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Star ratings for healthcare: why zero stars makes zero sense

Physician star ratings have made their way into healthcare—both in the form of third-party review sites such as Vitals and Healthgrades and via individual hospitals and health systems publishing ratings and reviews generated from their patient experience feedback like CMS star ratings for hospitals. With this trend sweeping the industry at warp speed, there is a need to adopt a methodological standard to ensure healthcare consumers are comparing care options apples to apples.

In recent weeks, there has been debate over the standard for star ratings methodology for healthcare; some propose that 5-star ratings should be measured on a six-point scale (0 to 5 stars instead of 1 to 5 stars). While healthcare as an industry has been known to do things differently from time to time, the methodology for star ratings scales should be universal across all industries to help consumers easily make better-informed decisions.

The 5-Star Standard Online

Today’s consumer is very familiar with seeing star ratings online. Sites such as Amazon, Google, Yelp!, and TripAdvisor have had star ratings incorporated into customer feedback for years. Everyone has a good idea of what a 5-star product or service is as well as what woes come with a 1-star experience—but what about a 0-star rating?

All of the most popular consumer review sites reject the concept of a 0-star review; the worst possible rating you can give on these sites is a 1-star. In fact, none of the sites listed above will accept a 0-star review. If you try to leave a 0-star review, these sites will stop you and say, “Hey, you forgot to leave a rating!”

The 5-Star Standard in Healthcare

The Centers for Medicare & Medicaid Services (CMS) uses a 1- to 5-star scale for hospital quality on its Hospital Compare website. And while the CMS force-ranked methodology is different from the consumer version of 5-star ratings, it is still on a 1- to 5-star scale.

The third-party healthcare review sites mentioned above also use the consumer-friendly 1- to 5-star format, as do all leading health systems publishing ratings and reviews, including Cleveland Clinic, University of Utah, OU Medicine, Duke, Intermountain Healthcare, and dozens of other market-leading organizations. In fact, we aren’t aware of any precedent of a 6-point rating system used anywhere.

The Visual Conundrum of Zero Stars

In addition to the de facto standard already present both in and out of the healthcare industry, zero stars is a confusing concept visually.

Across the Web, this graphic means that either: (i) this provider has zero ratings, or (ii) you need to select at least one star in order to rate your experience:

healthcare 0 stars
If you had a terrible experience, this is what a 1-star rating looks like on a 5-point scale:

healthcare 1 star image
But on a 6-point (0- to 5-star) scale, here’s what a zero-star review would look like:

healthcare 0 star ratings

While this graphic intends this to represent zero-star rating, it’s really difficult to understand it as such. At a quick glance, you see the one star highlighted. You may or may not even notice that there are six stars present—you could just feel like your eyes are playing tricks on you.

How does this hurt me?

Not only is using a confusing 6-point scale misleading to prospective patients, it also negatively impacts the online reputation of your physicians! If you display a standard 1- to 5-star scale on your website but calculate the rating on a 0- to 5-star scale, your doctors’ scores will come out lower than they are actually performing.

Best Practice for Simple and Correct Conversion of Patient Feedback Into Star Ratings

National Research Corporation has helped healthcare organizations publish more verified patient ratings than anyone else—over 4 million and counting. And in our work with leading health systems across the country and PhD data scientists, we’ve established a best practice methodology to convert patient experience feedback into star ratings. It’s publicly available via our hctransparency.org resources page.

In the transparent sharing of this patient feedback, it’s paramount that patient needs are put first. Amazon, Yelp!, Facebook, Google, Trip Advisor, Healthgrades, Vitals, RateMDs, Cleveland Clinic, University of Utah, OU Medicine, Duke, Intermountain Healthcare, CMS, and the rest of the internet all calculate their ratings on a 1- to 5-star scale. Don’t put your organization and providers at a disadvantage—and jeopardize the credibility of your transparency program—by calculating your star ratings on a 0- to 5-star scale.

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