Recently, the Family Equality Council (FEC) published a comprehensive research study designed to help us better understand the landscape of family-building for lesbian, gay, bisexual, transgender, and queer (LGBTQ+) adults in America today. 

The report included some inspiring statistics-all of which point to the fact that the number of LGBTQ+ families in the United States is set to grow dramatically in the coming years. In fact, the report states 77 percent of LGBTQ+ millennials (ages 18-35) are already parents or are considering having children-a 44 percent increase over previous generations. With the number of LGBTQ+ families set to rise at historic rates in the near future, it’s time for primary care physicians and all medical providers to make their practices more inclusive and welcoming to the specific needs of the community. Creating an inclusive practice for the LGBTQ+ community requires time and intention. A very focused effort could yield a designation with the Healthcare Equality Index (HEI). 

The Human Rights Campaign Foundation awards HEI status to policies and practices that meet the highest standard of LGBTQ+ inclusion and equality, a status our practice was awarded in 2017 and 2018, and one that must be earned each year. While gaining momentum to garner HEI status, here are five ways providers can make their practices more inclusive immediately.Mark Leondires, MD, is the practice director of RMA of Connecticut and founder of Gay Parents To Be.

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With the number of LGBTQ+ families set to rise at historic rates in the near future, it’s time for physicians to make their practices more inclusive and welcoming to the specific needs of the community.

5 ways primary care physicians can make their practices LGBTQ+ friendly

Prior to 2018, payers considered international normalized ratio (INR) monitoring (i.e., the testing and dosage adjustments required to manage warfarin therapy) part of the routine work associated with an office visit. This meant payment was bundled into the evaluation and management (E/M) code when physicians performed these services.
	
	Now, two new CPT codes allow payment when physicians order, review, and interpret new INR test results-even when patients self-test at home: 93792 (patient/caregiver training for home INR monitoring) and 93793 (anticoagulation management for a patient taking warfarin).
	This is good news for physicians who frequently treat patients on warfarin, because it means they’ll be paid separately for work they’re already doing, says Rhonda Granja, CPC-I, CPC, lead instructor at the Medical Management Institute in Atlanta. Many physicians still don’t know about these codes even though they’ve been active for more than a year, which means doctors are probably leaving money on the table, she adds.
	
	

Consider these four questions before billing for INR monitoring:

1) Do commercial payers reimburse for the service? Ask commercial payers to include CPT codes 93792 and 93793 in their contract if they haven’t done so already. Don’t assume payers will automatically cover these services just because Medicare does, says Granja.
	
	2) Will patients have the option to monitor their INR levels at home? Home INR monitoring isn’t only convenient for patients-it also frees up the schedule so physicians can focus on face-to-face visits with patients who have acute problems, says Norman Vinn, DO, family medicine home care physician in Laguna Hills, Calif. Home monitoring also has potential clinical benefits. “You can rapidly get answers and provide almost instant turnaround on dosage advice,” he adds.
	
	One caveat is that not every patient will have the physical and mental abilities to perform INR tests at home, says Vinn. “The operator reliability must be reasonably accurate and consistent,” he says.
	
	Vanessa Vinn, DO, internist in Costa Mesa, Calif. adds that younger and more tech-savvy patients may be the best candidates for home INR monitoring.

3) How will patients receive INR test results? What workflow will the practice use to communicate results and dosing adjustments? For example, will patients come into the office? Will a physician or nonphysician provider call them? Will staff send results through the EHR portal? A combination? These decisions will ultimately drive how the practice will bill for these services, says Granja.

4) How will the practice capture revenue? There are several ways in which physicians can bill for INR monitoring. The specific scenario and supporting documentation will dictate the most appropriate and compliant method. Granja provides the following scenario advice:

Patient monitors INR level at home and comes into the office to discuss results.
	
	Report CPT code 93793. Don’t forget to bill CPT code 93792 for the initial patient/caregiver training to provide education regarding use and care of the INR monitor, how to obtain a blood sample, and how to report home INR test results.

Patient goes to an external lab for an INR test and comes into the office to discuss results.
	Report CPT code 93793.

Patient has an INR test at a lab in the office or at the point of care and follows up with a visit to discuss results.
	Report CPT codes 85610 (prothrombin time) and 93793.

Patient presents for an office visit during which the physician also discusses INR monitoring.
	Report CPT code 93793 and the appropriate E/M code with modifier -25. Another option is to report the E/M code with a prolonged service code (CPT codes 99354-99357), but only when documentation includes a detailed description of the additional time spent-what the physician did and why.

Patient requiring INR monitoring already receives chronic care management (CCM) services.
	Include the INR monitoring in your total CCM time, and report the CCM only (CPT codes 99487, 99489, or 99490). Note that INR monitoring alone doesn’t constitute CCM.

Patient monitors INR level at home or goes to an external lab for an INR test, and the physician or a nonphysician practitioner provides results and instructions via telephone or electronic communications (e.g., through the portal).
	Report a CPT code from the 98966-98969 or 99441-99444 ranges.

Patient has an INR test at the lab in the office, and the physician or a non-physician practitioner provides results and instructions via telephone or electronic communications (e.g., through the portal).
	Report CPT code 85610 and a CPT code from the 98966-98969 or 99441-99444 ranges.

Articles

Two new CPT codes allow payment when physicians order, review, and interpret new INR test results-even when patients self-test at home

How to earn money monitoring INR levels

There’s a growing consumer force making its presence known in medicine: convenience.
	
	In the past, a practice could offer a handful of Saturday appointments and that was about the only convenience patients expected. But patients are now demanding the same expectations from practices that they do from restaurants or retailers, and if they don’t get them, they find another doctor.
	
	“If practices don’t adapt, they will see patients slowly migrate elsewhere,” says Susanne Madden, MBA, president and CEO of The Verden Group, a Nyack, NY-based healthcare consulting firm. Madden has first-hand experience, having recently switched providers herself.
	
	“I was on hold for 12 minutes to book a simple annual physical,” says Madden. “I used that time instead to fill out a transfer medical form and booked an appointment with a larger practice online and picked a new doctor.”
	
	Twelve minutes may not seem like much, but it was enough of an inconvenience for Madden to make the switch. She says if practices want to survive, they need to cater to consumer behaviors in medicine, even if there are no other doctors in town. “Some rural doctors might get
	patients not because they are amazing doctors, but because there aren’t many options,” she says. “But the day a competitor moves into town with a higher level of care access and communication, they’ll be out of business. They need to take the time to up their game.”
	
	Competition is coming from urgent care facilities as much as other medical practices, experts say, and often have the funds and expertise to give consumers exactly what they want and redefine what an appointment with a doctor looks like.
	
	Take GoHealth Urgent Care. Backed by private equity, its mission is to “redefine the healthcare experience.” It has 125 centers and is opening 30 more in the next year.
	
	GoHealth partners with local health systems and builds facilities with convenience at their core. Patients can compare wait times for GoHealth facilities online, make an appointment at the one with the shortest wait, and upon arrival, check-in via kiosk. Office designs are bright and open, and patients enter exam rooms where high-tech electrostatic glass walls change from clear to frosted for privacy. All equipment is either in the room or brought to the patient, so no moving about the office if, say, an x-ray is needed. Wall-mounted screens show the patient what the doctor is looking at and entering into the health record, and there is no checkout when the patient is finished-they just leave.
	
	“We compare ourselves to a restaurant, where consumers will not return after one or two poor experiences,” Dev Ashish, CIO of GoHealth, said at HIMSS19, an annual health IT convention. “The same rules apply to healthcare.”
	
	He said that instead of relying on the long patient satisfaction questionnaire with a low response rate that many in the healthcare industry use, GoHealth relies on a simple Net Promoter Score, which asks how likely someone is to recommend their services to a friend on a one-to-10 scale. Their response rate is between 40 and 50 percent, providing GoHealth with lots of data and is the same method used by the nation’s largest retailers. The company follows up with anyone offering specific feedback, good or bad.
	
	The transformation toward consumer-focused convenience in healthcare is similar to what he saw in the banking industry, says Mat Kremke, MBA, the vice president of the American Osteopathic Association. “When I started [in banking], we would sit at a desk and people would just come to us,” says Kremke. “Then banks added Saturday hours, then they opened up branches in grocery stores, then extended hours to 9 p.m.-if they didn’t adjust, they would be forced to close down. The medical industry is next on the list for consumers, who expect convenient-to-use digital platforms.”
	
	Consumer expectations are changing in part because they are shouldering more of their healthcare costs through higher premiums, copays and deductibles, says Madden. “I’ve seen patients seeking out everything from price transparency to wanting the same sort of service they can get elsewhere,” she says. “If they can book a hotel or flight at midnight, why do they have to call during the workday to book an appointment and get to spend time on hold for the privilege of doing so? They are looking for the same level of service and access as they would get from a service business.”
	
	


	
	The first step to adjusting to the patient-as-consumer is to understand how they view healthcare. “There needs to be an acknowledgement that we are in the service industry,” says Ken Hertz, FACMPE, chief consultant for the Medical Group Management Association. “We provide a service, just like a restaurant. We have to see ourselves the same way.”
	
	The biggest thing consumers want is convenience, even more so than a relationship with their doctor.. “They want their interaction to be easy and simple,” says Hertz. They are looking for convenient appointment times that fit their schedule and visits that are fast and efficient, he adds. In addition, they want to understand all the costs, including whether any referrals are in or out of their network, and be given online payment options.
	
	While this list may sound daunting to a small practice owner, experts say there are some basic steps that can identify the conveniences most important to their patients. The first step is to ask the patients, says Madden.
	
	“Every day as a patient is checking out, hand them a two- or three-question survey, and that will tell you everything you need to know,” says Madden. If a practice is looking at extending office hours, ask what days and times are most convenient for them. “Also, don’t forget to survey your staff for their ideas,” she adds. “They are hearing from patients and observing when the process begins to break down and patients become unhappy.”
	
	Kremke says to also look at what conveniences competitors are offering, and leverage technology to help be more efficient and offer a positive experience. This means offering online check-in, easy payment options, and increased communication. “The patient is expecting the experience to be seamless and not time consuming, and wants it to be almost as quick as ordering a drink at Starbucks,” says Kremke. “They want to see the physician as quickly as possible and walk out.”
	
	Finding the right technology solution is important, but everyone, including the staff, has to buy in to the commitment to customers, experts say.
	
	“You can’t do things the old way; things have to change,” says Hertz. “Every team member in the practice has to be engaged in the vision, mission, and values of the practice and needs to be held accountable for creating an experience for patients that is second to none. One of the most important things anyone can do is just listen to people.”
	
	


	
	When survey results are analyzed, certain patterns of what patients are concerned about will start to emerge. Madden says to identify the top three and then do a follow-up survey using open-ended questions to get more information about these areas. This will provide the details to help the practice figure out how to meet patient demand, whether it’s a piece of technology or just a different process.
	
	She says it’s vital to involve the staff when discussing survey results and potential improvements. “The buy-in piece is important, and without it, you won’t be able to implement anything,” says Madden. “You will end up with a lot of information about what’s wrong, but not have any mechanism to transform the practice.” Focus on the first three areas identified in the surveys and implement the solution that fits the culture and budget of the practice. “Once some meaningful changes happen in the practice, the staff will be much more willing to keep going,” she adds.
	
	Start small to increase chances of success, experts say. For a primary care practice, the mere thought of taking the time to implement process improvements can be overwhelming. “Pivot slowly and build on your early wins,” says Madden. “You want to build a culture of ongoing process improvement.”
	
	These changes will ultimately boost the viability of the practice. “What’s good for the patient is good for the practice,” says Alex Mangrolia, director of product management and digital transformation for Los Angeles-based Practice Builders, a healthcare consulting firm. “The practice is in business to earn money, and making customers happy is vital.”
	
	Mangrolia says physicians should check with their EHR vendor to see what tools might be available through the patient portal. For example, if an online scheduling app is available that already connects to the EHR, using it might make more sense than looking for a solution that doesn’t integrate or requires additional IT work.
	
	“One of the biggest things you want to look at when evaluating technology solutions is how easy does it tie in to the rest of your practice,” says Kremke. “The last thing you want is the need to sign in to 15 programs for one patient.”
	
	Despite the demand for more convenience, Hertz warns against losing sight of building relationships with patients. “If you can offer all the things the patient wants in their care as well as consumer-like convenience, then you have a win-win situation where you can keep the patient over a long period of time. They want to know that you as a physician will really hear their issues and have a connection with them. But if you don’t do it in a convenient and accessible way, the rest doesn’t matter.”
	
	


	
	Once a practice adds new conveniences, experts say it needs to focus on getting the word out to both existing and potential patients.
	One way is to use normal patient interactions to educate them about new options. “If a patient calls in to make an appointment, that’s a good time to mention that they can make an appointment through the portal now, how to register and how to use it,” says Mangrolia.
	
	An email marketing campaign to existing patients, plus printed flyers for in-person visits can also be effective in highlighting new services, he adds, noting that it’s important to match efforts to patient preferences. “Some people might not respond to text messages or emails, so you have to call them,” he says.
	
	Madden says to continue using surveys to educate patients. A check-out survey could highlight the changes the practice has made, ask if they noticed the changes and then rate them. This can lead to additional marketing through social media, such as posts that, for example, proclaim, “82 percent of our patients say our new online scheduling is a major convenience.”
	
	Hand out cards with the addresses of websites such as Yelp, Facebook and Healthgrades and invite patients to review the practice. “If you don’t ask, you won’t get them. Having hundreds or thousands of positive reviews can cancel out the few people that had a negative experience,” she adds. “This will also make you look fantastic online and is a way to get more business.”
	
	Call out all the changes on your website and use it to illustrate how this makes the practice  different compared to the competition, says Madden. Outline all the ways the practice values its patients’ time and the conveniences it offers.
	
	Hertz suggests that whenever possible, illustrate the changes from the patient standpoint, not the practice’s. “A YouTube video from Mrs. Jones talking about what a great experience she had and what it meant for her can be powerful.”
	
	Experts agree that for practices to remain viable, they will need to meet consumer demands for great convenience and access. Not doing so will most likely result in a steady drain of patients to a more convenient urgent care facility or a physician with a greater commitment to their needs.
	
	“Understand this is happening whether or not you want it to,” says Hertz. “You can’t stop it, and you can’t opt out from consumerism. All patients have been consumers in other parts of their life, and now it’s coming to medicine.”

In the past, a practice could offer a handful of Saturday appointments and that was about the only convenience patients expected. But patients are now demanding the same expectations from practices that they do from restaurants or retailers, and if they don’t get them, they find another doctor.

How practices can keep patients in the age of consumerism

Q: We saw that there are changes to the teaching physician documentation guidelines for 2019.  But we aren’t sure exactly what to make of them since they read almost the same as they did before. Can you clarify what the changes mean?

A: At first glance, they do seem to read similarly with, at most, very minor changes. 
	
	However, when you are a teaching physician supervising resident(s) on a daily basis, this change can save a good amount of documentation time.
	
	According to MLN Matters MM11171 (effective date of January 1, 2019 and implementation date of July 29, 2019, the policy clarification is in two parts. For the purposes of payment, E/M services billed by teaching physicians require that the medical records must demonstrate:

1) That the teaching physician performed the service or was physically present during the key or critical portions of the service when performed by the resident; and
	2) The participation of the teaching physician in the management of the patient.
	
	In addition, the patient medical record must document the extent of the teaching physician’s participation in the review and direction of the services furnished to each beneficiary.
	
	The extent of the teaching physician’s participation may be demonstrated by the notes in the medical records made by physicians, residents, or nurses.
	
	The last sentence is where I think we need to focus.  This is because the guidelines previously read, “Documentation by the resident of your presence and participation is not sufficient to establish such presence and participation.”
	
	So what this seems to imply is that Medicare is now allowing the resident or nurse to document the teaching physician’s participation in the visit, which aligns with Centers for Medicare and Medicaid’s (CMSs) less-stringent documentation guidelines for E/M services in general. 
	
	Also, the change applies to those visits under the primary care exception in the outpatient setting, which includes the E/M codes listed ibelow.
	
	Remember, the teaching physician guidelines only apply to Medicare patients. 
	
	Here is more detail from the CMS  Teaching Physicians Fact Sheet, which states (empjhasis added):

“You must be identified as the teaching physician who involves residents in the care of your patients on claims. Claims must comply with requirements in the General Documentation Guidelines and E/M Documentation Guidelines sections.
	
	“Claims must include the GC modifier, “This service has been performed in part by a resident under the direction of a teaching physician,” for each service, unless the service is furnished under the primary care exception.
	
	When the GC modifier is included on a claim, you or another appropriate billing provider are certifying that you complied with these requirements.”

The 2019 changes at first glance seem to have minor changes, but if you are supervising residents, the documentation requirements are now higher.

Understanding the 2019 changes to Medicare’s teaching physician guidelines

Primary care physicians, working in an environment where patients need to be evaluated, monitored, and motivated in short office visits, sometimes struggle to effectively treat patients with diabetes. Almost half of patients with diabetes don’t meet their related goals, including A1C blood glucose levels, blood pressure, and LDL cholesterol levels, according to a study in the New England Journal of Medicine. That’s a problem in the U.S., where more than 30 million people are diagnosed with diabetes, accounting for $237 billion a year in medical costs.
	
	The healthcare ecosystem is shifting to value-based medicine, notably through Medicare’s Merit-based Incentive Payment System (MIPS). That program rewards or punishes physicians financially, depending in part on their ability to meet quality metrics, including for patients with diabetes. Physicians are being measured on how they manage their patients’ A1C, blood pressure, LDL cholesterol, smoking cessation and more.
	
	“In the days of meaningful use, there were only rewards,” says Ashok Balasubramanyam, MD, an endocrinologist and professor of medicine in the Division of Diabetes, Endocrinology and Metabolism at Baylor College of Medicine, Houston. “Now we’re in phase of reward and punishment if not met.”
	
	How can doctors motivate their patients to adhere to treatment plans while meeting national quality metrics and maximizing reimbursement for diabetes care?
	
	


	
	Given all the metrics to track, such as A1C, the healthcare system has made diabetes mostly about the numbers, says Randall Stafford, MD, Ph.D., an internist and director of the Program on Prevention Outcomes and Practices at Stanford Preventive Research Center, Palo Alto, Calif. By doing that, it’s removed the patient’s ability to feel they’re contributing to their disease management. “If we continue to push for more attention on the numbers, it could backfire,” he says.
	
	One way Stafford motivates his patients is having them correlate how they’re feeling with what they’re doing with their own care, including diet, exercise, and blood sugar management. “It seems like common sense, but we’ve lost track of that to some degree,” he says. “We drastically undersell behavior as a strategy in diabetes.” Behaviors are important links to what people can do to better manage their diabetes, he says.
	
	Stafford avoids using the word exercise with is patients, instead calling it physical activity. “Many people view exercise as something that needs to be difficult and exhausting,” he says. He defines physical activity as something that can be social, like dancing or walking with a spouse. He encourages patients to increase their activity level for a few weeks, and most will realize they feel better. “If the physical activity can reinforce that correlation with how they feel, that leads to better engagement and better self-management.”
	
	Marc Price, DO, once used scare tactics with his patients, telling them stories of fictional characters, with downfalls that happened when they didn’t take care of their A1C levels. “That didn’t seem to work,” says Price, a family practitioner in Malta, N.Y. Now he uses motivational interviewing, asking patients questions to find out what internal motivators might encourage them to take better care of their diabetes. A patient’s motivation might be improving mobility, so they can play more actively with their grandchildren, for example.
	
	Price also finds it helpful to listen to patients’ struggles, as some share that they can’t afford to pay for medication and also their living expenses. He’ll work with them to find less expensive medications, if possible, and his office provides information on finding cheaper diabetes supplies like testing strips.
	
	He also explains to patients why they should be taking certain actions, even when they feel well. He may tell them to take their statin even if their cholesterol is normal, as diabetes causes life-long changes in various parts of the body.
	
	Lifestyle changes are the hardest for patients to make, so he encourages small changes. “We ask patients to lose 1 pound, not 50, and then we give a lot of feedback,” he says. He tells patients that even a small weight change will help their blood pressure glycemic control, and he tells them that weight change is mostly a result of dietary adjustment.

What can primary care ­doctors do differently?


	
	It takes time to finding out what issues patients experience while managing their diabetes, and this is further complicated by how short the typical office visit is. Time is the biggest factor in gaining patient trust so they’ll share this information, Balasubramanyam says. Meeting guideline-based metrics and checking them off in the EHR makes it harder to develop that patient relationship, as there’s less time spent in face-to-face conversation and more time spent looking at the EHR while asking questions. During visits with his patients who have diabetes, he asks a lot of questions about neuropathic complications, sexual dysfunction, depression, mood issues, and adherence. “I can’t think of any way other than making time and asking the questions,” he says.
	
	Even though it takes time away from the patient/physician discussion during the visit, the low-hanging fruit in improving care is measuring and recording the needed metrics. This is something a physician should be doing at every visit, and can be easily incorporated in the EHR, Balasubramanyam says. “That’s been shown to make a difference,” he says.
	
	The harder part of treatment is personalizing the treatment. “Diabetes isn’t one thing,” he says, and selecting what treatments to recommend for each patient is something many endocrinologists strive to do but aren’t necessarily doing. “If you treat everybody the same, you get a mixed bag of results that won’t make a difference,” he says.
	
	Instead, he recommends risk stratification measures, using clinical analytical tools. For each measure, like controlling sugar or blood pressure, there are subgroups with evidence for each. To get to that level of sophistication with treatment, he recommends education. The American Diabetes Association sponsors good research, publications, and CME, he says.
	
	The NCQA metrics set minimum standards for diabetes screenings, Balasubramanyam says. That includes eye and foot exams every year.
	
	In Price’s practice, the office staff ensures the patient is set up with an eye exam every year, and the medical assistant periodically checks the charts to make sure the patients kept the eye appointment. If not, the chart is annotated and Price follows up with them at the next primary care visit. Patients with diabetes routinely get their urine and thyroid checked yearly, and Price looks for the results when they come in. He recommends that his patients with well-controlled diabetes come for office visits at least twice a year, once for a physical, and once for a six-month check. If their diabetes is not well-controlled, he’ll ask them to come every three months, and if poorly controlled, every two to four weeks to check their sugars and adjust their medication.
	
	


	
	Using a team approach to diabetes care, the staff can spread the tasks out, Stafford says. “The physician may be in position of authority and seen as the captain of the team, but I don’t think the physician needs to do all the tasks.”
	
	With limited time for office visits, using a team-based approach can provide additional patient education and care, boosting reimbursement as well. “If the goal is an A1C below a certain threshold, it doesn’t matter if the physician, dietician, or community health worker is part of that process,” Stafford says. A team-based approach allows the patient to get more attention to the social and psychological dimensions important to some with diabetes.
	
	Endocrinology centers may be better equipped with healthcare extenders, but small offices can bring in specialists as well. Price has a diabetes educator/nutritionist come to the office once a month. Insurance is billed for these visits, as many of the patients have benefits that cover it. For those with no insurance benefits, Price’s office covers the cost.
	
	The Oak Forest, Ill., county clinic, Oak Forest Health Center, uses a team-based approach to diabetes care. Almost 25 percent of their patients are diagnosed with type 2 diabetes.  The team schedules lab tests before visits, calls patients with pending lab orders, preps the upcoming patient charts with A1C values, and conducts a daily huddle to share expectations and information before the day’s visits. Patients complete self-directed goal sheets at each visit, discussing them with the physician, who logs and monitors goals over time. Newly diagnosed patients and those with A1C levels at nine or above, are referred for diabetes education and care management. The program has been successful in better controlling patients’ diabetes.
	
	Though primary care physicians may be tempted to refer out difficult diabetes cases, Stafford says that primary care physicians should be able to care for patients with relatively complex care, including those on insulin and oral medications. “The primary care approach really is superior, particularly in the ability to see the whole person and all medical issues,” he says. “In my own experience in referring to endocrine, they do a great job in diabetes, but not necessarily treating the totality of a patient’s medical issues.”

Primary care physicians, working in an environment where patients need to be evaluated, monitored, and motivated in short office visits, sometimes struggle to effectively treat patients with diabetes.

Working with patients  to manage diabetes

 can be used to identify high-volume versus  low-volume surgeons, but determining true quality of care is difficult due to  inconsistencies among review site metrics and “soft measures” often  communicated by patients who use such sites, according to recently published research.

Jeffrey Segal, MD, JD, wanted  to determine whether doctors with positive online reputations actually deliver  higher quality of care typically associated with better clinical outcomes and  better safety records. 

online reviews from nine Web sites for high-  and low-volume surgeons

 who  performed lumbar surgery, total knee replacement, and bariatric surgery. The  scope of the study did not address whether patient volume and online reviews  are similarly correlated for primary care physicians in the office setting.

Segal concludes that  physician review sites online may not be the best indicators of true quality of  care because typically they measure whether patients “like” their doctor and  other subjective responses. Online review sites would benefit from using more  objective communication measures, such as asking about a doctor’s ability to  communicate risks of a procedure or treatment options, rather than simply  asking whether the physician listened to the patient or whether the patient  enjoyed his or her experience with the doctor, he says.

But the medical literature  also supports the idea that for some surgical procedures, volume correlates  with clinical outcomes, and volume is one area that online review sites could  identify accurately at least 61% of the time, based on analytics such as the  total number of ratings per Web site. Evidence exists that online review sites  can identify high-volume surgeons-which correlates with higher quality of  care-but the effect on patients is minimal, Segal writes.

“From a patient’s  perspective, a far better way to determine whether a surgeon performs a high  volume of procedures is to ask the doctor,” Segal writes. “Or the doctor could  preemptively provide such information on the various review Web sites.”

Surprisingly, Segal adds,  although the total number of reviews correlates with procedure volume, the  actual ratings values do not. And it’s unclear why the total number of reviews  and comments are associated with surgeon volume, the study notes. It could be  that high-volume surgeons are more comfortable with their skills and are  therefore more likely to ask patients for feedback, but that point requires  further study, Segal says.

Segal recommends additional  study to determine what other data from online review sites might be useful in  differentiating doctors who provide better clinical outcomes. 

How satisfaction surveys changed my approach

Patient relationships trump online reviews

Online reviews may be an accurate predictor of one key area of your work, according to a first-of-its-kind study. Discover the surprising result that could affect your reputation.

June 25 2019 edition

5 ways primary care physicians can make their practices LGBTQ+ friendly

How to earn money monitoring INR levels

How practices can keep patients in the age of consumerism

Understanding the 2019 changes to Medicare’s teaching physician guidelines

Working with patients to manage diabetes

Can online physician reviews really measure quality of care?