Saturday, April 15, 2017

Yelp reviews prove a reliable tool for determining hospital quality, New York State Health Foundation study says

You cannot base the quality of health care based upon one measure.

Yelp does just that, and is highly misleading to the public.

More consumers use those platforms and comment on them, creating a real-time feedback loop, Foundation says.

According to the New York State Health Foundation, 

"As online tools like Yelp become increasingly popular with consumers looking for information about doctors and hospitals, a study sponsored by the New York State Health Foundation showed yelp ratings were a clear and reliable tool for determining hospital quality as defined by potentially preventable readmissions rates."
"The news for hospitals is positive as well -- by pointing people to higher-quality doctors and hospitals, those institutions can attract market share, leading to more lives saved and more costs avoided for patients, taxpayers and employers."
The results are from crowd-sourced surveys conducted by Yelp.
These internet based rating services are highly inaccurate, misleading and contain faulty data.
Data Metrics
The authors stressed that while there's a strong correlation between Yelp reviews and 30-day readmission rates, there's a lesser correlation when it comes to other quality measures, such as mortality, morbidity and patient outcomes, infection rates, never happen episodes, none of which reflect or influence readmission rates.
The news comes as high-deductible health plans are gaining steam, covering nearly one in three Americans in 2016. The spread of these plans means consumers are paying for more and more of their care out of pocket, giving them a reason to seek out high-quality care at the lowest possible cost.
One-on-one assessment.  
I searched on Yelp for hospitals in my region of Southern California. This area includes a major University Medical Center, A UC Medical School, A regional county medical center which has merged with the new UC Riverside School of Medicine.
Here are the surprising results.  There were many small entities rated side by side along with major secondary and tertiary centers.
Typical Scores
The ratings (according to the number of 'gold stars' reveal how incorrectly Yelp has rates the hospitals in my area.  Perhaps things are different in New York State. In New York State the foundation has it's own self-interests and is biased in it's results to influence acceptance of many government programs for measuring quality and cost.

There may be some lag in the accuracy of the data, even measuring this one metric. And the outcome is highly inaccurate, just based upon one data set. Healthcare is complicated, and measuring it even more so.

The public must become more literate in understanding measures of health care, who is reporting it, and if the data is truly accurate or self serving to the reporting entity.

Much more accurate data can be found at the Medicare Web Site

Medicare provides a consumer experience rating based upon patient surveys as well as metrics established to improve patient outcomes.

Other more reputable rating sites are available. Beware of some of them.

The highest rated doctors may not provide the best care

The public can rate and review most things today: books, hotels, and restaurants, to name a few.  Even doctors.  There are more options than ever where patients can rate their doctors online, and hospitals also routinely survey patients about how satisfied they are with their physicians. But while you’re pretty much assured a great meal at a 5-star restaurant, whether you receive excellent care from a 5-star doctor is less certain.
Doctor ratings generally focus on the patient experience, such as wait times, time spent with the doctor, and physician courtesy.  Those are obviously important issues, but they paint an incomplete picture.  Doctors with stellar interpersonal skills may not be the best at controlling patients’ blood pressures or managing their diabetes.  High ratings may identify surgeons with great bedside manner, but mask high surgical infection rates.
The quest for ratings perfection influences medical decision making, as patient satisfaction increasingly affects doctors’ salaries.  According to the management consulting firm Hay Group, more than two-thirds of physician pay incentives are based on patient satisfaction scores.  And Medicare withholds as much as $850 million in payments to hospitals who fail to meet various quality metrics, with patient satisfaction being a significant component.
But doing what’s best for patients won’t necessarily make them happy.  Denying antibiotics for viral infections or saying no to routine MRIs for patients with back pain are both sound medical decisions, but can anger patients; some vent their frustration by poorly rating their doctors. It’s no wonder that many physicians acquiesce to patient requests. In a survey by Emergency Physicians Monthly, 59% of emergency physicians said patient satisfaction surveys increased the amount of tests they ordered.  In another survey by the South Carolina Medical Association, almost half of physicians said that pressure to improve patient satisfaction led them to inappropriately prescribe antibiotics or narcotics.  In fact, Senators Dianne Feinstein (D-California) and Charles Grassley (R-Iowa) wrote a letter to Marilyn Tavenner, administrator of the Centers for Medicaid & Medicare Services, saying that “there is growing anecdotal evidence that these [patient satisfaction] surveys may be having the unintended effect of encouraging practitioners to prescribe opioid pain relievers (OPRs) unnecessarily and improperly, which can ultimately harm patients and further contribute to the United States’ prescription OPR epidemic.”
These extra tests and treatments are expensive and can hurt patients.  A landmark study from JAMA Internal Medicine analyzed over 50,000 patient satisfaction surveys, and found that patients who were more satisfied with their doctors had higher health care costs, were hospitalized more frequently, and had higher death rates compared to less satisfied patients. That makes sense: Patients who receive more drugs and tests are exposed to their harmful side effects and complications.
Now, I’m not saying physicians shouldn’t be graded by patients. Subjective physician evaluations are valuable, but not by themselves. They need to be complemented with objective measures of medical care, like a surgeon’s operative complication rate, for instance. Until physician ratings evolve into a more holistic representation of doctors, they must not be financially tied to how physicians are paid.
And to patients: Don’t automatically choose doctors with the highest online ratings or perfect patient satisfaction scores, because they may be the ones who reflexively prescribe antibiotics or narcotic drugs to inflate their grade.  It’s conceivable that those who have mixed reviews may actually provide better care.  Because they could be the physicians who make the effort and take the time to occasionally say no to patients.


Yelp reviews prove a reliable tool for determining hospital quality, New York State Health Foundation study says
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