Your patients are talking: Isn’t it time you take responsibility for your online reputation?

William E. McGrath Jr, MD, of Fernandina Beach, Florida, says that his office provides patients with a list of 5 popular review websites during their visits, and that approximately 1 in 10 will follow up with a review. Patient reviews are also prominently posted on his practice’s website. The large, private, single-specialty group to which his practice belongs requires patient satisfaction surveys for quality assurance review and insurance contract negotiations. “It is all about physician-patient communication,” he says.

Keith S. Merlin, MD, of Brockton, Massachusetts, says that he has checked online reviews to ensure their accuracy. His practice uses surveys, a suggestion box, and a mystery shopper to measure patient satisfaction, a worthwhile effort he says to understand where the practice is doing well and what needs to be done better.

Wesley Hambright, MD, of Jacksonville, North Carolina, reports that he has established a Google Alert to monitor for new content relating to his practice.

Patrick Pevoto, MD, MBA, of Austin, Texas, informs us that he has just started to think about ways to manage his online reputation. He has created a website and is writing a monthly blog, which he posts on his site. He acknowledges the importance of assessing patient satisfaction in his practice but is not applying large-scale measurement techniques yet. To keep his patients happy, he handles concerns that arise on a personal, case-by-case basis.

John Armstrong, MD, MS, of Napa, California, also reports that management of his online reputation is in the beginning stages. He uses focus groups and feels that listening to his patients when they do comment on their experience is important to his overall practice. Listening helps to “identify areas to improve and reaffirms when we are doing well,” he says. To keep his patients happy, he strives to “give extraordinary care and simply be nice to people.” When issues arise, making it right and being polite are important elements, he asserts.

Delos J. Clow, DO, MS, of Chillicothe, Missouri, does measure patient satisfaction, and feels this is very important to his practice in order to identify and correct any negative trends. He does not actively monitor his practice reputation online.

Robert del Rosario, MD, of Camp Hill, Pennsylvania, similarly does not actively manage an online reputation, but does focus on patient satisfaction. To enhance satisfaction, he tries to de-emphasize the electronic medical record to “make visits more personal and less interrogative.” Additionally, his practice objectively gauges aspects of care that might be able to be improved upon.

Reference

1. Romano R, Baum NH. Using the Internet in your practice. Part 4: Reputation management—how to gather kudos and combat negative online reviews. OBG Manag. 2014;26(12):23,24,26,28.

The Office for Civil Rights (OCR) within the US Department of Health and Human Services (HHS) is responsible for handling Health Insurance Portability and Accountability Act of 1996 (HIPAA)¹ complaints. Deven McGraw, OCR’s deputy director of health information privacy, states that “just because patients have rated their health provider publicly doesn’t give their health provider permission to rate them in return.”^2,3 In fact, some health care providers who responded to poor online reviews ran into trouble with privacy rules established by HIPAA.^2,3

Mr. McGraw notes that, when responding to online reviews, health professionals should speak generally about the way they treat patients while complying with HIPAA regulations. He suggests, “If the complaint is about poor patient care … say, ‘I provide all of my patients with good patient care’ and ‘I’ve been reviewed in other contexts and have good reviews.’”^2,3

According to Yelp’s senior director of litigation, Aaron Schur, most patient complaints center on practice-based concerns such as wait times, office staff, and billing, not about the medical service delivered. Although most physicians do not respond, says Mr. Schur, those who do, tend to ask patients to discuss the matter in private or to apologize.^2,3

What are the consequences of a HIPAA violation?

OCR Director Jocelyn Samuels says that the office’s primary role is to help health providers follow HIPAA regulations.^2,5 The OCR can resolve HIPPA violations privately and informally, impose fines of up to $50,000 per violation, or it can file criminal charges against violators.^2,4

The majority of the office’s investigation and enforcement of HIPAA has been against large medical data breaches.^2,5 Small privacy breaches by large health care providers (eg, CVS, Walmart, Lab Corp, Quest Diagnostics, and others) generally do not result in legal consequences; the providers are privately warned. According to ProPublica, even repeated HIPAA violations tend not to be fined.^2,4

Small-scale infractions can be more damaging on a personal level to both patients and physicians. However, the OCR does not typically become involved in privacy breaches that include only a few individuals. Health care providers are rarely punished for small HIPPA breaches; instead, the OCR typically settles for pledges to fix any problems and issues reminders of HIPPA requirements.^2,5

Although the OCR is often the only place patients can go to seek vindication, HIPAA does not support the right to sue for violation of personal privacy. People who seek a legal remedy must find another means, which is easier in some states than in others.^2,5

Health care providers have tried myriad ways to attempt to combat negative reviews. Some have sued patients, attracting a flood of attention but achieving little legal success. Others have asked patients to remove their complaints.^2,3

Best practices
Create and circulate a policy. Medical privacy breaches involving sensitive health details can occur when office or hospital staff share patient information due to personal hostility or lack of understanding of HIPPA policy.^2,5 Have a practice policy for responding to online reviews by patients, and make sure the staff members who have access to the practice’s online accounts understand your policy and the possible repercussions of not following it. Teach and continue to remind your staff about HIPPA regulations and hold them to a high ethical level of privacy.

Solicit reviews on an ongoing basis. Jeffrey Segal, a review site critic, says that all reviews are valuable. Physicians should respond carefully to negative comments and encourage satisfied patients to post positive reviews. “’For doctors who get bent out of shape to get rid of negative reviews, it’s a denominator problem,’ he said. ‘If they only have three reviews and two are negative, the denominator is the problem. … If you can figure out a way to cultivate reviews from hundreds of patients rather than a few patients, the problem is solved.’”^2,3

CASE Resolved
Dr. Baum never responded directly to the negative patient review, and others he has received. He balances the rare negative response with numerous and plentiful positive responses by making it a practice to encourage reviews from all of his patients.

References

1. HIPAA for Professionals. US Department of Health & Human Services. http://www.hhs.gov/hipaa/for-professionals/index.html. Accessed October 11, 2016.
2. Hall SD. Providers responding to Yelp reviews must be mindful of HIPAA. FierceHealthcare. http://www.fiercehealthcare.com/it/providers-responding-to-yelp-reviews-must-be-mindful-hipaa. Published May 31, 2016. Accessed October 7, 2016.
3. Ornstein C. Stung by Yelp reviews, health providers spill patient secrets. ProPublica. https://www.propublica.org/article/stung-by-yelp-reviews-health -providers-spill-patient-secrets. Published May 27, 2016. Accessed October 11, 2016.
4. Ornstein C, Waldman A. Few consequences for health privacy law’s repeat offenders. ProPublica. https://www.propublica.org/article/few-consequences-for-health-privacy-law-repeat-offenders. Published December 29, 2015. Accessed October 11, 2016.
5. Ornstein C. Small-scale violations of medical privacy often cause the most harm. ProPublica. https://www.propublica.org/article/small-scale-violations-of-medical-privacy-often-cause-the-most-harm. Published December 10, 2015. Accessed October 11, 2016.