Over one-third of those who used online reviews chose their doctor based on positive reviews, and 37 percent reported avoiding physicians with negative reviews.
One response to the uncertain value of independent physician rating websites has been for healthcare systems to develop and maintain their own public websites with physician reviews, typically requiring a much larger sample of reviews before the results are posted. In December 2012, the University of Utah Health Care in Salt Lake City became the first health care system in the U.S. to implement online physician reviews, according to Press-Ganey (Transparency Strategies: Online Physician Reviews for Improving Care and Reducing Suffering). In 2013, Piedmont Healthcare in Atlanta followed suit.
The federal government is also extremely interested in helping consumers choose healthcare providers based on quality and cost. Medicare’s Physician Compare website, which was mandated by the Affordable Care Act, underwent a redesign in 2013. As noted in our Alert dated November 17, 2014, Physician Compare provides, for all physicians, nurse anesthetists, anesthesiologist assistants and certain other healthcare professionals primary and secondary specialties and board certification status, as well as information on medical and clinical training, hospital and group practice affiliations, and the status of the provider’s 2012 participation in the Physician Quality Reporting System (PQRS), the Electronic Prescribing (eRx) Incentive Program, and the Electronic Health Record (EHR) Incentive Program. Going forward, CMS plans to post information on all 2015 PQRS individual measures collected via claims, registry or EHR systems on Physician Compare in late 2016 “if technically feasible.” CMS will also expand public reporting of group-level measures by making all 2015 PQRS Group Practice Reporting Option (GPRO) web interface, registry, and EHR measures for group practices of two or more EPs and all measures reported by ACOs available for public reporting on the website in 2016.
Meanwhile, it seems likely that patients will continue to consult whatever physician rating services are available—regardless of this warning from Richard J. Baron, MD, President and CEO of ABIM: “The study results make clear that online physician ratings should, at most, be a small part of the decision making that should also include looking at other sources of quality information such as the status of a physician's board certification.” To help guide patients, anesthesiologists and pain physicians might consider adapting the following advice from a consumer website, the Center for Advancing Health, which offers the following regarding evaluating ratings websites:
They may not have all the information you're looking for, but online doctor rating sites can aid your search for a new doctor if you click carefully. Here are a few questions to ask and answer when evaluating a ratings site. This information isn't always clearly listed on a website, so you may need to dig deep.
- Who owns the site? Is it a nonprofit or for-profit site? Do doctors pay for their own reviews?
- Are reviews or ratings anonymous? Is there any way to tell if a reviewer is a patient?
- Is the information complete? Do you notice any missing doctors in your area?
- Does the website have an indication of how often information is updated? If a physician's data is out of date, you may miss important updates to their certification or disciplinary actions.
- How many ratings does a doctor have? If a doctor has one positive and one negative rating, how much do you really know about his or her performance?
What is lacking on many websites is the ability for physicians and others to correct inaccurate or even malicious information. Any defensive strategy starts with knowledge of the performance or quality information that has been made public. Anesthesiologists’ and pain physicians’ social media activities should include searching the internet for any and all reviews patients may have posted. This aspect of “transparency” is going to continue to develop rapidly. We hope that none of our readers will be caught unaware.
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