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Seeing Stars: Navigating Patient Ratings and Reviews

Executive Summary

Consumers seek and appreciate input from fellow consumers. This phenomenon is not limited to healthcare – online ratings and reviews are prevalent across nearly every major consumer touchpoint. In the healthcare context, ratings (i.e., ‘stars’) indicate how facilities or providers are seen through the eyes of those they serve; that view comes into sharper focus when accompanied by reviews (i.e., comments). It’s been just over a decade since healthcare organizations began posting ratings and reviews on their websites, and since then, virtually every hospital, health system, and physician group has at least explored the idea, with many now openly sharing ratings and reviews for both providers and facilities.

Where do ratings and reviews come from? How are they used? Who creates them? How do third-party sites factor in? This nSight highlights 6 points:

  1. The proportion of people who view ratings/reviews is almost double the proportion who post reviews themselves.
  2. Stratifying the data reveals the comparatively highest proportion of viewing behavior by demographic group: age = 25-44 years old; sex = female; race/ethnicity = Hispanic; household income = over $100,000/year.
  3. Posting behavior follows the same demographic pattern, except for sex: males are slightly more active in terms of posting reviews.
  4. Consumers point to Google as their primary source for third-party reviews of healthcare providers. And that’s where most of the reviews ‘live’: NRC Health data shows that 85% of these reviews are on Google.
  5. While the volume of ratings/reviews is considerably higher on health-organization websites than on Google and other third-party sites, it is possible to catalyze third-party reviews and realize very positive effects.
  6. Most 5-star ratings are accompanied by comments that focus on interactions with people while most 1-star reviews point to failures to meet expectations regarding functionality (e.g., scheduling, making appointments, wait time, waiting areas).

The process of generating ratings/reviews

NRC Health automates the process of turning patient experience data (e.g., likelihood-to-recommend) into star ratings and appending associated comments, allowing health organizations to publish ratings/reviews directly on their websites. This enhances the task of seeking care while amplifying search engine optimization (SEO) and boosting website conversions. NRC Health’s patient experience surveys yield a substantial volume of reviews: We made about 1.8 million available for health organizations to publish on their own websites over the past 6 months. And that’s what patients are looking for: Our nationwide Market Insights study documents that ratings/reviews are second only to ‘how to find a physician’ in terms of the information that patients deem most important on healthcare websites.

Use: views and posts

We know that reviews are important, but what do we know about how patients interact with them? Looking across 2023 – and focusing on the 155,603 people who had a healthcare experience within a year of their participation in the National Market Insights Study – reveals that 60.5% report having viewed online ratings/reviews of a doctor. This proportion has been slightly, but steadily, increasing year-over-year. Overall, a third of the same sample (33.9%) report that they have posted a rating/review of their doctor. While this number has also grown a bit over the years, it’s clear that a relatively small group is fueling the supply of ratings and reviews.

A powerful picture emerges when we look only at the 60.5% who report that they have viewed an online rating/review of a doctor – fully half (50.0%) also created an online review. In contrast, only 9.1% of those who have not gone online to see ratings/reviews report posting one themselves. It appears that viewing and posting ratings/reviews may be mutually reinforcing behaviors. But, of course, there’s more to it. We conducted a focused study (n = 125) to learn why people who leave online reviews for other products/services, do not post ratings or reviews for healthcare. The top 3 reasons:

  • Healthcare is personal and private
  • Do not want to hurt a hospital or doctor
  • Never thought about leaving a review for healthcare

The interdependence of viewing and posting behavior, coupled with the fact that some may have never even thought to leave a review in the healthcare space, suggests that there is real value in utilizing NRC Health’s tools to make it easier for patients to post online reviews about their experiences.

Who’s doing the viewing and posting?

All analyses and graphs in this section focus on consumers who reported having a healthcare experience within 1 year prior to their response to NRC Health’s National Market Insights Study (Jan-Dec 2023). Looking at age groups, we see the most use of ratings/reviews – in terms of both views and posts – by consumers who are 25-44 years old.

The comparison for males and females reveals a perhaps unexpected twist. While more females report that they viewed ratings/reviews, a slightly higher proportion of males report posting reviews.

And when it comes to race/ethnicity, while White respondents make up the majority of the sample (70%), it is clear that consumers identifying as Hispanic are more likely to report both viewing and posting online ratings/reviews compared to other groups. This finding takes on added importance vis-à-vis data we highlighted in the 2023 Experience Perspective, showing that Spanish speakers are more likely to report significantly lower trust in providers, tend to have more ‘alert-worthy’ issues after discharge, and have a greater percentage of unresolved concerns. So, at the same time that higher proportions of Spanish speakers are leaving their care experiences feeling unheard, patients identifying as Hispanic are more likely to voice opinions about their care online. All the more reason to focus on ensuring equity for all patients.

The relationship between household income and use of ratings/reviews is also telling. While there is a fairly linear upward trend in terms of viewing behavior, we see a marked bump in posting by consumers at the highest income level.

What about Google and other third-party sites?

In a study we conducted for a large health system, we found that consumers point to Google as their primary source for third-party reviews of healthcare providers. And that’s where most of the reviews ‘live,’ as evidenced by the data we track for reviews enabled by our Smart Requests solution, which makes it easy for patients to leave reviews on third-party websites: 85% of these reviews are on Google. While the volume of ratings/reviews is considerably higher on health-organization websites than on Google and other third-party sites, it is possible to catalyze third-party reviews.

Organizations that have deployed NRC Health’s Smart Request tool have seen an average increase of 379% in the volume of third-party reviews, with the vast majority of these being positive.

Our case study on UT Physicians details how this work led to a 776% increase in the number of reviews posted on Google within the first year. Even more impressive: The average rating went from 2.9 to 4.6 out of 5 stars.

Indeed, our analysis illustrates that most third-party ratings sparked by Smart Requests are positive, with 5-star ratings accounting for more than three-quarters of the total. In fact, people leaving ratings tend toward one extreme or the other; there are relatively fewer 2-, 3-, or 4-star ratings in the mix. Interestingly, the percentage of 5-star ratings differs widely by website: 89.9% on Healthgrades vs 77.5% on Google. And on Yelp, that number falls to just 33%.

A linguistic analysis of 1- and 5-star reviews from 2023 and early 2024 revealed important distinctions in focal points between those who left highly positive and those who left deeply negative feedback. Below is a scattertext plot showing the frequency of two-word phrases (called bi-grams) distilled from a random sample of more than 150,000 online reviews. Bi-gram frequencies from reviews associated with 5-star ratings are plotted along the vertical axis against frequency ranks from 1-star reviews, which are plotted along the horizontal. The color and size of each dot represents the percentage of 5-star reviews and subjectivity scores associated with the reviews in which each bi-gram phrase appeared (red = more negative; smaller = less subjective, more fact-laden).

This analysis illustrates that most 5-star ratings are accompanied by reviews that focus on interactions with the care team at all levels (e.g., front desk, staff, nurses, and doctors). These positive reviews are further differentiated by phrases related to taking time, answering questions, and making patients feel comfortable, underscoring the value of Human Understanding® as an organizational posture. On the other hand, most 1-star reviews denote failures to meet expectations regarding structure and functionality (e.g., scheduling, making appointments, wait time, waiting areas).

A note about CMS Star Ratings

According to CMS, “HCAHPS Star Ratings provide a quick summary of each HCAHPS measure in a format that is increasingly familiar to consumers and enable consumers to more quickly and easily assess the patient experience of care information.” Familiarity with the star-rating concept is one thing – think Amazon. But how many consumers know about HCAHPS Star Ratings?

NRC Health took a close look. We found that fewer than 20% percent of consumers, when directly asked, reported visiting the CMS Care Compare website. In other words, 2.75 times more people have used online ratings and reviews of providers and healthcare organizations than have accessed CMS Star Ratings. These ratings are important, but they are not a go-to resource for consumers.

Bottom Line

While ratings and reviews are only one part of the online experience for healthcare consumers, they are likely to continue growing in scope and scale, increasingly extending beyond clinical encounters to encompass access, billing/payment, and even the use of AI. Consumers have higher expectations for their healthcare experience than they attach to any other industry—and that’s a good thing. Understanding and addressing what matters to your consumers and patients as unique people is the key to honoring and even exceeding those expectations. NRC Health can help.

Explore additional nSight reports to get insider data and perspectives you need to drive strategic change. Discover More.

Explore additional nSight reports to get insider data and perspectives you need to drive strategic change. Discover More.

© NRC Health 2024

Suggested citation for this report:
England W, Makoul G. 2024. Seeing Stars: Navigating Patient Ratings and Reviews. Human Understanding Institute – NRC Health. (Accessed mm/dd/yyyy).

© NRC Health 2024