When more (and different) organizations start rating your hospital, what's a hospital leader to do?

Josh Zeitlin, Associate Editor

Who gets to define your hospital's quality of care and patients' satisfaction?

In the past few weeks, the Daily Briefing has reported on several organizations­­—from Yelp and ProPublica to Consumer Reports and CMS—all trying to stake their claim.

It raises several major questions: First, How should hospital leaders be thinking about ratings and satisfaction scores? And should organizations be publicly posting such data themselves?

I asked two experts who would know:

Here's what they told me.

Question: CMS's hospital data just became much more visible last week when Yelp, in partnership with ProPublica, announced that it is adding data on thousands of health care providers to its listings.

What do we know about how often consumers have been using sites like Yelp to make decisions?

Alicia Daugherty: Interestingly, Yelp actually got its start as a physician recommendation service, so it's finally living out the founders' initial health care vision, in a way.

In our recent national consumer surveys, we found that three-quarters of consumers do some research before choosing a doctor; however, less than 10% use third-party review sites. They're more likely to ask friends and family or visit a provider's or insurer's website. That's partly because, as one Yelp executive noted, many consumers don't know about the third-party sites, and they're often difficult to navigate.

Among our survey respondents who said online reviews influenced their choice of doctor, only 6% used Yelp and only 5% used CMS's Hospital Compare. I would certainly expect Yelp's number to grow with the addition of this data, which will also indirectly increase the reach of Hospital Compare.

Q: If more patients start looking to Yelp when choosing a provider, do you think that will cause providers to focus even more on the metrics published on Yelp's site?

Daugherty: The metrics that hospital leaders are prioritizing right now are the ones tied to value-based payments—a more pressing issue for provider organizations right now than other public data.

And most provider organizations have been working for years on the metrics that Yelp is featuring—ED wait times, readmissions, patient satisfaction, and others. None of these are new areas of focus. However, the attention could certainly help renew staff energy and motivation around some initiatives that have been in place for several months or years.

Jessica Suchy: Those measures that influence payment are certainly the main focus for providers today. At the same time, as more patient satisfaction data that are not tied to payment goes public—whether from outside organizations or from provider organizations themselves—I think we'll see the need for hospital leaders to focus on both mandated and other public satisfaction data.   

Across the last year, a number of organizations that we work with have either created a specific leadership position to oversee patient experience, or have implemented patient experience steering committees to focus their attention on all of the various sources and types of patient and consumer feedback. 

Moving the dial on patient experience is not an easy task, and so I think leaders will struggle a bit with which metrics to focus on. That makes it all the more important for leaders to take a strategic approach to measuring patient experience goals.

Case study: How iRound improves patient experience and sustains performance

Q: So with all of the various rankings out there—just last month, U.S. News published its "Top Hospitals" list, and ProPublica released a Surgeon Scorecard—how much should providers pay attention to rankings, and how can they be strategic about measuring performance?

Daugherty: Different rating systems can produce remarkably different evaluations of the same institution. What's measured, and how measurements are aggregated, both have profound effects on the final "score." As a result, most physicians and executives rely on their internal data and methods of calculation, though even internally there's plenty of disagreement about the best approach.

Many of our members use our Hospital Benchmark Generator to compare their Medicare scores to those of a custom cohort that they can define.

Q: There's another strategy some hospitals are employing, too. Last week, UPMC decided to publish its own ratings for more than 1,600 of its providers online, alongside comments received from patient surveys.

How should other provider organizations be thinking about whether they should take a similar approach?

Suchy: By cutting out the middle-man, organizations have a significant opportunity to garner trust from their current and potential patients—they are sending a message of openness and transparency, without waiting for a third-party to do so.

However, it's important that an approach like this is well thought out. To keep that trust, consumers must feel that the ratings and comments are honest and direct feedback, and not filtered by the organization to only show their providers in a positive light. Other organizations taking a similar approach should make sure they are engaging with their physicians during this roll-out and communicating with consumers very clearly on how the data are collected, and what may or may not be excluded.

Q: Do you see this kind of data sharing from providers becoming the norm? And, if so, is important for organizations to be early adopters?

Daugherty: I think this data sharing will quickly become a standard must-have, so the window for it to be a differentiator is limited. With volume, they'll probably cluster like patient satisfaction scores do, with relatively small differences among most organizations.

DIY performance reporting: An end-run around rating organizations?

As for the differentiation window, first movers will likely get the most "credit" in the market for improving transparency and building trust. Those who aren't first movers can think about how they can present the data in a more useful, engaging manner. The key is to keep it simple. And simplicity is surprisingly difficult.

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