March 9, 2016

Yelp Comes to Healthcare: Paying for Performance

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As many Monitor Mondays listeners may have noticed, UnitedHealthcare (UHC) is a frequent topic of my reports on the weekly Internet broadcast. I have criticized the company extensively for its inexplicable interpretation of the two-midnight rule and the retrospective denials of previously approved admissions. I am not trying to pick on UHC, but it’s as with comedians and Donald Trump, wherein the jokes almost write themselves.

So, what did UHC do now? In its March Network Bulletin, it announced that its provider directory, which patients use to find a doctor, now will include patient satisfaction ratings from Healthgrades.com.

While Healthgrades likes to portray itself as a non-biased source of information on the quality of care provided at hospitals and by physicians, I think it is really nothing more than an ad agency through which good publicity can be bought. Healthgrades’ patient satisfaction ratings are created by people who go to the website and post a review; all you need is an email address. If you post a review, you have to click a box indicating that you actually saw the doctor, but no one checks if you really did. When these sites starting appearing a few years ago (and there are many of them), I test-drove a similar site and was able to post eight stellar reviews of myself using eight different email accounts.

I also used the Healthgrades search tool to locate an internist in my hometown, and the top doctors on the list were 17 miles away. Why were they on top? Because they had the best ratings or reviews? Nope. It’s because they paid for top billing, referred to on the site as being a “featured provider.” In my area, the top doctor on the list did not even have the best ratings; in fact, that “top” doctor’s rating was 3 out of 5 stars, and the “experience match” was only 87 out of 100. There were many doctors much closer to me with 5-star ratings on every survey and an experience match of 100, but because they would not pay Healthgrades the required fee to be “featured,” they were not listed anywhere near the top.

As I am sure you all know, Healthgrades also rates hospital performance using MEDPAR and other publically available data. But you may not know that hospitals have to pay Healthgrades to advertise that they received a Healthgrades quality-of-care award. Kaiser Health News reported that one hospital’s charge just to advertise their Healthgrades award was nearly $150,000.  

Now, don’t get me wrong, patients should have access to data to help them select their doctor, but it needs to be accurate and meaningful data. I am not a fan of Press Ganey, the predominant provider of patient satisfaction rating surveys for hospitals, and have discussed how such surveys have played a part in leading to the nation’s opiate abuse epidemic – and the fact that patients who are highly satisfied actually have higher healthcare costs, are more likely to get inappropriate care, and are more likely to die, as noted in a study from UC Davis – but at least Healthgrades could send surveys to patients who actually received services, as Press Ganey does.

UnitedHealthcare has extensive claims data and knows more about doctors’ habits than their spouses do, so they should use that data to steer patients to quality providers and not “Yelp-ify” the process by using Healthgrade’s pitiful, profit-driven approach to collect satisfaction ratings.

About the Author

Ronald Hirsch, MD, FACP, CHCQM is vice president of the Regulations and Education Group at Accretive Physician Advisory Services at Accretive Health. Dr. Hirsch’s career in medicine includes many clinical leadership roles at healthcare organizations ranging from acute care hospitals and home health agencies to long-term care facilities and group medical practices. In addition to serving as a medical director of case management and medical necessity reviewer throughout his career, Dr. Hirsch has delivered numerous peer lectures on case management best practices and is a published author on the topic. He is a member of the Advisory Board of the American Case Management Association and a Fellow of the American College of Physicians. 

Contact the Author

RHirsch@accretivehealth.com 

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