Adding patient feedback in rating sites could encourage transparency

A federal hospital-comparison site should become a central repository for patient feedback -- and should add a physician feedback component as well, according to two doctors who wrote an article in the Oct. 20 issue of The Journal of the American Medical Association.

Tara Lagu, MD, MPH, and Peter Lindenauer, MD, of Baystate Medical Center and Tufts University School of Medicine in Boston, say patient reviews are a natural step in a continuing trend of greater transparency in health care. Instead of fearing what comments patients might leave, physicians and hospitals should encourage feedback.

The authors say it's something the government and other payers should encourage, starting with the addition of patient commentary to Hospital Compare, a website administered by the Centers for Medicare & Medicaid Services.

The physicians say Hospital Compare is logical place to centralize patient feedback because it already contains a large amount of information and data. They also suggest that CMS develop a similar website for physician practices.

The doctors' commentary was based on previous research of physician-comparison websites conducted by Dr. Lagu as well as the physicians' research of a government-run hospital-comparison website in the United Kingdom. Their commentary was published the same month that the Archives of Surgery released a study concluding that CMS needed to devote greater attention to patient outcomes in order to improve public reporting and provide more concise information to consumers.

No feedback on hospital sites

During her research, Dr. Lagu said, she was surprised to find that no hospital-comparison websites allowed patients to leave feedback. There are several privately run physician review websites that permit patient comments, but physicians have expressed concerns about them. The concerns include a lack of technical quality reviews, physicians' inability to respond to criticisms and the inability to verify that people leaving comments are actual patients.

Dr. Lagu, who published research on physician review sites in the Journal of General Internal Medicine in May, said many of those concerns are unwarranted. Her research found that between 70% and 90% of comments were positive and that most of the criticisms focused on nonclinical aspects of care could be addressed easily, such as poor parking and the courtesy of reception staff.

Another finding of Dr. Lagu was that not many people use the sites, which also could be the case for hospital-comparison sites, even if patients were given the option of participating. Few patients -- only 6% -- know the Hospital Compare site exists, according to a poll conducted in 2008 by the Kaiser Family Foundation. The survey also found that only 6% of the population has seen and used quality information on physicians, and 7% has seen or used it on hospitals.

"It's a concern of how much will patients use this," Dr. Lagu said. "If we add the opportunity for the patients to respond through an online feedback function, is that going to change the way they use the website? I don't know for sure. but I think it does add some really positive things."

For starters, she said, it will help make hospitals and physicians accountable in ways that quality scores and mortality rates do not.

"Consumers are often as interested in the subjective judgments of their peers as they are in more formal measures of quality," the authors wrote.

On a recent trip, Dr. Lagu saw a sign at her hotel encouraging guests to leave reviews on Trip Advisor, a travel review site. Before seeing the sign, she entered the hotel thinking they were committed to customer service.

"Maybe they are playing to the Trip Advisor crowd. They are realizing they are responsible to every single guest. And I think a patient feedback function on Hospital Compare will give hospitals the same level of accountability," she said.

As Dr. Lagu's article and others have noted, people generally rely on family and friends when it comes to hospital and physician referrals, and that is not expected to change. Adding an outlet for patients to get feedback on the experience at a hospital or practice will make them much more informed, the authors said.

Faults of rating sites

The authors acknowledge, however, that rating sites have shortcomings. One is that many physician rating sites allow anonymous comments.

"Anonymous online rating sites that don't allow physicians access add nothing to the quality of patient-physician communication and understanding," said former American Medical Association President Nancy H. Nielsen, MD, PhD. The AMA does not have a policy on physician rating sites.

However, Dr. Nielsen said, physicians should encourage feedback from patients to determine how best to meet their needs and increase the quality of care.

"Patients shouldn't hesitate to talk to their physicians about any concerns or questions they may have," she said.

Another criticism is that most rating sites don't allow physicians and hospitals the opportunity to respond to patient comments. This could be a function that is added to the private sites, but "responding to reviews on more than 30 sites is an impractical prospect for busy clinicians or practice managers," the authors of the JAMA article wrote. Creating a central place, such as Hospital Compare, will make monitoring the sites possible and could help protect physicians and hospitals, the authors said.

They used the U.K.'s National Health Service equivalent of Hospital Compare as an example of how the idea could work in the U.S.

The NHS Choices website has a place for patient feedback, which the British government has encouraged people to use. The government established strict rules meant to protect physicians and hospitals from unfair criticism.

All users are required to register, and all comments are monitored so that no inflammatory comments about a specific doctor are posted. Physicians and hospitals are permitted to respond, which, the authors note, lets patients see how their comments are being used to improve the quality of care.

Although the site has been criticized because comments are moderated and information on individual doctors is limited, Drs. Lagu and Lindenauer say the NHS Choices website is an example of a coordinated effort to make a rating site address the needs of both physicians and patients.