In this episode, Ron Harman King, CEO of Vanguard Communications, discusses the disparity between hospital success and patient satisfaction.
Welcome back to the Hospital Finance Podcast.
This podcast discusses a study done by Vanguard Communications that analyzed nearly 2,700 online reviews of the nation’s top-20 hospitals as ranked by U.S. News & World Report. They found that almost two out of three reviewers give the facilities a mediocre to poor rating on the social media website Yelp.com. Ron Harman King, CEO of Vanguard Communications, discusses the study and the disparity between hospital success and patient satisfaction.
Mike Passanante: Hi, this is Mike Passanante. And welcome back to the Hospital Finance Podcast.
A recent study has found that nearly two-thirds of hospital patients give the nation’s top hospitals mediocre to poor ratings in online reviews. Joining us today to discuss this disparity between hospital success and patient satisfaction is Ron Harman King, the CEO of Vanguard Communications.
Ron is a 25-year old veteran of healthcare management, marketing, PR and communications technology for private and academic medical practices. Ron is the author of Totally Wired Doctor: Social Media, the Internet, and Marketing Technology for Medical Practices which is available on Amazon. And he is a frequent speaker at medical conferences in North America and Europe, a television commentator, and a video blogger for the Website for Physicians MedPage Today.
Ron, welcome to the program.
Ron: Thank you, Mike. It’s an honor to be with you.
Mike: So, why don’t you tell us a little bit about Vanguard Communications just to kick things off?
Ron: I’d be happy to. We started in healthcare back in the 90s, really before the Internet. And our main function back then was to promote private medical practices. And we started in the field of fertility, reproductive endocrinology, IVF practices basically.
And back then, you could promote practices and drive patients to them by using the news media. And that was really what we did and focused on. We were into getting newspaper stories and TV coverage and so on for our clients.
Since then, of course, we have all experienced the rise of the Internet. And we moved into websites and then social media, marketing and communications and really patient education for our clients.
And today, we are also into process improvement. We have ventured into lean and waste reduction and so on. And we are a marketing management consulting and lean process improvement firm these days.
Primarily, we work with private and academic medical practices.
Mike: Thanks, Ron. And as we kind of intimidated in the opening, your organization has taken a look at some results available and sort of compared them in terms of the hospital ratings that all of our hospitals are used to and the ratings that real patients give in online review sites. And of course, that’s something new that hospitals are dealing with.
So, why don’t you tell us a little bit about that study, why you initiated it, and what you were looking for?
Ron: Of course, so we’ve been very interested in hearing more of the patient voice. And the Internet has really given patients the ability to have a voice for the first time in a way they’ve never had before. We study a lot of social media. We do a lot of research and studies on social media to find out what patients are thinking.
So, when we look at the social media that is now rampant across the Internet, everybody is reviewing everything from their latest restaurant experience to where they stayed, in hotels and resorts—and now, of course, physicians and clinics and hospitals.
So, we have been looking for quite a few years through a number of studies and social media comments in general about patient experiences—primarily, though, the physicians. And we go to websites where you can rate your doctor. And we studied the comments. And we count comments and categorize them and so on.
And a little over a year ago, we looked at about 35,000 reviews of not only doctors, but it also included clinics and hospitals. And we had some really surprising findings of that.
We’ve learned actually that despite what a lot of people think, doctors tend to get far more good reviews than bad reviews. In fact, by a factor of 2:1, patients are more likely to give their doctors online reviews of 4 and 5 stars than they are 1 and 2 stars. So 66% of these nearly 35,000 reviews were 4 and 5 stars. And only 32% were 1 and 2-star reviews for individual physicians, small clinics and practices, as well as the smallest to the largest hospitals. So, that was kind of a shock.
And then, we started thinking, “You know, I wonder how hospitals would rate if we look at just those.” And we looked at those that really had the best rankings by one measure or another. So we decided to look at the top 20 hospitals as ranked by US News and World Report. And as you know, this is a big deal every year when these come out.
So, we took the 2017 – 2018 top 20 in US News & World Report. And we looked at all their online reviews on the website Yelp.com. Yelp has become a real big influence and factor in healthcare these days. And I think a lot of patients really rely on it for their healthcare decisions.
So, we found there were nearly 2700 reviews of those 20 hospitals. It actually turned out to be 2679. We went and read all those reviews, and we counted the complaints versus the compliments. And again, some very surprising findings!
One of the main ones was these top 20 hospitals earned a combined average rating of only 3.2 out of 5 stars. So very mediocre ratings according to people who said they were patients at these hospitals.
And then, another rather surprising finding was that, of these 20 hospital ratings, we found that nearly two-thirds, 62.7% of the Yelp reviewers rated them at only 1 to 3 stars. So nearly two-thirds were given the mediocre to poor reviews.
And you would expect that the patients would be a little bit supportive and pleased by their care at these hospitals. But it was not the case in our findings.
Mike: So Ron, what were the biggest causes of patient dissatisfaction?
Ron: There were two or three major causes. A big one was long waits for doctors. Another one was billing. There were a lot of complaints about what people thought were billing errors, over-billing. Double billing, surprisingly, accounted for a high number of complaints. And then, there were quite a few people who complained that they had worked out payment plans with the hospitals for their bills, for their portion of the bill, and then they were put into collections anyway.
So, I think this is something that really has a lot of bearing in terms of hospital finance. I can understand where hospitals really have to struggle to collect on their bills. And at the same time, it seems like there’s a miscommunication I think between billing and finance people and consumer in one way or another.
I’m not an expert in this area, but I do think that improved customer service and communications would have a good impact on improving this problem.
And then, the last issue that you’ll hear over and over—and not just for hospitals, but in healthcare in general—is phones. We’ve come so far in healthcare technology and advancements and treatments, yet we still are dependent on this old technology called the telephone. And over and over and over again in social media reviews of all healthcare providers, probably the number one complaint is unanswered phones, unreturned messages, being put on hold, those kinds of things.
So, I would say those were the top three areas.
Mike: Yeah, it’s pretty amazing when you think about it. Medical providers are very much concerned with providing value around the healthcare that’s delivered, but it’s really the total experience when you think about it. Patients are looking at healthcare like they look at any other business that they do transactions with. And they expect a positive experience across the entire continuum, not just for the few minutes that they’re in, talking with the doctor.
Ron: Mike, I couldn’t agree with you more. And I want to hasten to add that US News & World Report does a wonderful service, as do some of the other rating enterprises—Becker’s and others—in really helping consumers learn more about what they can’t see transparently, and that is the quality of care.
We, as consumers, can’t possibly go around and have the same injury or the same illness and have it treated by different doctors with enough frequency that we really have a scientific view and assessment of the quality of care we’re going to get from a provider or a hospital. So these magazines and publications and online news sites that rank quality of care are really wonderful. I’m so happy they do it. That’s the hardest part for us healthcare consumers to really ascertain.
The more transparent part is what people really talk about in social media because it’s just easier to see. And we found that that’s the reason, no doubt, that 84% of the comments on healthcare providers—and hospitals specifically in this particular study—were about non-clinical issues, are customer service issues.
So, that I think is important to keep in mind. People will talk about those things more because it’s easier for them to really grade in some way.
But it also reinforces how important it is for healthcare providers to think about the total patient experience. And that includes some of the sub-listings, how people are greeted at the reception desk, how quickly the phone is answered, how many transfers you get on a phone call, how easy it is to find parking at a hospital and find your way around through the maze that hospitals often put in front of patients. All those things matter too.
And like it or not, we’re in an age where I think consumers—and I’m going to use that word instead of “patients.” Our patients are consumers. They consume healthcare. And they judge their experiences in hospitals in the same way they judge them at restaurants, hotels, resorts, banks, any service organization, retail stores. All of those are judged the same way that now people I think judge their healthcare providers.
So, the good news I think especially for hospitals who take on the most complex cases generally is that these kinds of complaints are easily addressed. And the customer service problems are easily remedied.
The hard part is heart transplants and hip replacements and delicate surgeries. That’s the hard stuff of medicine. The easier part is really the customer service. And I’m happy to see a lot more hospitals paying much more attention to that.
Mike: And Ron, we talked a little bit offline about the idea of HCAHPS and how that is really starting to play into how hospitals get paid. And you addressed in your study a little bit about the correlation between—or maybe you point to another study that addresses the correlation between Yelp (which is what you looked at) and HCAHPS. Can you tell us a little bit about that?
Ron: I’d be happy to. One phenomenon I see almost daily is the human tendency to not feel very good when somebody criticizes you publicly. And that’s something I really, really can understand.
And I think, unfortunately, the upshot of it in healthcare is that physicians and hospitals and clinics and practices tend to want to often dismiss criticisms as unfair. We all know that not every patient is a happy, well-adjusted, psychologically balanced person. And with our own clients, we deal with complaints by patients that are frankly problems for their providers. And in many cases, they’re problems because I think they’ve suffered chronic health issues for all their life. And that would make me cranky too.
So, there’s a little bit of a tendency to dismiss online reviews as not scientific—which they are not, and often not fair (which they certainly are not always fair), and not a representative sample. All that is true. But here, the countering argument to that, there is often enough information and reviews to be useful to healthcare providers and nothing to be do dismissive of this online phenomenon that’s going on, rate your doctor phenomenon.
And there was a study a couple of years ago by a group of physicians in a peer-reviewed journal, Health Affairs, that found that any hospitals that had at least three reviews on Yelp was fairly well-represented in those reviews.
In fact, the study compared the reviews to the HCAHPS reviews that we all probably know and love well in the hospital world. It’s the Hospital Consumer Assessment of Healthcare Providers and Systems, of course (HCAHPS). And what the study found was, again, if anybody had at least three reviews, they correlated pretty well to the HCAHPS surveys. And in addition, they actually tended to give more information than the HCAHPS revealed.
So, I think that’s a pretty good sign that we can’t totally throw these online reviews out the window. And to be honest, a lot of patients don’t know how to find the information from HCAHPS reviews or some of the hospitals that have their own transparent reports on their customer service and so on. It’s hard for the average patient to know where to go to find those things. Whereas, Yelp and other websites like it are very easy to find on the Internet.
And that means that we’re probably getting some of the best information we can get from social media currently. Until a better system comes along, I think that healthcare consumers, hospital patients included, can have some degree of confidence in these reviews when you read them as a large number, when you read them in the aggregate. When you look for recurring patterns of complaints or praise, it probably means those are fairly accurate comments on social media, notwithstanding the fact that they are not scientifically based or a large sample.
Mike: Ron, how can healthcare consumers avoid and address customer service issues?
Ron: Well, the first thing I’ll say is do the healthy lifestyle so you don’t have to go to the hospital.
Ron: And fortunately, our advances in medicine are helping us in that direction. As you know, there is just a dramatic increase in day surgeries and outpatient surgeries. You can even have a total hip replacement as an outpatient and go home the same day of the surgery. So, that’s helping as well.
As far as selecting hospitals, I think there’s a number of things that patients can keep in mind. One of them is not to necessarily accept the recommended hospital given to you by your provider, whether it’s your surgeon or your primary care doctor. Do your own research. Be your own advocate. Get educated.
And I frankly say go to Yelp and some other websites and see what others are saying about their experiences in these hospitals. We do these when we buy something on Amazon.com or any other online retailer. We see what other customers have said. And we go by it fairly faithfully. If you’re wise, we take it with a grain of salt with these reviews. We typically dismiss the overly praising and the overly critical ones. But by and large, I think even in selecting hospitals, it’s a reliable guide that you can go by.
Another issue that we saw a lot in this study—I think it’s very relevant here—we see an awful lot of complaints about emergency departments, emergency rooms. And we can understand that from the inside, because almost by design, ED’s are chaotic. They often have more than they could handle and some of the more acute cases. And it’s just hard to do your best customer service inside ED’s.
So, I think some of the problems that have added to that are the fact that too many people wait until something is an emergency or they believe it’s an emergency, and they show up in the ED.
Urgent care centers are hopefully taking some of the relief off of this, the pressure off of emergency departments.
And I think also your insurance company (if you are insured) will certainly discourage you from using emergency rooms because the charges and the docs are usually much higher. So that’s another thing to keep in mind.
And lastly, I would say, if you are going to be hospitalized, one of the best things you can do is to go with someone who is a loved one or a trusted friend who could be your second set of eyes or ears. And this is something else that really turned up a lot in our examination of these reviews.
There are a lot of people who complained that they got billed for specialist visit that they didn’t authorize or even know were coming. And I think that’s what your advocate who goes with you to the hospital can help you with.
Now, hospitalizations often usually require sedation. Patients are woozy or even unconscious while lots of things are happening around them. With another set of eyes and ears, you can have a good observer and a recorder of events. And they can help you later if you want to dispute anything that you felt was unfair and you were charged for a specialist that you didn’t give consent to to come see you and bill you for.
So, those are some general tips I think.
I’ll also say, Mike, we do have some of these tips and more on a webpage at the address, TipsforHospitalConsumers.com. So, if anyone is considering hospitalization, that might be a place to check into for some advice and guidelines.
Mike: That’s great, Ron. And if anyone in our audience would like to find out more about your analysis in this case, where can they go for more information?
Ron: We have it on our website, VanguardCommunications.net. And if you look under the tab—I believe it’s under Healthcare News, you will see some more details about our findings, our press release and so on. If you look under Healthcare Marketing & Management News, you’ll find several articles on this study and others that we’ve done.
Mike: Ron Harman King, thank you for joining us today on the Hospital Finance Podcast.
Ron: It’s been my pleasure and honor, Mike. Thank you very much for having me.