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Publishing physician star ratings: how transparent is your transparency?

We’ve extensively discussed the growing transparency trend of health systems self-publishing patient experience survey data in the form of verified patient ratings and reviews. This sharing of information has enabled better-informed consumer decision-making, but it’s also raised the question, “is everything being shared?”

It’s a reasonable thing to wonder. Would a health system really publish negative reviews and 1-star ratings about their own doctors?  What about scathing comments?  Since 2014, over 70 health systems have selected National Research Corporation (NRC) as their transparency partner – to automate the publishing of their patient ratings and comments and provide expert guidance throughout the implementation of their transparency program. We’ve been discussing questions like these for a while alongside healthcare’s foremost innovators in transparency.

Is it acceptable for some comments to go unpublished?
Almost everyone can agree that some comments are unfit for publishing, and we refer to these as “excluded comments.”  But just what qualifies a comment for exclusion can vary from organization to organization. There is no one “correct” set of exclusion criteria for all organizations, but there is one correct approach to implementing them. Since the name of this trend is “transparency,” it’s essential that healthcare organizations clearly define what exclusion criteria they use and publish these criteria prominently on their websites.  This way, consumers have an accurate understanding of exactly what they are and aren’t seeing.

Why might a comment NOT be published?
After researching all live transparency programs, NRC found that all exclusion criteria can be grouped into just five categories (with slightly different wording from one organization to another).  Comments might be excluded if they:

a)   Contain offensive or profane language
b)  Could be considered libelous/slanderous/defamatory
c)   Risk jeopardizing the privacy/confidentiality of the patient
d)  Reference other departments, providers, or instances of care.
e)   Are considered irrelevant

In Practice: What exclusion criteria do most health systems use?
In September 2016, we took a look at 50 live health systems publishing patient ratings and reviews, and complied data on what published exclusion criteria they are using.  Below are our findings.

Live organizations publishing comments (with published exclusion criteria) 45
a) Use “profane language” as a criteria 82% 37
b) Use “slander, defamation, or libel” 91% 41
c) Use “jeopardize patient privacy” 100% 45
d) Use “irrelevant” 18% 8
e) Use “unrelated to the provider or about other departments” 18% 8

In addition, we found that seven health systems are publishing “ratings only” without publishing patient comments. And finally, for an additional five health systems publishing comments, we were unable to find published exclusion criteria on their websites.

What does NRC recommend?
Exclusion criteria are well structured if they are easy to implement and clear to interpret consistently. If a physician appeals a published comment—or a comment scheduled to be published—the appeal process should simply be exploring the question, “which exclusion criteria was met?” With these guidelines in mind, NRC believes that criteria “a, b, and c” above are easy choices for healthcare organizations to include in their exclusion criteria. It’s fairly easy to gain consensus about whether or not a comments falls into one of those categories, and most consumers and administrators alike can understand why those comments should be excluded.

Criteria “d” above, “other providers,” is really more of an organizational preference about what they want their transparency program to include.  Some organizations feel that “unfiltered” comments can and should include commentary on every person a patient encounters during their healthcare visit. Others who are publishing provider-specific ratings feel strongly that the comments should only be focused on the healthcare provider for whom the survey was completed. Neither approach is right or wrong, but every additional exclusion criteria means slightly fewer comments will be published. All things being equal, publishing more comments means being more transparent.

That leaves criteria “e,” the question of relevance. If healthcare organizations want to use “irrelevancy” as exclusion criteria, they certainly can, and they will still have a credible and successful transparency program. However, of all the criteria listed above, this one opens the door to the most subjectivity, and therefore might result in more work on the part of the healthcare organization to implement reliably and consistently. An unexpected benefit of publishing comments that are clearly irrelevant is that it can demonstrate to consumers that an organization is committed to transparency and signal that they are not filtering comments to suit their own interests.

Have any questions that weren’t answered in this post?  Please post them in the comments or get in touch with an expert at NRC today!  If you want to receive future updates on this topic, be sure to subscribe to our blog.

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