A Physician Appeals Process Helps Advance Transparency at Northwell, Geisinger

Added on Aug 23, 2016

Ensuring a Physician Appeals Process Helps Advance Transparency at Northwell, Geisinger
By Audrey Doyle
From Industry Edge August 2016

Transparency of physician performance information is essential to informed decision making. Recognizing this, an increasing number of hospitals and health systems are posting on their public websites physician ratings and unedited comments gleaned from patient experience surveys to help current and prospective patients and their families choose a health care provider that best meets their needs.

Northwell Health and Geisinger Health System are among the organizations currently posting physician ratings and comments online. According to Dr. Ira Nash, Northwell’s senior vice president and executive director, and Dr. Greg Burke, Geisinger’s chief patient experience officer, online posting of ratings and comments—positive as well as negative—can be beneficial to physicians because it tells them whether they need to alter their practice or style in order to provide an optimal patient experience.

However, some physicians are slow to embrace the transparency movement—particularly the posting of unedited comments—because they worry that negative comments may inaccurately or unfairly describe past doctor-patient interactions. In an effort to avoid such situations, Northwell and Geisinger give their physicians an opportunity to appeal the posting of negative comments that concern them. This allows the facilities not only to paint a more accurate picture of prior patients’ experiences of care, but also to stress to their physicians that their transparency initiatives are fair and just.

Listening to the Patient Voice

Strong advocates of the value and importance of openness, communication and accountability, Northwell and Geisinger went live with public reporting of their physician ratings and comments last year.

“I’m a big believer in transparency, and to really be transparent, we couldn’t just post the ratings. We also had to post the comments, including the negative ones,” said Dr. Nash. “Not only does this build patient trust, but it also elevates the importance of the patient experience in the minds and actions of our physicians.”

“Health care transparency is about being patient-centric,” added Dr. Burke. “People have been recommending and not recommending doctors to friends and family for decades across kitchen tables and over the phone. Posting unedited physician comments—the good ones and the bad ones—allows us to open those conversations up to a larger audience.”

The physicians at Northwell and Geisinger were initially concerned that posting negative comments about their interactions with patients would have negative repercussions. At Northwell, for instance, some doctors felt this was akin to “airing dirty laundry” and that it would result in damage to reputations and professional practices. At Geisinger, there was concern that this was causing the doctor-patient relationship to be diminished to a commodity and that it was an affront to the profession.

Despite these concerns, Northwell and Geisinger felt it was imperative to be up-front about patients’ perceptions of their care; otherwise, the process wouldn’t be meaningful, effective or reliable. “The point of this isn’t to manipulate the data, it’s to provide the best possible experience for our patients,” said Dr. Burke. “The public is wise enough and savvy enough to realize that nobody gets only glowing reviews. The negative comments lend legitimacy to the process.”

The ratings and comments that Northwell and Geisinger post on their websites come from the portion of the survey that asks patients to provide feedback on their interactions with their physicians. As such, patients aren’t asked to rate or comment on the physicians’ surgical skills or diagnostic expertise, or on how they experienced aspects of their visit over which their physicians had no control, such as parking or courtesy of office staff.

Physicians who have received at least 30 ratings have their data featured in their online profiles. Comments, meanwhile, are collected for review. Both Northwell and Geisinger have a team of reviewers who read each comment and filter out those that meet at least one of the following exclusion criteria:

  • Uses profane, offensive, abusive, discriminatory, slanderous, libelous or malicious language
  • Describes the physician’s personal appearance
  • Includes names or details that jeopardize patient confidentiality
  • Includes comments about other physicians or departments
  • Disagrees with the physician’s diagnosis or treatment plan

At Geisinger, any comments the review team is unsure of are put on hold at this point. “Then we meet as a group, typically once a month, to discuss the comments in this difficult-to-call range,” said Dr. Burke.

The point at which physicians can read the comments and file an appeal differs between the two health systems.

At Northwell, physicians review comments after they’ve made it through the exclusion process but before they’re posted. “Physicians are notified by email when comments are ready for them to review. After reviewing a comment using our Webbased preview tool, they can choose ‘Publish now’ and the comment will be posted to our public website within 24 hours,” said Dr. Nash. If they want a comment to be excluded from their profile, they click “Appeal,” and an electronic form comes up that asks them to briefly explain why the comment should be excluded. At this point, the comment is in limbo and the appeals process begins. If the physician takes no action, the comment goes public in two weeks.

At Geisinger, comments that haven’t met any of the exclusion criteria are posted; then the physicians get a chance to review them. If a physician sees a comment they feel should have been excluded, they can file an appeal. “Often we’ll pull the comment from the website while it’s being discussed,” said Dr. Burke.

The appeals process is similar at both health systems. The physician explains to an appeals committee why they feel the comment wasn’t appropriately filtered, and the committee discusses the issue. If the appeal is upheld, the comment isn’t posted (in Northwell’s case) or is removed from the website (in Geisinger’s case) and the appeals process ends.

If the appeal is denied, physicians at Northwell have the right to a second appeal; this appeal is heard by an executive-level committee, which discusses the issue and makes a final adjudication. At Geisinger, the comment remains on the website.

Both Dr. Nash and Dr. Burke said that very few comments end up being appealed. For example, as of the end of June, Northwell had received 15,297 patient experience comments, 3,500 of which were administratively removed using the exclusion criteria. Of the 11,797 comments that remained, 42 comments were appealed by 37 physicians.

Neither health system has tracked the percentage of appeals that have been upheld, but both Dr. Nash and Dr. Burke described it as “small.” They also stressed that their appeals committees work very hard to ensure fairness—to the patients as well as the physicians. “We can spend half an hour on one comment because we’re so committed to getting it right, to respecting and promoting the patient’s voice while also being credible and respectful of our physicians,” said Dr. Burke.

Therefore, when an appeal is denied, the facilities reinforce the message to the physician that, good, bad or ugly, this is how their patient experienced the interaction, and that at this point, the physician must accept that the comment reflected a legitimate feeling or an accurate portrayal of the interaction. “We remind our physicians that these are the voices of our patients,” said Dr. Nash. “So whether the visit seemed that way to them or it didn’t is not the point. It’s not about them, it’s about their patients.”

Dr. Nash and Dr. Burke said that allowing physicians to appeal negative comments has changed physicians’ attitudes about publicly posting the comments. Although it can still be difficult emotionally for doctors to read negative comments about themselves, “they live in the real world—they go to TripAdvisor, use OpenTable and read Amazon reviews—and they realize that negative reviews and comments are a ubiquitous part of doing business today, even in health care,” said Dr. Burke. Allowing them to appeal comments they disagree with lets them more actively participate in the organization’s transparency initiative, he said.

“There’s a nearly universal recognition here that, even if we stop doing this, it’s not like our physicians will no longer be the subject of patient reviews. They’ll just be the subject of less reliable patient reviews and will have no input into how the process is performed and no guarantee that the data accurately reflects the patient’s experience,” added Dr. Nash. “By giving them a chance to appeal comments that are concerning, we’ve helped them gain confidence in the process, recognize the importance of transparency and understand that they’re being treated fairly.”