When an unhappy customer pans a hair stylist’s work on review site Yelp, the salon can go online and try to appease the disgruntled patron. The same goes for restaurants, retail shops and other businesses.
But for doctors, there’s a big hurdle in the way of confronting online criticism: If a physician comments publicly on a patient’s review, that doctor could be acknowledging the reviewer is a patient – and that runs afoul of federal privacy laws.
Those laws are meant to protect sensitive health care information, but they have the side effect of handcuffing physicians in a world where consumers are increasingly turning to Yelp and other sites to winnow their choices for everything from sushi to psychiatrists.
“We’re restricted from responding in some ways, and it puts physicians in zones that are little bit unfair,” said Dr. David Hopp, a Beverly Hills plastic surgeon and board member of the Los Angeles County Medical Association.
Hopp described a situation in which a patient expressed satisfaction with his services in the office, but after receiving a delayed co-pay bill that patient wrote a negative review on Yelp, offering to take it down only if the office dismissed the fee.
“It would be nice to able to respond to the review, saying, ‘This patient had lovely results and had gone on and on (about them),’” Hopp said.
While a 2010 study in the Journal of General Internal Medicine found that the majority of online patient reviews are positive, it’s the bad ones that can be a pebble in a practice’s shoe as doctors have long relied on referrals.
“In private practice you need exposure,” said downtown L.A. podiatrist Noah Blumofe. “It’s all word of mouth.”
Mum’s the word
It’s tough to compare shopping for a heart surgeon to scouting out a new breakfast spot, but perhaps the biggest difference is that health care providers are heavily regulated – partly because they’re dealing with patient safety and partly because much of their revenue comes from government funds handled by Medicare, Medicaid and other programs.
One key piece of regulation is the Health Insurance Portability and Accountability Act, or HIPAA, which was passed by Congress in the 1990s and ensures the security and confidentiality of patient data.
Because of HIPAA, there’s a laundry list of patient details doctors can’t disclose, said Nick Merkin, chief executive of West L.A. health care consulting firm Compliagent, which provides guidance on regulatory compliance.
“A patient could decide to go on Yelp or a social media forum and disclose whatever information he or she wants about their care or physician,” Merkin added. “But just because the patient goes ahead and discloses that doesn’t mean the physician has carte blanche to respond.”
Heavy penalties
If a doctor violates HIPAA or state privacy rules, it could cost anywhere from $100 to $50,000 in enforcement penalties, he said.
Sometimes those consequences leave physicians frustrated when confronting public criticism of their work on the Internet.
Beverly Hills cardiologist Yaron Elad described a situation in which a patient left a fairly unhappy review on RateMDs.com disputing the diagnosis and treatment given.
“They disclosed what their problem was and some of the treatments and what I told them the diagnosis was,” Elad explained. “I of course disagreed with everything the patient had written and didn’t feel I’d made any errors. But the problem was because of HIPAA and patient confidentiality, I couldn’t really respond to the statements the patient made in writing.”
Elad said he wrote to the site saying he disagreed with what the reviewer had written and found it slanderous. Later, he found the comment text had been removed but the accompanying low rating remained.
Granted, he’s also reaped the benefits of more upbeat online comments, saying many patients have come to his practice because of positive online reviews. Still, he wishes there were a more direct way to respond to negative comments.
“Ideally there should be a dialogue,” Elad said. “There can be a dialogue if you get bad service at a restaurant.”
San Francisco’s Yelp Inc. insists there is such an opportunity.
Morgan Remmers, the company’s senior manager of business outreach, said many doctors use the site’s response tools, including private messaging and responding generally in comments, while aiming to comply with privacy laws.
But the site does not provide any context for consumers explaining that doctors won’t be able to respond to comments as freely as other businesses.
“Every industry is completely different,” Remmers said. “It’s really up to the business … to make sure it’s complying with (regulations of) the given industry.”
She also pointed out that Yelp gives doctors and other businesses free exposure to potential customers, drives new business and offers the opportunity for proprietors to learn from customer feedback.
Prescribed remedies
Merkin, the compliance consultant, suggests doctors try to preempt negative reviews by contacting patients directly to ask how their visit went.
“Reach out to those patients to see if there are any issues they have before it reaches the level of getting to a social media site,” he said.
He suggested that doctors spend time thoroughly educating patients about why they did or didn’t make a specific medical recommendation or are prescribing certain drugs to help avoid the kind of confusion and frustration that leads to bad ratings.
He also said doctors might want to encourage satisfied patients to write reviews, though the California Medical Association advised members in a note earlier this year that physicians need to be sure they aren’t coercing patients into giving them good online ratings.
But if all else fails and doctors find negative online reviews of their practice, Merkin said it’s best to respond very generally. Rather than focusing on perhaps one or two extraordinarily bad reviews, the California Medical Association said doctors should focus on patterns, using the feedback to improve their practices.
“We live in a day and age where social media is prevalent, for good and bad,” Merkin said.
