Doctors and Health Care Businesses and Health Care Reform and Health Care & Insurance

Doctors squirm as patients rate health care

April 6, 2009

Dr. Dmitry Arbuck treats pain for a living. But he might have to start taking his own medicine.

Arbuck has built a practice that by all traditional standards is exemplary. But patient reports on multiple online rating services make Arbuck seem arrogant, incompetent and downright scary. "This Dr.  is  a QUACK," " one patient wrote in November on the Web site RateMDs.com.

"I can't believe this dr. hasn't been investigated yet," said another in February.

"Probably made my problems even worse than they were before I saw him," " wrote a patient a on Vimo.com.

As health care slowly shifts to operate more like retail stores, comments like these have become commonplace on more than 30 physician-rating Web sites, including a subscription service run by Indianapolis-based Angie's List.

The sites are trying to help consumers make informed decisions but, by most accounts, have a piled up too little information to be particularly useful.

"It''s still highly fragmented," said David Knott, managing partner of the global health care practice at consulting firm Booz & Co.  "But I think a lot of these sites are attempting to advance the cause."

Doctors generally dismiss the ratings as over-representing disgruntled patients. That's certainly how Arbuck sees it.

"It's a disservice to patients because it's so biased," said the Carmel psychiatrist. His practice, Meridian Health Group, includes five physicians who treat their patients' pain as a team.

Arbuck, who also teaches part time at the Indiana University School of Medicine, explained that his practice treats patients only after other doctors have failed. That means patients often come to him seriously addicted to multiple painkillers—so much so that the painkillers start causing the patients' pain.

Trying to get them unhooked is necessary, but often strongly resisted.

"We upset many people who want narcotics," he said.

Some doctors have been so upset by the online rating services that they have asked their patients to sign a contract promising not to post comments about them online.

Demand for the contracts is so strong that a North Carolina firm, Medical Justice Services Inc., began selling versions for doctors to have their patients sign. The contracts stipulate that patients won't post comments about the doctor on a Web site without the doctor's permission.

"On rating sites, patients, or people posing as patients—such as disgruntled employees, ex-spouses, or competitors—can damage a hard-earned reputation," Medical Justice wrote in a recent press release.

Arbuck said such contracts are "wrong," because patients should be able to express themselves. Other local doctors contacted by IBJ said the same.

Angie Hicks, chief marketing officer of Angie's List, said she has heard from at least one patient in Indiana who has signed such a contract.

"It's completely wrong that a patient should have to make a decision between health care and their freedom-of-speech rights," Hicks said.

Praise, too

Not all ratings on these Web sites are negative. In fact, most Indianapolis-area doctors received high grades—A's on Angie's List, 5's on RateMDs, and four or five stars on Vitals.com or Vimo.com.

"Patients, they have this kind of a kindred spirit for people that have the same thing they've gone through," said Heidi Gerdts-Lohner, saying that's what drove her to post positive reports on Angie's List about doctors who treated her 6-year-old son.

She disagrees with Indianapolis doctors who say most posters are disgruntled and therefore dismiss the comments out of hand.

"Yeah, that's how [those doctors] treat their patients," said Gerdts-Lohner, 34, who lives in McCordsville.

Dr. Judith Sutton of Cornerstone Family Physicians in Indianapolis has 10 reports filed about her on Angie's List—nine of them an A, and one an F. "She is very approachable and very patient with any questions that you may have. She makes sure that you understand what is happening," one patient wrote. The problem is, Sutton's 10 reports are an anomaly on Angie's List. Most doctors have just one or two reports about them. Arbuck, for example, has one report on Angie's List—an A.

"I would highly recommend him," the patient wrote about Arbuck and his practice. "Any type of pain, they have a doctor who can cover it."

All doctor-ratings services are in a race to build the biggest database of comments because size is vital to their financial success and market position, independent health economist Ruth Given wrote in a November report.

"Attracting a consistently high (and ideally representative) volume of MD ratings from users is one critical success factor for MD rating Web sites," Given wrote in her evaluation of 33 physician rating services, which was posted on The Health Care Blog. "This ensures value for users and fairness for the providers being rated."

Dr. Abideen Yekinni agrees. He waved off the four reports available about him—two on RateMDs, one on Angie's List, and one on Vitals.com. However, he said, the reports would matter if the sites piled up scores or hundreds of reports.

"If you get consistently good reviews, that should count for something," Yekinni said. "If you get consistently bad reports, that ought to count for something."

Still, Yekinni and other doctors think their quality should be measured by more than just patient reports.

Yekinni mentioned traditional quality measures: a doctor's training, length of practice, and specialization. Such information is available though Web sites including HealthGrades and MDNationwide. Both sites charge a fee for a doctor's report.

He also said patients should tap traditional word-of-mouth sources.

Arbuck would like to see services that gathered the opinions of all patients who saw a doctor over, say, a week. That way, the ratings wouldn't skew toward disgruntled patients.

Ratings by other physicians and the number of successful medical malpractice suits might be useful, too, he said.

Hicks, of Angie's List, agrees that patient reports about doctors are not the only source of quality information consumers should—or do—consult.

"Even if it's a handful of reports, or if it's just three to four reports, that certainly gives the consumer one more data point that they can use," Hicks said. "This is one part of their toolbox."

For doctor-rating services to truly meet consumers' needs, however, they're going to need to add more tools, contends Knott, the health care consultant at Booz & Co.

Ultimately, Knott foresees independent companies' signing deals with health insurance plans—such as Anthem—to combine reliable out-of-pocket cost estimates with doctor quality reports.

He also foresees ratings companies bulking up the quality of their information by posting statistics about how often a doctor has performed certain procedures.

Only when patients can get reliable and meaningful information about both price and quality will health care really operate like retail, Knott said.

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