From airlines to restaurants today, it’s all about the customer experience. Were they treated respectfully and promptly, and did they get what they came for? That’s increasingly true for health care organizations, and UC San Diego Health is no different.
The 500-physician hospital system is so set on improving its patients’ experience with their doctors that it was about to post on their physicians’ public profile pages critiques from patients about care they received — horrible to wonderful — along with star ratings indicating overall scores.
But UCSD has had to halt that project after realizing the surveys that went out to patients didn’t disclose that their comments could go public, potentially revealing their identities.
"We were ramped up to go live," said Dr. Thomas Savides, UCSD’s chief patient experience officer. But two weeks ago, a member of the hospital's project team received an electronic version of the survey and noticed "there was no disclaimer to the patients that the information (they wrote) might be put on the internet," Savides said.
"We decided that's not fair to patients. … So we’ve had to reset the clock," he said.
UCSD postponed the public launch three to six months to redistribute patient surveys with appropriate disclosure language. To let it go forward without doing that, Savides said, might not necessarily be a violation of patient privacy laws, “but it could be."
Although patients' names are always scrubbed from their comment postings, "sometimes the patient might write something thinking they were writing a confidential comment about a doctor, but which they never anticipated would be out on the internet," Savides said.
"It may be that the patient writes something that perhaps identifies them to the doctor, so they say, 'Gosh, I'm a 45-year-old woman with two kids and a cat, and I'm HIV positive.' That's enough that someone might be able to identify who that person is, including that physician and their staff."
Certain expressions a patient might use, or descriptions of how far they had to drive, paired with a doctor's specialty might also reveal who the commenter is.
That realization prompted UCSD to take down a demonstration of the program, which was limited to comments about Savides’ own patients on his official UCSD profile page.
When UCSD does start showing its patient comments on each doctor’s profile pages, it will join about two dozen healthcare organizations nationally that are incentivizing better physician behavior by displaying publicly what their patients think about them. The idea is that patient experiences may be almost as important in improving and maintaining health as a correct diagnosis and treatment.
UCSD, a two-hospital system with extensive ambulatory clinics and offices in La Jolla and Hillcrest, would have been the first hospital system in San Diego County to launch such a public critique of its own doctors, although Sharp and Scripps officials say they are considering similar reviews. Kaiser officials said they “aren’t ready to speak about” their plans.
Savides said the absence of appropriate disclosure was due to the failure of UCSD to include it in its survey cover letters that Press Ganey, the national vendor that distributes the survey, sends to UCSD’s patients. Savides said the problem came to light recently, after UCSD switched to using Press Ganey’s electronic surveys rather than paper, and a lot more surveys were being returned.
“Each health care organization writes their own cover letters for their Press Ganey-administered surveys,” Savides said in an email. “In our case, when we noticed that our letter did not inform our patients that we might use their anonymous comments online, we did not feel comfortable” with posting patients’ comments.
It's unclear how much of an issue this is with other organizations’ patient experience surveys. Press Ganey officials declined to comment and canceled an interview scheduled with President and Chief Operating Officer Joe Greskoviak the evening before it was scheduled.
An email from a press representative said, "Upon further review, we don’t think he has sufficient enough commentary for you and other Press Ganey associates declined to participate." Follow-up requests with specific questions about the alleged disclosure issue were not answered.
Across the country, at least two dozen big name hospital systems and medical groups have started posting online physician star ratings, including negative and positive comments, from patients based on these surveys.
The University of Utah Hospitals and Clinics was first, in 2012, followed by Piedmont Healthcare in Atlanta in 2013; Wake Forest Baptist in Winston-Salem, North Carolina, in 2014; and Stanford Medicine in Palo Alto, Cleveland Clinic, Geisinger Health System in Pennsylvania and Northwell Health in New York in 2015.
The surveys ask patients to score their doctors on a five-star scale based on five to 10 questions, such as whether the doctor listened, was courteous and respectful, and spent enough time. Their responses are aggregated into a star score. The experience survey star ratings and comment postings are not designed to measure quality of care — whether the patient got the right diagnosis or treatment — only the experience of care, and only that provided in an outpatient setting.
Organization to organization, the criteria for inclusion is highly variable. Some allow comments and star ratings for the entire patient experience, including wait times for appointments, time on the phone on hold, courtesy of office staff and even ease of parking.
Others include only what happened between the patient and the doctor in the exam room. Some allow comments and ratings for nurse practitioners, midwives and physician assistants while others limit responses just to physicians.
While most comments are overwhelmingly positive, some are brutal.
At the University of Utah Hospitals and Clinics, Dr. A. Wayne Meikle, received a low 3.8 stars and this: "I have little confidence in this doctor. He almost gave me a prescription based on the lab results of the wrong date. I had to point that out to him." Or Dr. Don Coleman, who received 4.4: "HORRIBLE PATIENT CARE…I felt like I was just a burden to them and a quick pay-check."
By allowing these reviews, organizations risk tarnishing the reputations of some of their doctors. But by having a higher number of reviews for each physician, the doctors get higher billing in a Google search, above listings from Healthgrades.com, Vitals.com, ZocDoc.com, Yelp.com and other online physician rating companies that may tend to be more negative.
According to a 2014 paper published in JAMA, one in four people surveyed in 2012 said they picked a primary care physician based on such commercial ratings.
The organizations also can be sure that comments come only from real patients with real experiences, not competitors or angry family members, or even the doctors themselves.
The process also puts pressure on physicians to adopt friendlier behaviors, and alerts them to issues in their practices about which they may not be aware.
And, most organizations only post reviews or star ratings for providers who have at least 30 reviews, so a few single negative remarks about one doctor will almost always be overshadowed by positive comments from other patients.
Savides wasn't sure if the lack of disclosure might be an issue for other organizations now using Press Ganey's online tool.
Dr. Thomas Miller, chief medical officer for the University of Utah Hospitals and Clinics, isn’t worried. “This is a non-issue," because all personal remarks are scrubbed, he said.
"We’ve been doing this almost four years and patients know they can find the comments online. We've never had anybody complain about it." He added that although he doesn't have "a lot of background" on the UCSD discovery, "I think this is just physicians pushing back. It's an excuse not to do this."
