An Interview with Healthgrades: How Healthcare Review Sites Can Improve Our Medical Experience

Online review sites have entered the consumer space with much aplomb. A 2007 empirical study showed that online user reviews indicate how word-of-mouth plays a dominant role in driving revenues.1With over 21 million online visitors a month, Yelp ranks as one of the most popular sites in the US.2Its model is rather simple: helping consumers navigate the small business space by using testimonials posted by other consumers. This model can be seen across numerous service industries and has now made its presence felt in medicine. A survey by RockHealth showed that nearly half of Americans go online to find reviews of physicians.3These online consumers can use quality of care ratings and customer comments to target specific doctors. The proliferation of this technology can potentially transform the nature of the physician-patient relationship to one that begins from the moment a patient turns on their computer.

I recently interviewed Rob Draughon, CFO and President of Hospital Solutions at Healthgrades, an online database with information on over 3 million healthcare providers. With more than a million users a day, Healthgrades is a pioneer and industry leader in hospital and physician review services.4The objective of Healthgrades is to connect patients to the right doctor and the right hospital. Although some view healthcare as a commodity, Healthgrades, from its inception, has helped to disprove the fungibility of medical procedures. An early study by the company showed that complication rates from knee replacement surgery varied wildly between 17 Denver hospitals.5This sort of information can be vital to patients, allowing them to find the healthcare provider that is most adept and experienced to serve their needs. The impact of Healthgrades goes beyond helping patients select physicians, as these review services can also help physicians and hospitals in unique ways.

How Healthcare Reviews Help Patients

For an industry that has traditionally lacked transparency, Draughon believes that the site’s reviews provide critical information to consumers that allow them to make a more informed choice. In his opinion, “the open comments are the most valuable piece. That’s where you find out about outcomes. If you operate on a knee and the patient still has complications a year later, that’s the sort of information that really helps the consumer.” Doctors with many vilifying comments that catalog missteps and inadequacies in their treatment may repel future patients. On the other hand, doctors who are praised and highly-rated can reassure existing patients and attract new ones.

Draughon mentioned that these comments are especially valuable because: “Outcome data isn’t published on specific physicians; it’s only published on hospitals.” Large metropolitan hospitals can have thousands of employed physicians. When their outcome data is aggregated by federal claims, information relevant to the skill of one specific physician gets lost in the cracks. Therefore, testimonial comments from sites like Healthgrades may be the only source to find direct, personalized information on a local physician.

We live in the era of the informed consumer, where products are constantly compared side-by-side through online reviews

How Healthcare Reviews Help Doctors

Draughon addresses one of the main misconceptions about Healthgrades: “We don’t rate doctors, we rate hospitals.” Using data on mortality and complication rate from the Centers of Medicaid and Medicare Services, Healthgrades assigns ratings for specific procedures at hospitals. The reviews for specific physicians are solely based on consumers. This can be beneficial for doctors for a few reasons. First, it highlights a doctor’s personal interactions with a patient, even for those that work in team settings in large hospitals. Consumers can comment on and rate qualities like helpfulness and trustworthiness — qualities not directly dependent on the hospital environment but more so on the personality of a doctor. This can act as a platform for doctors to stand out. Second, Healthgrades can allow doctors to attract new patients. One of the features of the site is that doctors can log onto their own profile and update contact information and confirm if they are accepting new patients. This, in effect, acts as an online Yellow Page advertising their services.

A more inconspicuous feature of the site may actually be the one most helpful for doctors. Under a physician’s profile, Healthgrades displays the insurance that doctor accepts. For private and small-group practice doctors that take new contracts with insurance companies, the burden of filing paperwork and negotiating reimbursements is placed on the physicians themselves. When this happens with multiple patients from a variety of new insurance plans (some of which may reject reimbursement), a physician may end up spending a significant, uncompensated chunk of time sorting it out. Patients can use Healthgrades to sort local physicians by insurance plans they accept. This helps physicians streamline their reimbursement process through insurance channels that already exist and relieve their administrative burden.

How Healthcare Reviews Help Hospitals

Healthgrades publishes their ratings on hospitals, which hospitals can then use to promote themselves and advertise to consumers. Just recently, the site released a list of Excellence Awards in Patient Safety and in Patient Experience.6Hospitals post these recognitions on their own sites — many even on the home page. The advertisement of a hospital’s own services was banned until 1980 by the AMA and remains a controversial topic today.7In recent years, hospital advertisements feature a success story of a single patient’s recovery. Ezekiel Emanuel, a renowned voice in medical ethics and health policy, criticized the anecdotal nature of hospital ads, saying that “What isn’t there is the overall quality of a system, measured in some objective way. They’re telling you the one good case without telling you how many didn’t work or weren’t so successful. They’re not lying, but they are distorting things.”7Third-party sites like Healthgrades can provide this objective measurement of a hospital’s quality and allow it to advertise in a more ethical way.

Healthgrades can also help hospitals target areas for improvement. The site evaluates hospital outcomes in specialty areas (like orthopedics, pulmonary care, cardiac care) relative to one another. Draughon mentions that “of 20 procedures that we rate, hospitals might do great in 10 of them, and bad in the other 10.” Healthgrades even provides consulting services to hospitals with recommendations for how to improve and preserve their quality of care.

The Future of Healthgrades: Challenges and Outlook

Healthgrades, like Yelp and many other review sites, must continue to adapt and evolve to meet consumer needs. Draughon mentions that one of the primary challenges for the company going forward will be obtaining more outcome data for specific procedures. “If I do a search for orthopedic surgeons in Atlanta, I might get 300 names. But I need shoulder surgery, and half of those doctors may not do shoulder surgery.” Going forward, Healthgrades wants to improve accuracy and volume of a doctor’s procedural history. More detail and transparency in this area can help consumers find the right care without shuffling through multiple doctor’s offices. “You don’t want the guy that’s doing one shoulder surgery a month, you want the guy that’s doing hundreds of them.”

Flaws may also exist in Healthgrades consumer review system. ConsumerAffairs rates Healthgrades 1.5/5 — with many comments by physicians taking issue with patient reviews on the site.8Healthgrades does have a framework for disputing reviews, and has a policy to exclude reviews based on hearsay, racist/sexist remarks, and personal attacks. Still, it is difficult to monitor and filter every review and rating posted on the site. The founder of RateMDs.com, a similar site to Healthgrades, said that he receives weekly legal threats from doctors and monthly subpoenas from reviewers claiming that their anonymity was breached.9The sensitivity of medical information and physician reputation makes attempts to shed light on these topics more difficult than in other industries. Review bias may also exist — in which only patients with markedly good or bad experiences are motivated to post. More has to be done to attract the average patient to posting on the site and truthfully reviewing a physician. Healthgrades and other healthcare reviews sites hold great potential for growth and integration with other services like cost transparency, scheduling, and telemedicine.

Regardless of the criticisms, these sites are here to stay. We live in the era of the informed consumer, where products are constantly compared side-by-side through online reviews. We see bits of ourselves in the reviews and comments of a product — how we would apply it to our daily lives, how we would feel if it was faulty, how we would share its value with our peers. Ultimately, online review sites provide us with the information to find a product that fits our needs. In healthcare, it’s difficult to compare providers side-by-side in real-time, and obtaining the proper information and product can be the difference between life and death. The process of finding the right fit may be the most critical part of medical care. The influence of sites like Healthgrades on patients, physicians, and hospitals is undeniable. As Draughon acknowledges, “There’s not a lot of information and there’s not a lot of transparency [in healthcare]. And that’s what we are trying to bring forward.”

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1Wenjing Duan. Do online reviews matter? — An empirical investigation of panel data. Decisions Support System Journal. 2An Introduction to Yelp Metrics as of March 31, 2016. 3Malay Gandhi & Teresa Wang. Digital Health Consumer Adoption: 2015. 4Healthgrades. About Us. 5Jayne O’Donnell. New doctors site rates for experience, quality. USA Today. 6Healthgrades Releases Its 2016 Outstanding Patient Experience Award and 2016 Patient Safety Excellence Award Recipients. 7Hospital Advertising: Good Business, or Time to Pull the Plug? Knowledge @ Wharton. UPenn. 8Healthgrades.com Consumer Complaints and Reviews. ConsumerAffairs. 9Ron Lieber. Why the Web Lacks Authoritative Reviews of Doctors. New York Times.