[Editor's Note: Today's guest post is from Orrin Franko, MD, a practicing orthopedic surgeon in the San Francisco Bay Area. Dr. Franko is the Founder of SurgiSurvey.com, an automated marketing system designed to manage a practice's online reputation by collecting 5-star Google and Yelp ratings. We have no financial relationship.]
How do I deal with a disgruntled patient who is posting false and harmful reviews about me and my practice online?
Today's post discusses online physician reputation management through ratings and reviews — a recurrent “hot topic” among physicians. Surprisingly, online reputation has only been addressed once on the WCI, back in 2013.
In Part 1 I'll review the history of physician ratings, discuss the most relevant websites, report data correlating reviews with patient volume, and demonstrate the financial value of improving online reviews.
In Part 2 I'll focus on different techniques and systems that can be integrated into any practice model to encourage and enhance your online reviews and reputation, as well as how to protect against and respond to negative reviews.
The relevance of online reputation management to a physician personal finance blog should be obvious by the end of this post. Despite a significant percentage of WCI blog posts and discussions about savings, investments, and taxes – the vast majority of wealth earned by readers of this site will be earned by treating patients and billing for professional services day after day.
While there are many factors that influence physician pay (geographic location, payor mix, specialty, billing, etc), online marketing is one of the most accessible and modifiable factors available to most physicians to boost practice volume, collections, and income. In many ways, this is the perfect physician side hustle!
Although some physicians are not financially incentivized by online ratings, such as salaried physicians without a productivity bonus, or emergency providers whose patients do not “choose” their doctor – I still believe that online reviews can be relevant for all doctors due to the many intangible benefits listed below.
Online physician rating websites have been growing in popularity over the past decade, serving as a platform for patients to leave both positive and negative reviews about their doctor. Without a doubt, these sites have introduced numerous challenges for physicians related to the accuracy of reviews, blatantly fake reviews, lack of correlation with care quality, inability to respond to criticisms, linking reviews and ratings to advertising dollars, selectively promoting/discounting reviews, etc. Further, these challenges have spawned numerous other discussions regarding HIPAA protection vs. free speech online, as well as concerns that appeasing patients’ desires (and presumably improving online ratings) is ultimately harmful to patient care. All of these concerns are valid and warranted.
And yet, online physician rating websites persist. In my opinion, physicians who take an active, positive role in influencing their online reputation can be rewarded with less stress, increased reimbursement, and happier patients.
A complete history and review of physician online review sites go beyond the scope of this post. Early websites dedicated to physician ratings, such as HealthGrades.com and Vitals.com have now been supplemented and often replaced by general review sites, including Google reviews and Yelp. Existing patients now have many platforms on which they can share about their medical experience.
More importantly, prospective patients have numerous opportunities to learn about a potential physician when selecting where to receive care. Recent literature suggests that up to 60% of patients consider online reviews important when choosing a physician, and increasing numbers of patients routinely “google” their doctor and make decisions based on their findings.
There are subtle, but relevant differences among the most popular physician rating websites. HealthGrades.com is one of the oldest and best-known sites that includes 1-5 star ratings, as well as descriptive reviews. Listings are based on public NPI data, but physicians may claim their profile to add more accurate information. Vitals.com has been around for a while and similarly provides both ratings and descriptive reviews, however, their popularity appears to have recently waned and their search rankings have dropped (making them less relevant). Other physician-specific sites have variable penetrance in different markets, including: RateMDs.com, Lifescript.com, DrScore.com, and Wellness.com.
The most important review sites are now Google and Yelp. Registering your practice on Google Business Listings allows Google to an informational box on the right side of a search page, something Google calls a “Knowledge Graph” (Figure 1). Registering on Google Business is free, and can significantly improve your search ranking.
Yelp has recently included medical practices and providers in their business listing, resulting in significant stress among physicians. While Yelp requires reviewers to register an account and attempts to improve the veracity of reviews with a secret algorithm, their aggressive marketing techniques (often repeatedly calling and emailing medical practices) and suppression of reviews has left a negative impression on many doctors who perceive that advertising dollars are required to improve public ratings. (Yelp has assured me on numerous occasions that this is not true, despite evidence to the contrary).
To find out which review sites are most important to you and your practice, simply “google yourself” and see what returns in the top 10 rankings. Be sure to use various search phrases that a patient might use, e.g. “Dr. John Smith allergist”, “Reviews John Smith MD,” “Bay City Allergy Clinic Reviews.”
Correlation of New Patients with Referrals
“Will reviews increase patient referrals?” The short answer is “yes.” There are no peer-reviewed publications correlating online reviews with practice volume to date. However, when I started practice 3.5 years ago, I began collecting online reviews and tracking my online reputation very closely. My senior partner, a well-established and successful hand surgeon, did not. I subsequently correlated my review volume with practice volume over 42 consecutive months for both me (actively emphasizing reviews) and my partner (no specific effort made).
The results are shown in Figure 2 demonstrating a correlation coefficient for a young surgeon focused on reviews at 0.917 (highly correlated) compared to a correlation coefficient of 0.07 (not correlated) for my partner. This suggests that online reviews clearly have the potential to generate new business and patient referrals.
Are Online Referred Patients Valuable?
It is worth asking whether “online referred” patients are valuable to a practice. As is often the case, the answer is “it depends.” Many patients who have time to “google their doctor” do not have high-acuity pathology. Rather, they typically present with mundane, self-diagnosed, and often questionable diagnoses that often require significant visit time without much personal or financial reward. Thus, the value of online referred patients will be variable depending on your practice demographics and income formula.
For example, a young physician with ample office availability who is paid based on wRVUs would certainly benefit from any increase in patient volume, regardless of payor mix or medical urgency. In contrast, an established surgeon whose schedule has a 6-week waiting period filled with complex surgical cases referred primarily by other physicians is unlikely to benefit from low-acuity, self-referrals.
In my practice, patients referred from the emergency department, urgent care, and surgeons returned about 113% of our average dollar collections per patient. In contrast, internet referred patients generated only 64% of our average revenue. Thus, internet-referred patients were less profitable than “the average” patient, but certainly still worth filling open scheduling spots. The overall value of internet-referred patients depends on your specific specialty, compensation model, and scheduling availability.
Value of Online Reviews
It is clear that
A) online reviews are prevalent and important to patients, that
B) practice referral volume correlates with online reviews, and
C) patient referrals can be quantified by their financial value to the practice.
From these data points, I calculated the dollar value of a single 5-star online review. The result is shown in the form of a moving average that changes monthly based on the number of online reviews and number of patients referred each month (Figure 3). Predictably, the value increases with time, as each review generates new referrals in perpetuity. In my practice, a single online review (in this case: Yelp or Google) was worth $518 after year 1, $598 after year 2, and $893 after year 3.
Recognizing that most reviews do not disappear over time, the value of accumulating 5-star reviews becomes immediately apparent. Obtaining online reviews can be extremely easy and very inexpensive (eg: free), and I believe that all physicians should focus on improving their online ratings. While the specific value to your practice will undoubtedly be higher or lower based on numerous factors outlined above, it’s free to ask patients for reviews with no down-side and potentially hundreds of thousands of dollars in revenue. In part 2, I will expand upon the most efficient method for collecting reviews to generate business and the return-on-investment in my practice.
Intangible Benefits of Improving Online Profile
It is important to note the intangible benefits of improving your online profile. Patients often present to new doctors or consultants with preconceived expectations about their interaction based on a quick “google search.” Improving your online profile can certainly facilitate smoother visits that start from a place of trust and confidence gained from what patients have read online.
Further, some hospital systems use online ratings as one variable into determining departmental promotions, bonuses, or reappointments. Lastly, it’s no secret that doctors (like most people) like to feel good about the work that we all do. Positive reviews reinforce our decision to sacrifice so much for our patients.
There is a popular Chinese proverb that says “The best time to plant a tree was 20 years ago. The second best time is now.” The same would be true for managing your online reputation and collecting reviews. Part 1 of this post demonstrated the financial and intangible value of improving your online reputation. Part 2 will teach you how to get it done!
Get the Right Mindset
Most doctors are extremely uncomfortable asking patients to leave reviews. Much of this hesitation is based on cultural and generational differences regarding the appropriateness of self-promotion within the medical field. I do not suggest that anyone should compromise their personal values in the pursuit of patient volume, and if the concept of asking for reviews gives you the “ick” feeling, then stop reading now.
An alternative viewpoint is that online physician ratings exist whether you approve of them or not. Companies like Google, HealthGrades, Vitals, WebMD, Yelp, and many more did not ask your permission to collect your NPI number, training background, create a webpage (without your input), and post negative and positive reviews about patients’ experiences in your office. Many physicians believe that encouraging patients to leave positive reviews is a way to take back control of your online reputation that was unfairly taken from you in the first place.
Whether or not you approve of the practice, patients are leaving comments about you online. I believe that as physicians our only recourse is to make sure the happy patients have a voice that is being heard.
Choose your plan of attack.
The most obvious and direct method for accumulating reviews is to ask your happiest patients to leave a review online. If you want to be specific, suggest they use popular websites such as Healthgrades or Vitals. Or if you have a Google or Yelp business page, those would be good options as well.
Consider increasing your success rate by handing out a business-card reminder with a link to your online profile. HealthGrades even provides a template for you to download and print (Figure 4). Unfortunately, this very direct and seemingly successful model has been shown to be only marginally effective.
Based on a study performed in my office among 2,000 patients, only 3% of patients will leave a review when asked and handed a reminder card. This is still better than doing nothing, which yields a response rate of less than 1% (Figure 5).
An alternative option is to automate review requests. This involves introducing software that automatically emails each patient after their first visit with you, asks about their experience and whether they would leave a review. There are numerous companies that promote these types of software, often for a significant fee.
Personally, I wanted to achieve the same effect using free or inexpensive tools and created a custom system for my own practice. The results were astonishing.
By introducing an iPad to our registration counter for new patients to complete during their visit, we were able to collect over 300 unique 5-star reviews in less than 3 years. The review rate of the automated system resulted in a 5-star review from over 10% of patient visits – more than 3-times more successful than handing out review request cards… and, it did not require any physician action whatsoever (Figure 5).
Furthermore, by calculating the increased number of referrals and revenue from those patients, I could demonstrate the financial benefit to my practice each year (Figure 6). Based on a system cost of $1,200 per provider ($2,400) total, the return on investment thus far has been 1,900%, 3,313% and 4,088% in each of the last 3 years! How’s that for a side hustle?
As you can see, introducing an automated review collection system into my practice was extremely successful. I devised a system that works for my practice and can work for yours as well. But if you don’t have the time or desire to build your own automation scheme, there are numerous companies who will help you collect reviews and market your practice to new prospective patients.
How to Select for “Happy” Patients
Instituting an office protocol to ask for reviews either through direct requests or automated emails/text messages can be very effective. But, since you may not be screening patients based on their satisfaction, how can you be sure they will leave positive reviews? The short answer is, “they just will.”
A few studies have studied this, one of them from my co-fellow during training. In that study conducted in 2016, there was no difference in review scores between surgeons who handed out request cards to all patients, versus those who requested reviews from “happy” patients.
My conclusion from this result is that, generally speaking, patients recognize why you are asking for a review and clearly understand you want good scores. Most patients who plan to leave a review are happy to comply, and the remainder simply do nothing at all.
Selecting good reviews with automated requests is even easier. For example, the system I designed for my office and use in SurgiSurvey sends an email request with a choice of 5-, 4-, 3-, 2-, or 1-star options. If the patient selects “5-stars” they are automatically directed to leave a review on Google or Yelp. However, if they select any of the lesser stars, they are directed to a private “feedback page” that is forwarded to my office. That way, only high-scoring reviews are publicized.
Many people will read this and think, “Hey, that’s manipulative!” Yup, you bet it is. It’s also what everyone else is doing. You know what else is manipulative? HealthGrades (as an example) making a webpage for my professional profile (without my permission) and allowing patients to leave slanderous and inaccurate reviews that harm my reputation and my practice. Collecting 5-star reviews is my way of taking back control.
The Solution to Pollution is Dilution
No doctor will ever be immune from negative reviews, but acquiring significant numbers of positive reviews is highly protective against the occasional disgruntled patient. In my opinion, the best protection against bad reviews is to flood your profiles with good reviews. Having 2 bad reviews is not fun, but when counter-acted by 50 great 5-star reviews, they appear almost meaningless. As shown above, this can be done easily and inexpensively.
However, occasionally a negative review will hit close to home, prompting an emotional response. Perhaps there are blatant lies or misinformation in the review. Unfortunately, due to HIPAA privacy laws, doctors are very limited in what can be said online to respond to negative reviews (it should be noted that many review sites allow you to “reply” to a review both publicly and privately).
I am not a lawyer, but general advice is that only generic responses are appropriate, such as “We strive to treat all patients with respect and regret that you were disappointed with your visit. We would be happy to address your concerns personally, and you are invited to call our office for additional help.”
Alternatively, I have had success reaching out to unhappy patients directly (typically it is quite obvious who has left the review). I typically say something like, “I noticed the review you left on Yelp and wanted to reach out. It was certainly not my intention to disappoint you, and I’m wondering how I can make it up to you.” My experience has been that 3 of 4 patients apologized for their review and deleted their comments.
Lastly, it must be noted that none of these techniques will be 100% effective. Negative reviews will always exist, and the best solution is simply to drown them out with a flood of positive reviews.
I think that making an active effort towards improving your online reputation is a necessary component of being a successful doctor. For most doctors, asking for reviews does not come naturally, but thankfully technology has the ability to help overcome many obstacles by automating this process. If done well, there are financial, as well as intangible benefits.
Financially, the annual return on investment has been 4,000% for me in my practice when one considers the number of new patient referrals generated compared to the cost of implementing this system. In my 2-person practice, automating our reviews generated over $235,000 of revenue in just 3 years. Furthermore, receiving and reading about patients’ positive experiences is heartwarming. Although we all know the gift that we give our patients each day, it never hurts to hear “thank you” every now and then.
What are you doing to manage your online reputation? Comment below!