The Inside Scoop: A Cancer Center Fares Better on Patients’ Internal Ratings

In an era when hospitals and health systems must pay more attention to reputation management, a new study shows that some may be overlooking an obvious source of high marks: their own internal patient surveys.

A study in JCO Oncology Practice, published by the 45,000-member American Society of Clinical Oncology, found that one of the best-known cancer centers in the world fared better on its internally generated patient satisfaction scores than it did on physician-rating websites.

Thus, the authors concluded, it may be in a hospital or health system’s own interest to voluntary publish patient satisfaction scores, which include more data and are more scientifically valid.

Gauging patient satisfaction with internal scores offers health care facility staff the opportunity to identify areas of strength as well as those that can be improved upon. Website ratings, by contrast, are a public forum used by patients who are looking for a physician. While each can useful, the two different strengths and weaknesses that the researchers sought to examine.

The internal scores, generated using the Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) survey, were collected by The University of Texas MD Anderson Cancer Center, located in Houston. Internal scores were linearly transformed into a star rating on a 5-point scale for the purpose of the study, and physicians were only included if they had 30 or more internal patient reviews.

Overall, 510 physicians were included in the analysis. Median numbers of reviews and scores from internal surveys and the 4 most commonly used physician website ratings—Google, HealthGrades, Vitals, and WebMD—were compared for the study.

Researchers developed a measure that for the internal scores that examined the median score while looking more closely at the scores in the middle. The median was 4.89. For the physician website rating, the number of reviews per doctor ranged from 2 to 7, with median scores ranged from 4.4 to 5.

The research team noted a key weakness with online physician reviews: often there are not enough of them to make an assessment that is statistically meaningful, much less fair. This finding is consistent with a recent study by the firm Reputation, which found that 65% of physicians had no online reviews and 50% of health systems lacked them in 2020, a year when more people were seeking online information about healthcare than ever.

The researchers noted that in online reviews, a physician may be graded harshly for things that have nothing to do with the doctor-patient relationship, such as inadequate parking or a cranky receptionist. By contrast, the 8 validated questions from the CG-CAHPS used for internal surveys focus on the patient-provider relationship.

Other limitations included that fact that patient anonymity made it impossible to compare internal scores with online reviews written by the same people or to analyze demographics. Patients may also respond differently to surveys given by an institution than they would to an external review done online.

The study was originally done to convince MD Anderson’s providers that publishing survey results online would help their reputations. Doing so also highlighted the importance of giving providers a chance to improve over time without being haunted by old reviews. Under the cancer center’s system, old reviews to roll off after 12 months. Physician websites, on the other hand, often leave old reviews up indefinitely, even if a provider has gained experience and overcome a habit with training.

“In this study, we demonstrate the need to publish internal scores online to give patients more complete information regarding physician performance,” the authors concluded.