Patients Find their Own Ways to Rate Providers

With healthcare quality being so difficult to quantify, flawed ratings are unavoidable. Health plans, patients and governments, however, are desperate for some sort of yardstick by which to judge providers.

Key Points

The service was reasonably good, so I gave him his perfect score, even though his approach was a bit manipulative. He seemed unnaturally focused on the survey and less focused on the actual service he provided. I suspect his job hinged upon receiving excellent ratings.

As pay for performance gains ground in healthcare, many are worried we'll see physicians unnaturally focused on processes that achieve high ratings and less focused on what works for a particular patient. Physicians are being graded through means that may or may not measure actual performance, and skewed ratings could potentially harm their professional reputations or put them out of business.

The Center for Studying Health System Change (HSC) reported last year that at least one-third of adult consumers have a low tolerance for inaccuracy in provider ratings, but more than one in five would tolerate ratings that were 20% to 50% inaccurate. Consumers are relatively tolerant of inaccuracy when provider ratings are used for tiering networks or public reporting, but are less tolerant for imprecision when ratings are used for choosing their own doctors. They are the least tolerant when ratings are used for P4P programs.

Consumers' ability to stomach flawed ratings is certainly above what physicians will tolerate. Until we can create a more accurate system, quality watchdogs should consider reporting the margin of error among their measurements. That might clue in patients on when to take provider ratings with a grain of salt, while also cutting the physicians some slack with the imperfect scoring tools.


Consumers themselves are rating doctors through health plan portals and independent sites. One site I checked out recently,, which was founded by a computer programmer, boasted 700 new physician ratings that day alone. The site presents subjective individual experiences, such as whether the patient finds the doctor knowledgeable or punctual.

By the way, it also asks patients to note the name of their insurance carrier and how much they paid for the visit. (Can you see what's coming next?)

User-generated content is king, and the healthcare community shouldn't discount the impact these sites can have. In spite of past advice to ignore the unqualified ratings, physicians do need to pay more attention to their public images now that patients are becoming the online judge and jury.

As we struggle to develop accurate performance measures, random patient opinions are eclipsing the industry's more scientific efforts. Physicians who are resisting industry rating systems and opting out of P4P programs might change their minds when they see what their patients are up to.

Julie Miller is editor-in-chief of MANAGED HEALTHCARE EXECUTIVE. She can be reached at