WHAT'S YOUR SCORE?

Online physician rankings can boost, harm a practice

Editor's note: In this issue, we explore Web sites that allow patients to "rate" their doctors, as well as steps you can take if false or unjustified negative comments appear about you or your practice. Also, read more online at www.dermatologytimes.com/Residents to learn how residents say such sites are helping them to grow professionally.

National report - Love or loathe them, public Web sites that let patients rate their physicians aren't going away, experts say.

Making these sites work for you rather than againstyourequiresongoingvigilance, broad-based patient participation and - for some physicians - patient contracts, they add.

"The biggest problem with these sites is that you're not sure who is evaluatingyou: a real patient, a competitor, a disgruntled employee or other anonymous source," says Vic Narurkar, M.D., associate clinical professor of dermatology, University of California, Davis.

Most physicians are uncomfortable with online rating sites, says Jeffrey Segal, M.D., J.D., CEO of Medical Justice, a company that helps physicians fight online defamation. Such sites can represent "the dark side of the Internet," he says.

Currently, he says, "There are more than 40 sites, mostly anonymous. And most sites have zero to three ratings - they're not particularly useful to anyone yet."

"The good sites are good; the bad ones are really bad," adds Beth Santmyire-Rosenberger, M.D., a Fairmont, W.V., private practitioner whose patients have used such sites.

Fortunately, only one disgruntled patient has everpostedfalse comments about her practice, she says, and, luckily, when she called the site and disproved the comments, they were deleted.

Dr. Narurkar says that in his case, a succession of personal attacks on yelp.com convinced him he was being stalked.

One post said Dr. Narurkar treats medical patients disrespectfully because he'drather do expensive aesthetic procedures.

"I only do aesthetic procedures. Patients knowthat coming in," he says, adding that he never could determine whether an actual patient made these remarks. "None of the reviews had anything bad to say about my performance" medically, he says.

Dr. Narurkar says he complained about the negative comment to the site's managers, who investigated the matter. Days later, "They removed the reviews. But even seconds on the Internet can damage your reputation."

Another post called Dr. Narurkar "fancy" because he had attended private schools (his educationalbackgroundis available online).

"The yelp.com people called me saying that this was posted," he said. Dr. Narurkar says the caller insinuated that the dig would disappear if he advertised on the site.

Because of the nature of the post, Dr. Narurkar said, "I was afraid for my own personal safety," and he called the police. He said after he informedyelp.com that he'd discussed the matter with police (though he made no formal report at the time), "The review vanished."

Stephanie Ichinose, yelp. corn's director of communications, says she cannot access details of Dr. Narurkar's incident, or determine the number of similar complaints yelp.com receives. However, she adds, yelp.com absolutely does not let advertisers manipulate reviews, outside of choosing a favorite to lead the list.

Potential clients may misinterpret such details during sales calls, she says. Non-sponsors can report suspicious postings to site managers, and respond to reviewers publicly or privately, for free, she adds.

The fact that Dr. Narurkar called police wouldn't have affected yelp, corn's decision to remove a posting, Ms. Ichinose says. "There must have been something in it" that violated yelp, corn's guidelines, she says.

DrScore scores high

Many sites charge patients for physician reports, Dr. Santmyire-Rosenberger says, "and that s even worse (than posting unsubstantiated attacks), because patients are paying for information that may not be true. There's not much regulation of the sites."

Accordingly, she says she's "not a big fan" of any rating sites except for DrScore.com, which she says she has used for more than three years.

DrScore.comwaslaunchedbyStephen R. Feldman, professor of dermatology, pathology and public health, Wake Forest University School of Medicine, Winston-Salem, N.C.

Compared to other doctor rating sites, Dr. Feldman says, DrScore uses a more detailed survey specially designed by a patient satisfaction scientist to give validated feedback at a level of detail on which doctors can act.

The survey's interactive nature is "truly unique," he adds. "If patients say there's no problem in certain areas, we don't ask any more questions. But if they identify that an area can be improved, then we drill down in that area to get more information."

He says the site uses proprietary technologytoavoidreportingofmultiple negative or positive reviews on a single doctor visit.

'Little things' matter

Dr. Santmyire-Rosenberger says that, overall, her practice's DrScore.com feedback - delivered via quarterly reports which she reviews with all her staff- has been positive.

But the staff "also learned there are little things" she says she would never have guessed bother patients.

"Some of them believe that if they're not sitting here for three hours, you're not spending enough time with them. Actually, a 40 -minute visit is how it's supposed to be."

DrScore.com feedback also persuaded her to stamp herpractice's name on its cash receipts, Dr. Santmyire-Rosenberger says.

James A. Zalla, M.D., says that along with evaluating everything including a practice's parking facilities and signage, DrScore.com provides anonymous free-form comments that can be equally eye-opening.

Shortly after he enrolled in DrScore. com, "One or two patients commented about rude responses from a new receptionist." After Dr. Zalla monitored the receptionist's performance himself, "She was gone in about a week," he says. "Otherwise, that process could have smoldered" much longer. He is president of Dermatology Associates Northern Kentucky in Florence, Ky.

In another case, a patient's mother complained that one of Dr. Zallas colleagues lectured her for taking the teenager to atanningparlor. Accordingly, he says DrScore.com's only downside is "You don't have control over the patients who choose to provide feedback."

Dr. Zalla says he also likes that DrScore. com lets him gauge his practice in total - and each physician therein - against national mean scores for dermatologists and non-dermatologists (patients see only composite physician scores online, not detailed comments).

This way, "We can see if we've got a weak link among individual physicians in a particular area. You may not get that feedback except from patients."

Before DrScore.com, Dr. Zalla says, patients rarelyprovidedfeedback Traditional satisfaction surveys could cost $4,000, butprovide no ongoing picture as DrScore.com does, he adds.

As such, "It's an opportunity to maintain the quality of care we like in a relatively inexpensive way (about $100 per year per physician)." Sharing his practice's ratings with insurers has helped him secure higher contractual reimbursement rates with three carriers to date, Dr. Zalla adds.

Achieving accountability

"The Internet is here to stay," Dr. Segal says. "The question is, how can we persuade sites to be accountable," balancing reasonable patient expectations with physicians' legitimate concerns?

One solution, he says, involves Medical Justice's "anti-defamation program," which includes a waiver that participating physicians require patients to sign. The agreement directs patients to sites Medical Justice considers appropriately balanced (including DrScore.com and RealSelf.com), he says.

The agreement doesn't prevent patients from posting anywhere, but it gives the physician copyright to any postings. This gives the doctor authority to quickly yank inappropriate or egregious postings, Dr. Segal says.

Regarding the agreement's effectiveness, he says that whenever physicians have tried to enforce the contract, "More often than not the posts have been removed."

Membership in the online defamation program costs $495 per physician for the first year; $350 yearly, thereafter. Joining all Medical Justice programs, including medical liability, costs $625 to $1,800 per physician yearly, depending on state and specialty, he adds.

Regarding Web sites, Dr. Segal recommends that they make patients sign their postings or otherwise document that they are actually patients. Medical Justice moreover suggests that sites compile at least 25 ratings per physician before publicizing this information.

"The more good information that patients put online about you, the more it overwhelms any bad that may pop up," says Dr. Santmyire-Rosenberger, who, like Dr. Zalla, urges all patients to rate every appointment.

Dr. Segal also recommends that Web sites limit ratings to subjective impressions regarding a doctor's communication skills, waiting times and the like. Conversely, having a patient evaluate a doctor's expertise "probably isn't fair unless you have an expert to back that up."

Ultimately, Dr. Segal says, Web sites should report safety and outcome data. "But that won't happen next week." For now, he says Web sites can begin "deputizing" patients to record simple observations such as whether physicians wash their hands between appointments.

Dr. Santmyire-Rosenberger adds that she hears much discussion about sites associated with insurance companies one day providing clinical outcome information. "The problem is, in many situations there's also financial incentive" for steering patients to one doctor or another, she says.

Image management issues

Meanwhile, "People must keep an eye on what's out there about them on the Web," says Dr. Santmyire-Rosenberger, whose husband/practice manager does this monthly. Similarly, Dr. Narurkar says he and a staff member monitor his online image weekly.

Should a cyber-slam surface, Dr. Narurkar advises contacting the Web site to determine if the rating is legitimate.

"If it's arealpatientthat's disgruntled, I always try to communicate with the patient to see what went wrong" and how to fix it, he says.

Dr. Segal also recommends using search engine optimization (SEO), which he says can help companies control the first two pages of relevant Google searches. "If you don't populate the Internet with content, others will do it for you," he says

Zack Roth, senior vice president, global business developmentwith Reputation Management Consultants, says, "SEO is a an ongoing monthly process of optimizing existing pages, adding new pages of optimized text content to the site and building links from a wide variety of relevant, authoritative sources pointing in to the doctor's domain name."

[Sidebar]

"The biggest problem with these sites is that you're not sure who is evaluating you."

Vic Narurkar, M.D.

San Francisco

[Sidebar]

story highlights

* Online doctor 'ratings' Web sites can help or harm your practice

* DrScore. corn's features rank high with physicians

* Some services offer methods to 'optimize' your Web presence

[Sidebar]

"The question is, how can we persuade sites to be accountable?"

Jeffrey Segal, M. D., J. D.

Greensboro, N.C.

[Sidebar]

"We can see if we've got a weak link among individual physicians in a particular area."

James A. Zalla, M. D.

Florence, Ky.

[Author Affiliation]

By John Jesitus

Senior Staff Correspondent