Why Geisinger posts negative physician reviews
Late last month, CMS updated its Overall Hospital Quality Star Rating program, its first update since July. In the update, 112 hospitals are now deemed five-star hospitals, up from 102 five-star hospitals in July but down from 251 in April 2015. As Becker's Hospital Review noted, the October release includes updated data on patient experience, safety, effectiveness and timeliness of care.
The star ratings are related to patient satisfaction with care experiences based on data from the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) measures. The survey covers topics such as how well nurses and doctors communicated with patients, how responsive hospital staff were to patient needs, how clean and quiet hospital environments were and how well patients were prepared for post-hospital settings.
Opponents of the ratings have argued they oversimplify complex data and thereby convey misleading information that can harm reputations and reflect unfairly on certain hospitals. However, the move toward value-based care and transparency has led some healthcare organizations – such as Intermountain Healthcare and Geisinger Health System – to publish what patients think of them, for better or worse.
Patient stories have a greater impact on clinicians more than metrics like HCAHPS, Dr. Greg Burke, chief patient experience officer at Geisinger, told Healthcare Dive last week after a panel discussion on patient experience at U.S. News & World Report's Healthcare of Tomorrow conference.
Geisinger serves more than 3 million residents throughout 45 counties in Pennsylvania. The physician-led system is comprised of approximately 30,000 employees, including nearly 1,600 employed physicians. It's been in the news a bit lately due to its unorthodox move implementing its ProvenExperience money-back guarantee (It has refunded at least $400,000 as of August). Burke stated that Geisinger posts about 97-98% of the comments it receives on the system's clinicians.
The why and the how
The effort was initiated by the system's former CEO, Dr. Glenn Steele. Under the direction of current President & CEO Dr. David Feinberg, Geisinger first opened the physician review data internally in June 2015. Only doctors inside the system and certain employees could view the data. The system expanded the data to the public later in October 2015.
Burke says the impetus to such an effort was seeing how well the University of Utah Health Care's Press Ganey scores improved after becoming transparent and posting online reviews.
Since its implementation, Gesinger uses the patient reviews to help ground and inspire its clinicians, Burke said. At the system's leadership meetings, which include about 400 individuals across 10-12 sites, Feinberg will begin with an email he received from a patient describing how he or she felt about the care experience.
Whether positive or negative, the stories have an impact on fellow clinicians, Burke notes. Positive reviews that share how a physician went above and beyond the call of duty can help inspire others, while negative reviews can highlight areas of improvement and keep clinicians grounded. "Stories are great learning tools but probably impact behavior and culture more than metrics," Burke said.
Geisinger has a committee that screens the comments. Patient information such as phone numbers, names or other personally identifiable health information are scrubbed out of the reviews to keep them HIPAA compliant. The committee at times brings in lawyers and its chief diversity officer to assure the comments aren't slanderous.
"We've been very challenged by these competing goals of being transparent and being the patients' voice but also sometimes protecting the reputation of the physicians and getting the story right," Burke shares. For example, one review that was not published accused a back surgeon of discriminating against overweight patients. In the review process, the surgeon explained back surgery is not recommended for individuals over a certain BMI due to complications. Instead, such individuals are referred to weight loss programs.
"We didn't post that comment because we thought that's where we have to have the back of our clinicians – to say we're not going to throw them under the bus for good medical thinking and decisions," Burke said.
What other organizations should know
The system requires at least 30 surveys on a clinician before a rating is posted. Burke stated he found the reviews to be fairly reliable. While patients tend to like their physicians (about 10% of comments on a provider at Geisinger are negative), Burke has found a correlation between providers who receive more than the average share of negative comments and their score.
That Gesinger requires 30 surveys on a clinicians gives the system some credibility for providers, Burke said, adding such an effort has to be seen as statistically relevant. Organizations looking to adopt such an effort "have to be smart in how they approach it. They have to go to the stakeholders first, which is often the clinicians. You have to have physician leadership buy-in," Burke says.
Burke said the system also helped clinicians understand patients generally like their providers so most will be four stars or above. While most may have four-star ratings, he shares there still can be competition among clinicians. "If you're a 4.1-star doctor versus a 4.9 doctor, I can still judge where they are on a percentile ranking although they are all four stars," Burke said. "I've told patients anyone under 4 stars is probably not stellar for patient experience, but you will still find a majority like their doctor."
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