Despite efforts to increase the visibility of radiologists among patients, the majority still remain in the background -- at least in terms of popular physician-rating websites, according to a new study published in the Journal of the American College of Radiology.
In fact, researchers from Emory University School of Medicine found that 80% of diagnostic radiologists have no presence on these sites, even though the trend has become more prevalent; for example, the likelihood that an average physician would be rated online rose from 0% in 2005 to 16% in 2010, lead author Kirven Gilbert and colleagues wrote.
Why does this matter? As the U.S. Centers for Medicare and Medicaid Services (CMS) continues its migration from fee-for-service payment models to value-based ones, patient reviews could become increasingly valuable in terms of setting payment levels.
"The Internet has a growing role in the field of healthcare, and physician presence and patient satisfaction are important parts of that," Gilbert told AuntMinnie.com via email. "Increasingly, patients will be looking toward these resources in identifying their physicians and making other important healthcare decisions."
Out of the reading room
Professional radiology societies have been calling for their members to become more relevant, meaningful, approachable, and accessible, but many in the specialty continue to practice as "invisible radiologists" -- and are therefore disadvantaged in a context of patient rating-driven delivery and payment systems, according to the group (JACR, August 2015, Vol. 12:8, pp. 867-871).
Since CMS' Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) program was established in 2006, the agency has been tracking patient satisfaction scores and using the information to inform some of its hospital reimbursement and incentive programs. Patient reviews haven't yet affected Medicare physician reimbursement, but that may be coming, Gilbert and colleagues wrote.
"Given calls to abolish fee-for-service arrangements and instead pay doctors using value-based methodologies, an online HCAHPS-like methodology potentially could be extended to physicians, with patient reviews acting as a partial basis for payment levels," they wrote.
For the study, the researchers randomly selected 1,000 radiologists from a directory of Medicare-participating physicians maintained by CMS. These radiologists represented all 50 states, the District of Columbia, and Puerto Rico. They then chose five physician-rating websites, and over a seven-month period in 2014, they searched these sites for the 1,000 radiologists. The websites were HealthGrades.com, HealthcareReviews.com, RateMDs.com, Kudzu.com, and Yelp.com.
Of the 1,000 radiologists, only 197 (19.7%) were profiled on any of the websites, and the majority (173, or 17.3%) were rated on only one site, Gilbert and colleagues found. Only 2.4% were rated on any two of the sites, and none were profiled on three or more. Two sites had no ratings for any of the 1,000 radiologists.
|Radiologist presence on rating websites
|No. of rated radiologists
Radiologists represent 5.2% of all Medicare-participating physicians, according to Gilbert and colleagues. But on HealthcareReviews.com, for example, only 30 (0.4%) were radiologists -- a statistically significant underrepresentation. (These 30 were not part of the group of 1,000 selected for the study.)
Interestingly, when radiologists were reviewed, they were rated by similar numbers of patients as nonradiologists, and they were actually rated higher than their fellow physicians. On a scale of one to 10, radiologists were rated at a median of 8.5, compared with a median of five for nonradiologists.
"Because radiologists have not traditionally been on the 'front lines' with regard to patient contact, we expected that they would be underrepresented in such physician-rating sites," Gilbert said. "But we were quite happy to see that of those who were reviewed, radiologists had higher ratings on average compared to nonradiologists."
Gilbert and colleagues acknowledged that patient reviews are subjective -- which could put physicians in a weak position.
"All physicians are potentially vulnerable to the variability in the veracity of posted content, which may be difficult to correct," they wrote. "Patients ... are free to post material on these informal and readily accessible sites, but physicians -- bound by HIPAA and ethical guidelines -- are largely precluded from responding and rebutting."
The group also acknowledged that patient-satisfaction rating sites may not be well-suited for some specialties, as patient reviews are generated by face-to-face interactions with physicians. One way for radiologists to get around this is to focus on workflow metrics, such as the ease of making appointments, timeliness of the exam, and access to a final report, as well as availability for personal communication with patients.
This last metric may prove the most important, according to the authors. By improving their availability for consultation, radiologists can become a more visible part of the healthcare team, which may foster favorable online reviews from patients. Gilbert and colleagues also suggested that radiology groups consider establishing a formal social media program to provide information about the role radiologists play in caring for patients.
"It's definitely more difficult for radiologists [to have a robust online presence on rating sites] than, say, for family practitioners, but I believe it can be done," Gilbert told AuntMinnie.com. "And those radiologists pursuing the American College of Radiology's Imaging 3.0 initiatives -- which include more interaction with patients and their families -- will likely find themselves represented much better on these sites."