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September 11, 2017

Online Reviews Make You Want to Yelp?

By Benjamin Mindell This article originally appeared in the August 2017 issue of Chicago Medicine magazine. Reprinted with permission. Don’t be defensive, track what’s said and remember that a well-run practice will get enough good reviews to lessen the blow from bad ones. THE DOCTOR DOESN’T LISTEN, THE STAFF ACTS SULLEN, THE WAIT IS TOO LONG, THE…

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By Benjamin Mindell

This article originally appeared in the August 2017 issue of Chicago Medicine magazine. Reprinted with permission.

Don’t be defensive, track what’s said and remember that a well-run practice will get enough good reviews to lessen the blow from bad ones.

THE DOCTOR DOESN’T LISTEN, THE STAFF ACTS SULLEN, THE WAIT IS TOO LONG, THE EXAM IS TOO SHORT.
The potential for a negative online review is limited only by all the possible interactions where medicine is practiced and the capacity for outrage—justified or not—of the reviewer. For physicians, it can be a jolt to have all their expertise and commitment to patient care reduced to a one-sided narrative and a low star rating. “These attacks feel, and can be, very personal,” says Andrew Bernstein, MD, a pediatrician at a North Suburban group. He hasn’t been the target of a negative review, but as the practice’s “tech guy” he monitors relevant sites and responds to reviews, which itself can be a minefield. The wrong reply “may fuel more arguing and can make the doctor look petty and mean.”

A study published in the February 2017 Journal of General Internal Medicine found a distinct digital divide when researchers asked 828 physicians and 494 patients in Massachusetts about their views on physician rating websites. Less than a quarter—21%—of doctors were in favor of posted “narrative comments” versus more than half—51%—of patients. More than a third—39%—of patients had made at least one visit to a physician-rating site. More than three-quarters of doctors—78%—believe comments would add to their job stress. Yet most reviews of doctors are positive and star
rating averages are closer to the five-star end of the scale than the one-star. For example, a study published in 2014 by JAMA Otolaryngology–Head
& Neck Surgery found the mean score among 266 otolaryngologists on Healthgrades was 4.4 out of 5.

Unfortunately, critical reviews can carry an outsized sting. “People go out of their way to read the negative ones,” warns Derek Kosiorek, a principal consultant at the Medical Group Management Association’s Health Care Consulting Group.

A JAMA research letter published in 2014, showing responses of more than 2,000 members of the public, reported that 59% found rating sites
somewhat or very important in terms of selecting a doctor. About a third—37%—who had checked a review site, reported having “avoided a physician with bad ratings.”

Responding? Try a Little Tenderness
Earlier this year, JAMA Facial Plastic Surgery published a research letter analyzing 152 five-star reviews and 112 one-star Yelp reviews of big-city dermatologists, plastic surgeons and facial plastic surgeons. One factor topped the lists at each end of the satisfaction spectrum—bedside manner, defined as “the physician’s approach or attitude toward the patient.”

Similarly, patients—both reviewers and readers—are going to be watching how the practice responds to criticism. When it comes to negative reviews, “you have to look at the motivation of the people who are writing it and the people who are reading it,” says Kosiorek. As for the negative reviewers, “the best thing to do is to invite them to contact you and share their stories.”

LEFT: Andrew Bernstein, MD, a pediatrician at a North Suburban group practice, also notes “that these attacks feel, and can be, very personal.” As the practice’s “tech guy” he monitors relevant sites and responds to reviews. RIGHT: Andrew Rainey, executive vice president of strategy and corporate development at Binary Fountain, says that “physicians often, and for good reason, take negative feedback personally.”

At that point the public nature of the review site, and demonstrating openness to receiving feedback, can be an advantage. “Everyone who reads it after that is interested in that somebody is listening and responding to negative reviews,” notes Kosiorek. Patients have the right to complain about the way they are treated. A negative online review might be more public than the doctor wants, but it is still an expression of discontent. Responding opens the door to resolving a complaint with a patient and offsetting negative attention to the practice. It can even prompt a patient’s change of heart and result in the post being taken down, but don’t count on it.

Still, HIPAA can make that engagement tricky and even downright dangerous for the practice. The general advice from commentators is to be brief, generic, and get right to an offer to discuss the matter privately. “We recommend a public facing response where you take the conversation offline, always being mindful of protected health information,” says Andrew Rainey, executive vice president of strategy and corporate development at Binary Fountain. “For example: ‘I’m sorry to hear about the long wait time when you visited our facility. Will you please email us so we can better understand your experience?’” Always provide an email address so the patient can act on that request.

McLean, Va.-based Binary Fountain specializes in providing patient feedback management in the health care sector, and says it has tracked and analyzed more than 10 million patient reviews for clients encompassing 2,800 facilities. It is part of a greater reputation management industry that encompasses every type of consumer activity—restaurants and retail are among the most common—where a business can be profoundly affected by ratings and comments.

“For health systems, hospitals and medium/large group practices, we recommend that the marketing team respond on behalf of physicians, as opposed to a direct response from the physician themselves,” says Rainey. “Physicians often, and for good reason, take negative feedback personally. Marketing teams are responsible for the digital presence of the facilities as well as the physicians, and should take a disciplined approach to engaging patients online.” That also includes an often overlooked but valuable way to show engagement, replying to good reviews and not just to critical ones.

Be Aware of What’s Being Said
But before a practice can respond, it has to know what’s out there. “The most difficult part is monitoring,” says Kosiorek. “In order for you to respond quickly you have to know that they are there. At least weekly, you have to check in to see what is there,” continues Kosiorek. “I think a lot of practices are just blind to it. They don’t realize that the reviews are there. At a small practice, checking websites could be just part of the morning routine for a staff member.”

Primary care doctors, especially, should expect to be reviewed. In terms of reviews and any other online mentions, all doctors should be diligent. At the very least, having a Google Alert set up to track both the physician’s name and the practice’s name is a must. Also doing an occasional Google search can be useful. Not all patients go directly to specific review sites; they use the search box instead. Since searchers generally look at only the top results, it is important to experience a search the same way prospective patients do.

“Our platform helps clients identify the sources that are in most need of new patient feedback,” says Rainey. What they are looking for includes low volume of reviews, recent negative feedback, or an overall negative score.

The company’s work for clients includes facilitating the posting of data collected under the federal Agency for Healthcare Research and Quality’s CG-CAHPS program—formally, the Clinician and Group Survey of the Consumer Assessment of Healthcare Providers and Systems—which encourages dissemination of the information. Commercial ratings sites—Yelp and Healthgrades, for example—require the reviewer to log in, individually, to each site. That’s a challenge for the smallest practice to the largest hospital system.

“We encourage our clients to run promoter campaigns, where they reach out to their patients to ask [them] to leave a review and rating on recommended third-party or social networking sites,” says Rainey. Methods include email, texts, word of mouth, or cards that are handed out.

Note, however, that before letting patients know that the practice is open to being reviewed, it’s important to understand the terms of service of any sites that are mentioned. Yelp is one of the most influential sites, but it has a strict policy—backed by the threat of a damaged rating—against recruiting reviewers to go to the site.

Medical ethics has traditionally looked askance at patient testimonials. Research and commentaries tend to treat online ratings as a fact of life in modern medicine. That is probably because they come with an expectation of transparency—the system should treat bad reviews the same way as good ones. The general consensus also seems to be that a few negative reviews need not be seen as disastrous if the overall trajectory is positive.

How high up a review appears is important. “More positive feedback will dilute the impact of negative reviews by pushing them lower down,” says Rainey.

But while physicians understandably don’t want outside attention focused on a negative review, practices would do well not to be defensive and should work to uncover the truth of even a hurtfully worded post. A single negative review “should be enough for you to trigger an investigation,” says Kosiorek. “Find out if that is true, and if it is true make a change. If not true, then just keep going forward.”

Benjamin Mindell is an award-winning writer and former editor of American Medical News. He lives in Chicago.

About the Author

Kayla Zamary
Marketing

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September 05, 2017

Beware of HIPAA When Responding To Negative Reviews Posted Online

Volume 17, Number 8 • August 2017 Report on Patient Privacy As medical review sites proliferate and cumulatively rack up millions of views per day, physicians and health care systems need to understand what they can—and often more importantly, can’t—say online in response to a negative review. Consumers who frequent online review sites for other industries…

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Volume 17, Number 8 • August 2017
Report on Patient Privacy

As medical review sites proliferate and cumulatively rack up millions of views per day, physicians and health care systems need to understand what they can—and often more importantly, can’t—say online in response to a negative review.

Consumers who frequent online review sites for other industries are accustomed to seeing responses to reviews, especially to negative reviews. But “hands are tied for the provider,” says health care law attorney Robert Coffield, who practices with Flaherty Sensabaugh Bonasso PLLC in Charleston, W.Va. “The [HIPAA] rules don’t allow them to actively participate in the discussion,” Coffield tells RPP.

Health care providers—or their representatives—can engage people online who post negative reviews, but they need to be extremely cautious when doing so, other medical privacy experts also say.

“When patients are looking at reviews, they want to see a response back,” but health care practitioners must be mindful of HIPAA privacy rules at all times, says Andrew Rainey, executive vice president of strategy and corporate development for Binary Fountain, which provides patient feedback management solutions designed specifically for health care.

Rainey tells RPP that he recommends responding briefly online, but then shifting the conversation out of the public space to a secure platform as quickly as possible.

“It obviously makes sense to respond to negative reviews,” says Rainey. “But that’s not to say it makes sense to respond to all of them. You get a feel for what type warrant a response. I understand frustration on the physicians’ side, but consumerism is very real.”

When HIPAA was enacted and the regulations were written, social media didn’t exist, Coffield says. Therefore, stakeholders are attempting to apply it in a way that wasn’t envisioned at the time, he says, adding, “I think a lot of people have struggled with it.”

Over the past seven or eight years, Coffield says, physician and hospital clients evolved on their thinking about implementing a social media policy. Initially, he says, most organizations avoided all social media, due to HIPAA regulations. But as social media has matured, “it starts to get to the point where we have to let [employees] on social media to do their job.”

“My sense and my recommendation is, you want to work towards a pro-social media policy that educates and informs employees what they can and can’t do on social media” to comply with HIPAA, Coffield says. “You almost can’t sit back and not respond” to negative feedback, since failing to respond looks far worse than a HIPAA compliant response. “You need to have a well thought-out policy to respond.”

Medical Rating Sites Abound

Reviews come in a variety of formats on a growing number of websites, and can range from simple star ratings to anonymous essays. Different sites handle comments and reviews in varying ways:

  • Facebook offers an option for businesses to add a space for reviews to their pages, but clients also can leave public comments on a business or personal timeline. Either way, the physician or health care entity in question can post a response or open a dialogue. Most people on Facebook post under their own names.
  • Twitter doesn’t offer a reviews option—instead, users can post and share comments, called tweets, that “tag,” or identify, a subject such as a physician or hospital. The physician or hospital in question can respond by replying to the comment. Twitter is not primarily a review site, and it does not gather reviews in one place. Some people use pseudonyms on Twitter.
  • Yelp, which is better known as a site to find restaurant and hotel ratings, also has a plethora of reviews for doctors, hospitals and other health care facilities. Entities can post responses to reviews, and many do so. Yelp users can post under their own names, but most do not.
  • Zocdoc combines reviews and appointment scheduling, offering users the ability to search physicians and other health care providers by specialty and insurance accepted, and then schedule an appointment via the app or website. Reviews can include first names, and Zocdoc notes when a reviewer is a “verified patient.”
  • RateMDs, a site specifically for doctor reviews and ratings, allows anonymous written reviews and provides health care practitioners with the opportunity to write a response to those reviews. The site has more than two million ratings.
  • Healthgrades, which has high web traffic, has come in for plenty of criticism from health care practitioners because it allows anonymous reviews without verification that the reviewer is a patient. The site does allow providers to respond to negative reviews, but physicians have cited HIPAA concerns as part of what they say is an inability to properly refute unfair reviews.

Some sites, such as WebMD, allow users the chance to provide a star rating for a health care practitioner or facility, but don’t give the opportunity for comments from the reviewers or responses from the practitioners.

Offer To Speak with Unhappy Patients

Physicians and other health care entities cannot respond directly to specific patient complaints in negative reviews, Coffield says.

“You can either be silent, or if it’s your patient, you can follow up directly with the patient,” he says, adding that it’s best to bring the patient into the office to deal with the complaint directly, person-to-person. “You can’t respond [like that] online,” or even by phone, he emphasizes, even though he acknowledges that “it’s difficult for physicians to do, especially older physicians where they’re used to compliant patients.”

Replying directly online, even without addressing specific complaints, has to be done extremely carefully in order to comply with HIPAA regulations, Coffield says. He adds that a HIPAA-compliant response might read something like: “This website is not the proper forum for these types of discussions. If you have an issue with this particular provider, contact the facility.”

He adds, “You should respond in almost a webmaster-type fashion, and then immediately call the person [if the person can be identified] and say, ‘I just saw your post, and I’d like you to come in and talk about it.’”

There shouldn’t be anything problematic about responding to a negative review by saying, “Please give me a call at this number,” Coffield says. But getting into detailed discussions—even through Facebook and Twitter’s private messaging systems—is “pushing the envelope.”

“A lot of providers think if they don’t say who the patient is or don’t divulge many details that they’re not violating HIPAA—they’re keeping confidential information confidential,” Coffield says. However, protected health information under HIPAA includes information that could give someone the ability to identify a patient, and social media posts that include even scant detail could do that, he says.

Anonymous reviews pose even more significant problems, Coffield says. “Engaging validates the patient on the other side, and with some of these people you can’t win—the more you engage, the more you anger them. But at the same time, failure to respond at all might anger them, even if the response is, I’m not going to respond.” In those cases, provider organizations should attempt to take the discussion offline, but also should be prepared to stop engaging entirely, he says.

Develop a Response Policy for Reviews

Binary Fountain works with clients to manage their social media presence. When it comes to review sites, Rainey says, most feedback tends to be positive or neutral, but it appears more realistic for the provider to have a few less-than-stellar reviews in the mix: “You want to have a mix of positive and negative reviews.”

Deciding to respond online to negative reviews, even in a minimal, HIPAA-compliant fashion, requires a case-by-case analysis, says Rainey. For example, if a provider only has two reviews, and one is negative, then “maybe” it would be worth a response to balance out the negativity, he says, although “obviously not with any level of detail” that speaks specifically to outcomes or to anything identifiable about the case.

On Facebook, where names are clearly visible and usually real, Rainey suggests replying to negative comments using language like this: “I’m sorry to hear about your negative experience. We strive to ensure that these negative experiences don’t happen to anyone.” Then the reply should urge the person to call or email the office, in an effort to “take the conversation offline.”

For example, Binary Fountain client Providence Health & Services, based in Renton, Wash., responded to a negative Facebook post from a man who said he was disappointed in his care: “This is certainly not the feedback we like hearing from our patients, Dave. We strive to provide each and every one of our patients with the highest level of compassionate care possible. Thank you for taking the time to share about your experience, as it is what helps us to improve our overall quality of service.”

Other hospitals take a similar approach. For example, Sentara Regional Medical Center in Williamsburg, Va., responded to a negative review by saying: “We always strive to give the best patient care and are very sorry to see this happened to you and your wife. Please send your contact information to 1800Sentara@Sentara. com so we can route you to the appropriate patient advocate and learn more.”

On Yelp, the approach is again similar, even if the reviews are anonymous. Northwestern Memorial Hospital in Chicago responded to a recent negative review by saying: “Thank you for your honest feedback and we are sorry to hear about the troubles that you’ve experienced. If you haven’t already spoken with our Patient Relations Department, please fill out the following online form and our team will be in touch to help. Thank you.”

Twitter requires shorter replies—it’s limited to 140 characters—but the format still allows for the standard “please get in touch” approach recommended by experts. For example, an anonymous Twitter user tweeted at Providence Health & Services recently, saying “@ Prov_Health thanks for costing me thousands of dollars. Worthless criminals should [be] ashamed.” Providence replied, “Is there something we can help you with? Please dm [direct message] us and we are happy to look into your concern.”

Doctors Advised to Remain Mum

It’s important to train physicians not to respond directly and impulsively to negative reviews, Rainey says.

“We see physicians who do take this very personally,” he says, adding that “we do not recommend the physician respond back—oftentimes that’s going to involve ‘shooting from the hip.’” Responding to negative online reviews or comments in an emotional manner can result in major HIPAA problems, he adds.

“Inherently, it is incredibly challenging for the average patient to provide an accurate review of the quality of care they received,” Rainey says. “And it’s not just the quality of the procedure—it’s the parking, the quality of the front desk staff,” and other factors, some of which are not under the provider’s control.

Instead of the physician responding directly to negative comments, an established marketing team— assuming one is in place—can be trained and tasked with formulating responses, he says. The message from that marketing team to physicians should be: “Please do not go and create your own account and respond to this.”

Appropriate, measured responses can sometimes even persuade a reviewer to change the review, Rainey says. In one case, he says, a reviewer posted a negative review of a large hospital system’s emergency department on Yelp, but revised the star rating upward after the emergency room director reached out personally.

Contact Coffield at RCoffield@FlahertyLegal.com and Rainey via Binary Fountain spokesperson Michiko Morales at michim@gabrielmarketing.com.✧

Copyright © 2017, Health Care Compliance Association (HCCA). This article, published in Report on Patient Privacy, appears here with permission from the HCCA. Call HCCA at 888-580-8373 with reprint requests or email us at service@hcca-info.org.

About the Author

Kayla Zamary
Marketing

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August 17, 2017

Binary Fountain, Kyruus Integrate to Enhance Patient Acquisition & Engagement

via HIT Consultant Binary Fountain, a provider of patient feedback management solutions is teaming up with Kyruus, a provider search and scheduling solutions for health systems to increase online patient acquisition and improve patient experience. As part of the partnership, Kyruus wil integrate its Kyruus’ ProviderMatch for Consumers, a web-based provider search and scheduling solution…

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via HIT Consultant

HIT ConsultantBinary Fountain, a provider of patient feedback management solutions is teaming up with Kyruus, a provider search and scheduling solutions for health systems to increase online patient acquisition and improve patient experience. As part of the partnership, Kyruus wil integrate its Kyruus’ ProviderMatch for Consumers, a web-based provider search and scheduling solution health systems embed in their websites with Binary Star Ratings, a healthcare transparency solution.

Click here to read the full article on HIT Consultant.

About the Author

Kayla Zamary
Marketing

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August 03, 2017

Three Ways Reputation Management Is Changing Healthcare

via Social Media Monthly Binary Fountain’s EVP of Strategy & Corporate Development, Andrew Rainey discusses with Social Media Monthly how healthcare consumerism and patient experience are chaining the healthcare industry. Click here to read the full article on Socia Media Monthly.

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via Social Media Monthly

Binary Fountain’s EVP of Strategy & Corporate Development, Andrew Rainey discusses with Social Media Monthly how healthcare consumerism and patient experience are chaining the healthcare industry.

Click here to read the full article on Socia Media Monthly.

About the Author

Kayla Zamary
Marketing

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July 19, 2017

Three Reasons Why People Are the Key to a Successful Purpose Transformation

via Inc. Binary Fountain’s SVP of Marketing, Aaron Clifford discusses with Inc. how company purpose has transformed the customer relationship. Click here to read the full article on Inc.

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via Inc.

Binary Fountain’s SVP of Marketing, Aaron Clifford discusses with Inc. how company purpose has transformed the customer relationship.

Click here to read the full article on Inc.

About the Author

Kayla Zamary
Marketing

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