social media marketing for fertility centers

A Stern Warning for Fertility Clinics Who Complain About Patient Review Sites

By Griffin Jones

"Change is not painful. resistance to change is painful."

Consider this a gentle "love tap" from a friend. 

A direct warning from me is far milder than what the market has in store. If I don't speak up about this single issue now, then I am neglectful in my duty to help protect the field of reproductive health from cultural and technological shock, because the internet-led market has proven to be unforgiving.

easy part.jpg

When I entered the fertility world, I accepted the responsibility of preparing those inside the field from the disruption coming from outside. I built a company to help bridge the gap between the status quo of reproductive health and what's happening in the rest of the tech revolution. So that we're not dealing with contemporary business buzzwords, allow me to give this definition to what entrepreneurs and venture capitalists call "disruption":

  • Major enterprises losing double-digit market share or going out of business within 36 months due to brand new players who come from outside of their field. 

ONline reputation is hardly the tip of the iceberg

This article does not come in reference to any one particular conversation I've had (perhaps even with you) in the last few months...because I've had several. Some have been with clients, some with vendors, some with strategic partners; it's a recurring theme.

When I first started creating content for fertility practices, the topic of "online reputation" is what really piqued the interest of fertility doctors. Many of us are concerned with what people say about us online. We often find the comments to be unfair, untrue, or at the very least, unkind. As we explore, however, you may agree that the root of the issue has less to do with the comments of others and more to do with a strategically flawed grasp for control.

Technological and cultural change are sweeping through nearly every facet of society. We are dissecting online reputation in this instance, simply because it happens to be a very common pain-point. In this deep-dive, we closely examine

  • The cause behind the information shift of the last twenty years
  • Why patients have embraced it
  • The four principal reasons that practices have NOT embraced it
  • Why patients rely on social proof to make decisions
  • The real threat to a fertility center's online reputation
  • What to do once we've stopped resisting 

Many doctors tell me that negative reviews upset them to the point where they can't sleep. You've done everything you could, and if you could wave a magic wand, you would wish for nothing less than for your upset patient to have a healthy baby and a happy family. Before we separate your perspective from the patient's right to have and share a completely different perspective, let's first examine the informational shift that has happened over the last two decades.

the human need to move away from information ASYMMETRY

For any patient to think that she or he is more qualified to review her or his case after a few hours (or even hundreds) of internet research, must be insulting. If you're a fertility doctor, you've gone through four years of undergraduate studies, four years of medical school, four years of residency, and three years of REI fellowship. That's fifteen years of higher education, followed by some of the most demanding board exams in medicine. If you've grown accustomed to this legacy of information control, it's because you've worked extremely hard to do so. 

Information asymmetry, wherein the seller (provider) almost always has an information advantage over the buyer (patient) is wonderful...when you're the seller. Recall other pre-internet situations in which you have been the buyer. Call back to a time when you had to buy a car when only the car dealer knew the manufacturer's suggested retail price (MSRP) or its pre-owned history. Think of buying a house when only the realtor knew the last sale price, its home improvements, and recent sales in the neighborhood.  How did that feel? The best real estate agent in your market has a lot more experience buying and selling homes than you do. She may also be a very authentic and trustworthy professional. Does that mean she should expect you not to use Zillow and Trulia? You don't need me to explain the deep-seated human need to shift from information asymmetry to information parity. As consumers, we do it every day.

For over a century, virtually the only way for someone to obtain in-depth knowledge about any given medical condition was to attend medical school. Like our example of home-buying, patients had a scarcity of information, few provider choices, and no means to talk back. Contrast that with our very different world today.

The drive toward information parity

change coming for ivf centers

When I was a kid in the early 1990s, I wanted a million dollars so I could buy my own video game arcade. Now I have one on my phone (that I have never used). Every one of our patients walks around with a super computer in his or her pocket at all times. Within sixty seconds of being diagnosed with infertility, one can

  • Read various definitions of infertility
  • Study the most common causes
  • Research potential treatments
  • Compare providers
  • Watch video explanations from medical doctors from around the world
  • Find humor and relief from satirical and artistic content
  • Connect with thousands of other patients via social media

Information asymmetry is over. Forever.

patients often need to rely on each other 

Some of us are frustrated that just because our patients have access to virtually limitless information, that does not qualify them to make any diagnoses or prognoses. Correct; they are not medical doctors. They don't have to be. They are human beings with opinions and emotions and they have a right to share their experiences with each other. They frequently have to turn to one another for social proof to help them assess this information.

Also known as informational social influence, social proof is the psychological phenomenon where people rely on the actions and opinions of others to determine the appropriate behavior for a given situation. Talk about ambiguous social situations! What is the appropriate mode of behavior when someone learns that they've been diagnosed with infertility? When they've paid $18,000 of their life savings for two failed IVF cycles?

Social proof may be even more necessary for those dealing with infertility because of the tremendous social pressure to have children. When so few people in one's social network can relate to what they're going through, our patients frequently have to turn to the internet to find those who can empathize with their emotions and relate to their experience. 

information parity meets social proof meets technology

Imagine having to spend thousands of dollars of your own money on fertility treatment, and having no way of knowing which doctor or clinic could be the best fit for you. Along comes a fantastic user experience (UX), with sleek design and fields of search deeply relevant to those struggling with infertility. 

I don't own any equity in or have any commercial partnership with Fertility IQ at this time. Yet when I set myself free from my own desire to have perfect control over my paying clients' online ratings, and put myself in the position of the patient, it's easy to understand why they are using the platform in the hundreds of thousands. Instead of comparing apples to oranges on Google reviews, RateMDs, ZocDoc, Vitals, HealthGrades, or even Yelp, people with infertility read verified experiences from patients by their

  • Age
  • Diagnosis
  • Type of treatment(s)
  • Number of treatments
  • Success or failure of each treatment
  • Income level
  • Number of doctors seen

Complaining about Fertility IQ or any other review site is not as trivial as disliking a website. It's partaking in the exhausting struggle against what patients desperately seek. It is the hubris attempt to fight the human drive to move away from information asymmetry toward information parity. The market, whether through Facebook, Instagram, FIQ, Google, or any other platform will find a way to give it to them. It does not give a damn if we are inconvenienced.

the four main reasons for resisting patient reviews

Tech disruption in infertility field

I won't tell you to let go of control because we can't let go of something we don't have. If Muammar Gaddafi, the despot who antagonized western powers for decades, couldn't suppress social media, how could we? Why would we want to?

Well, after hundreds of conversations with fertility doctors, nurses, and practice managers, I've identified four principal reasons that we yearn to have control over what people say about us online, leading us down the path of most resistance.

  1. What we do is so hard and complicated. People don't have a right to criticize what they don't understand
    Consider the phenomenon of flight. What a magical experience. Distances that would have taken us weeks to travel a century ago, now take us a few hours. Instead of physical exertion, we're served snacks and alcohol while we enjoy unlimited entertainment on our personal supercomputers. The logistics, expertise, and technology required to provide this luxury to us are overwhelming.

    Left to my own devices, I would be lucky to mount a camel for a few miles. I still hate United Airlines, and so do you, and so do millions of our peers. Could we do a better job piloting, procuring maintenance for tens of thousands of aircraft, and maintaining schedules for tens of millions of travelers? Absolutely not. Should we have any right to complain when we're inconvenienced by what is still a tremendous luxury compared to the alternatives? Should is irrelevant; we do have the right, and we frequently exercise it. We are citizens of countries where free speech is (meant to be) protected by our constitutions. 

  2.  These reviews are fake
    Of the four reasons for resistance, this is the most legitimate, if the review is in fact illegitimate. False reviews are a real problem. Up to 15% of online reviews may be fake. If you are certain that a review is not from a patient at all, but from a competitor or an internet troll, flag it for review. I recommend flagging the review from more than one user account. At Fertility Bridge, we see fake reviews rear their ugly heads, and aren't always able to get them taken down. It's unfair and it pisses me off too. Because at least 85% of our reviews are authentic, let's focus on what we can control.

  3. Only unhappy people leave reviews
    A widely held assumption among fertility doctors is that IVF center reviews are overwhelmingly negative. This simply isn't true. In an analysis of 504 fertility clinic reviews, conducted by Fertility Bridge in 2015, 63% of reviews were positive and 37% were negative. Yes, there are reasons that people are motivated to leave negative and positive reviews about their practices. Someone may not have been able to become pregnant and want to take it out on you. Others may sing your praises because they were pregnant. Still, some centers are able to minimize their negative comments and maximize their positive ratings; that is our goal.

  4. Negative reviews use libel and slander
    If you'd like a good laugh with your morning coffee, read RateMDs' FAQs for doctors. In 12 paragraphs, they tell you how you can go pound sand if you think you're going to sue them. Vitals and HealthGrades do too, but RateMDs is the most humorous.
    Sometimes reviews violate the platform's terms of agreement by using hateful or vulgar language, and the site will remove them. Most of the time they do not.

the greatest threat to the accuracy of your reputation

Once we've moved beyond our four cardinal motives for resisting public feedback, we can focus on the real liability to the accuracy of our online reputations.

Last summer, in a summary of fertility doctors' responses to their online reviews, I corrected the old adage, "the customer is always right," to "the patients (plural, meaning the market) are always right". I'll use my own company as an example. Fertility Bridge served eight IVF clinics in 2016. If two of them were dissatisfied, one held a neutral opinion, and five were delighted with the service they received, I might be able to identify a few patterns. But what I would really want to do, is increase the volume of evaluation. Eight sources of feedback? Better than three, I guess. Thirty would be a heck of a lot better. 

The same is true for an IVF center's online reputation. When a fertility doctor has two scathingly negative reviews, one luke-warm review, and one glowing review, the public doesn't have enough information to accurately judge this physician. Very often, fertility doctors have unfavorable online profiles because they simply don't have a high enough volume of reviews on that particular platform. Forget these four motives for distrusting online review platforms; lack of volume is our worst enemy. The higher a clinic's volume, the more likely their reviews are to be positive. Period.

what to do now

Okay, Griffin. We've stopped resisting. We have a high volume of reviews but our ratings are still low. We still hate this. Make it go away.

disrupting the fertility field

If we've truly made it thus far, then we have the best road map for operational/personnel adjustments that we could ever ask for.  We have data to identify the most common problem areas in our practices and fix them. That's right, the same platforms that take control away from us give it right back...if we choose to act on it.

In my opinion, no review site makes it easier to evaluate customer service patterns than Fertility IQ. Clinics are rated by 

  • Operations
  • Scheduling
  • Billing department
  • Nursing Team

Physicians are rated by

  • Whether they treated their patient like a person or a number
  • Communication
  • How often they saw their patients at appointments
  • Response time

When we can measure how patients adore our nursing staff, and their disappointment in when their calls are returned, it's a lot easier to smoke out capacity-related issues that hinder the excellence of our practice experience. Of course we don't have to wait until patients leave our practice to listen to their stories. We can use tools like Press Ganey or Rep Check Up to solicit patient feedback, in-house. Public ratings are the final word, however, and in the eyes of the public, perception is reality.

a new review site is barely a baby serving of disruption

We've hardly seen the tip of the iceberg, my friends. If we cannot adapt to the reality of how patients use the internet to share their experiences, we are not long for what is to come. Regulation has sheltered healthcare from many of the market effects that have impacted other areas, but it won't hold forever. The executives of Zoc Doc, Vitals, and Health Grades are not worried about awkward run-ins at ASRM with physicians who subscribe to their premium offerings. They are interested in being the marketplace where patients find their providers.

FertilityIQ was started in the birthplace of many other innovative tech companies, the San Francisco Bay Area. It was started in the way most disruptive tech companies are, from outside. FertilityIQ doesn't receive funding from IVF clinics. They didn't need our permission to build their company and patients don't need our permission to share their experiences on their platform. This is what disruption looks like. Thousands of entrepreneurs are chomping at the bit to change healthcare in their own way. If we stay in the habit of yearning for control that we don't have, we will wistfully long for the days of unfavorable online profiles being our biggest pain in the neck.

Blockbuster Video chose to be nostalgic about the adventure of going to the video store. Netflix didn't. Marriott could have invented the world's most used lodging app; AirBnb was happy to do it instead. The largest taxi companies balked at the idea of hundreds of millions of passengers choosing to ride in a strangers' car; Uber bet the pot on it and became a multi-billion dollar company.

We are presented with an incredible moment in time to use new market opportunities to build the most successful versions of our practices. I started a company inside of our field, rather than outside, because it is far more agreeable to strategically adapt to technological and cultural change than to be rocked by the market. This is just advice, you certainly don't have to take it. Before you decide anything though, you might ask yourself if what you do now will make you right or wrong in the context of history.

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To learn more about how to improve your fertility practice's online reputation, and to adapt to new patient behavior, download your free copy of the Ultimate Guide to Fertility Marketing

Flipping People's Peanuts at MRSi 2017: Everything is changing, and it's just the beginning

By Griffin Jones
 

This is my third annual recap of the Midwest Reproductive Symposium international (MRSi) , so I'm going to have a little fun with this one. I don't feel like writing another list and I think there's a more valuable point I can convey to you. As of right now, MRSi holds the title for my favorite meeting in the field of reproductive health and I want to use it nudge other meetings to follow suit. I should be a fair judge, I go to almost all of them.

It certainly doesn't hurt that it's on Lake Michigan in Chicago in the summer time, and Dr. Angeline Beltsos knows how to incorporate an interesting theme. Those are pluses, but not enough to make a meeting my favorite. It's big enough to have a diverse range of programming and small enough to be very collaborative and social. People get to know each other and build meaningful relationships. I truly understand how important that is for the field. Louise Brown, the first baby ever born from IVF was a guest at the conference. As Louise put it,

"My parents were willing to advance science and try something that had never been done before because they felt their doctors were truly there for them."

These reasons not withstanding, do you know what I really think MRSi holds over our other meetings in the field? It's the most forward-looking.

Other meetings sometimes do a great job of exploring the latest science and the future prospects for assisted reproductive technologies, but they often stop there. I believe that's a mistake. Compared to some of the technologies that are being developed both inside and outside of our field right now, PGS looks about as complicated as tying a shoe.

A Change Gonna Come. Oh wait. It already did.

Several presentations detailed the incredible growth of technology across multiple facets of society, not just ART. My own talk was titled The Biggest Change Ever in Human Communication: the Tech Revolution and Our Patients. The title isn't hyperbole. I made the case that we are living through a bigger shift than that of the printing press, perhaps even greater than the written word itself. If you would like the slides from my presentation, I will be happy to e-mail them to you. Here's the punchline: the supercomputer in every one's hand, that we call a smartphone, has changed dating, parenting, conversation, and commerce, for us and our patients. We have hardly begun to adapt our operations accordingly. And this is only the beginning.

Bob Huff, Chief Information Officer of RMA of Texas, shared with us technology that is changing the way generalists refer patients, and even the way patients are diagnosed. Scientists have just created functioning mouse embryos through 3D printing

My co-speaker, Hannah Johnson, Operations Director of Vios Fertility, and I, had the pleasure to speak to the mental health professionals group as well as the practice administrators' Business Minds group. We desperately need more of this inter-disciplinary kind of discussion because entire industries are being radically and forcibly changed. You'll forgive me for not using the popular buzzword, "disrupted". I prefer to put it more bluntly. Large institutions and established companies are losing double digit market share or going out of business in periods of 12-36 months. How does that sound?

"We could be looking at widespread clinic closures within the next 5-10 years."--Hannah johnson

I don't want that for this field. I started my career in radio advertising. I watched wealthy and powerful stakeholders go bankrupt because they were comfortable or because they weren't willing to invest time, money, and energy to adapt. As Dr. Francisco Arredondo from RMA of Texas says, "we produce one new fertility specialist per 10 million people per year". A need of such titanic portions is one that is begging for more technological disruption.

how can we learn if every effort is required to produce a particular result?

Broad social and technological change isn't a frame of mind that we usually allow ourselves to explore at most of our regional meetings throughout the year, or even at ASRM. It's a bit more welcome at MRS to question the status quo, and test new platforms and processes, without the scrutiny of the exact result that any particular effort might produce at the given moment. Elizabeth Carr, the first baby born from IVF in the United States, is now a marketing data consultant who also spoke at the conference. "I wouldn't be standing before you today if my parents and their doctors weren't willing to try something that had never been done before."

Virtually every area of medicine and practice management is ready to be disrupted by technology. We can wait for pain, or we can put in the effort and patience required to adapt to these changes. MRSi is the first meeting in our field where we're starting to think and talk in these terms. I hope it serves as an example for the others.

 

The 7 Steps of the Fertility Bridge Proven Process for Tracking IVF Marketing Results

How we measure and improve our KPIs (key performance indicators) in the fertility field.

How we measure and improve our KPIs (key performance indicators) in the fertility field.

how do we measure the return on investment (ROI) of an ivf marketing program?

Jackie Sharpe is Regional Marketing Director for HRC Fertility in Southern California. Once, at an Association for Reproductive Managers (ARM) marketing meeting, I asked Jackie, "Is it easier, or harder, to track the effectiveness of marketing today than it was several years ago?"

I could tell she had thought about it before. "It's harder," she replied.

Harder? We have every tool under the sun, from Google Analytics to every kind of Customer Relationship Management (CRM) software and marketing dashboard. We can track every click, page view, Instagram like, Yelp review...everything down to how many minutes the average visitor spends on our website. How is it not easier than ever to track our ROI? Yet, you know what? She's absolutely right.

It's harder to singularly track patient sourcing, not only in spite of these infinite tools, but partly because of them. The  avenues from which today's patient becomes aware of our services are virtually limitless. So too, are the factors that can influence her decision. We need a system, as opposed to a single figure.

indispensable indicators need to be analyzed together

In my last blog post, I wrote about the Six Indispensable Indicators that IVF Marketing is Doomed Without. There are six, because individually, none of them offer us a wholly accurate synopsis of our marketing results. Whether we use the hottest CRM, or an Excel workbook, tools do not replace our overall system for tracking and measuring results. Two examples explain why we report on multiple sources of data.

  1. Human Omission: About 1/3 of patients of Fertility Bridge clients do not fully complete their referral-source questionnaires.  Furthermore, the number of questionnaires entered by the practice is typically only 75% of the total number of new patient visits.  
     
  2. Limits to Digital Tracking: We track internet goals (i.e. appointment requests), but sources are frequently only attributed to the most direct channel. In simpler terms, an IVF clinic on the west coast hosts informational fertility sessions at their offices. When we run ads on social media, registrations increase. On the submission form, registrants overwhelmingly check Facebook or Instagram as the sources of how they came to hear about the event. Still, when we look at our goals in Google Analytics or Hubspot, a much smaller percentage are credited for coming directly from any one channel. 

Instead of relying on numbers that provide incomplete information, we use a proven system that includes our Indispensable Indicators. Functioning as a whole, the system allows us to measure and understand the effectiveness of our efforts, and subsequently, the money we're spending. These are the seven steps of the Fertility Bridge Proven Process for Tracking Marketing Results that we implement with each new client.

1). Put the right person in the right seat

Someone inside the clinic must own your Indispensable Indicators. If these data are not readily available and accounted for, then the marketing strategy operates aimlessly. This person is often the practice administrator. He or she may be the clinic liaison, marketing director, or billing manager. Ideally, this is someone who is fascinated with being a student of your practice's key performance indicators. If the person has neither the authority nor the capacity to implement all of the steps involved in the Proven Process for Tracking Results, the point is moot. Whoever is chosen, he or she is responsible for reporting on the Indispensable Indicators every single month.

2). Collect existing data

Because of clinical reporting, you likely know your clinic's IVF volume, year-to-year, but that doesn't tell us anything about our monthly progress. We still don't know what impact individual marketing efforts have had on profit and patient volume.  In this phase of the Proven Process for Tracking Results, we gather all of the information we have for our Six Indispensable Indicators and enter them into one file. It's likely that you don't have complete figures for all six indicators, but partial information is a start. If you use a practice software like eIVF, you may be able to readily pull some of these fields.

3). create uniformity

Even when clinics do record some of their necessary KPIs, we at Fertility Bridge often find that we're not comparing apples to apples. The way you define your Indispensable Indicators can be customized to your practice, but they must be defined to ensure continuity. 

Monthly recorded table of Indispensable Indicators

Monthly recorded table of Indispensable Indicators

1). Lead

Is a phone inquiry, a website appointment request, and an RSVP to a fertility seminar all worth the same?

2). New Patient Visit

Does this include patients who had a successful IVF cycle with your practice but come back for babies two and three? Only someone who comes to the practice for the first time? Phone consults? Couples (including same-sex couples)? Individual female patients? Male and female patients separately?

Define new patient visits so that there are no duplicate or missing appointment numbers.

3). New Patient Sources

One clinic on the east coast had "the internet" listed as one of four questionnaire options for more than six years. So of course, from 2010 to 2016 the number of people that came from the internet increased by nearly 70%. But the internet has changed a lot in six years. What does "the internet" mean? Online reviews? Referrals from friends through social media? Searching for reproductive health services?

Offer different referral sourcing options to which respondents check "yes" or "no" to reduce ambiguity.

4). IVF cycles: For business purposes, how do we define an IVF cycle? Starts? Frozen transfers? Once the cycle bills? Does our number include restarts? Cancellations?

Again, the objective is to avoid duplication. An IVF cycle, as it is billed, should be unique to a particular month.

5). IVF Conversion Rates

If New Patient Visits and IVF Cycles aren't uniform, this number will start to look really funky.

6). Gross Revenue

4). Set benchmarks

Once we have our figures, month-to-month, we have clear benchmarks from which to measure our progress. The more months of data, the more reliable the benchmarks. It typically takes Fertility Bridge clients at least three months to collect this data; it's not readily available.

5). Set Internet Goals

Marketing dashboard customized for fertility clinics

Marketing dashboard customized for fertility clinics

Many IVF clinics have appointment request forms on their websites, but most do not have goals set for these forms in Google Analytics. Using a thank-you page for these forms, we track how many appointment requests and contact forms we receive on a weekly and monthly basis. Depending on your practice's size, you may have anywhere from fifty to several hundred of these forms completed in a given month. The person in charge of your Indispensable Indicators  checks how many inquiries went on to schedule new patient visits. Once we know how many new patient visits lead to an IVF cycle, we can even assign dollar values to these goals. 

6). Link the appropriate online properties

All vessels must row in the same direction. When we run a pay-per-click campaign on Google, Bing, or Yahoo, for example, we sync with your website's Google Analytics account so that we can measure the effectiveness of your campaigns in one place. When we run Facebook and Instagram ads, we install a pixel on your practice's website to show us how our ads convert. It's another way of seeing how many people fill out a form submission when coming from these channels.

Tracking how many request appointment forms came from a Facebook campaign

Tracking how many request appointment forms came from a Facebook campaign

7). Collect Weekly. Report Monthly

Tracking these numbers at the end of each month would be a bear. It's much easier to record them as they come in. Weekly recording also provides greater accountability; we don't wait until the end of the month to realize that we are missing our Indispensable Indicators

the whole is greater than the sum of its parts

We have a year of data on IVF cycles, patient volume, and referral sourcing. At month 12, we feel comfortable making a shift in our marketing strategy. We decide to take half of the budget that we had spent on print advertising, and spend it on paid social media advertising. How do we track the return on investment of our new advertising campaign?

If we've only recorded one number, we likely won't be able to.  If between months 12 and 15, however, we have the necessary data to see

  • A 30% increase in new patient appointments.
  • An 18% increase in new appointment requests submitted from visitors coming from social media, and
  • A 50% increase in the number of patients who report coming to our practice after having seen us on social media

then we can reasonably conclude that that marketing campaign was successful.

In a vacuum, none of these figures give us enough information to gauge the effectiveness of our marketing efforts. Because there are so many factors for which to account, we implement one system to measure and understand them. Individually, they are incomplete, and can therefore be misleading. When we organize and rely on our Six Indispensable Indicators, however, our IVF marketing's return on investment becomes greater than ever.

For more tools and tactics on measuring your fertility marketing efforts, read chapter 2 of my free e-book, The Ultimate Guide to Fertility Marketing.

 

 

5 Hidden Patterns Uncovered Across the Top 25 Fertility Doctors in Patient Reviews

By Griffin Jones

What a world it is where patients can form an opinion about their fertility doctor before they even schedule an appointment. A 2013 study shows that 90% of respondents reported that online reviews influenced their purchase decisions. Through public feedback from their peers, people dealing with infertility have a plethora of information to make their decision from online review sites that exist for the benefit of the patient. Here's where it gets interesting.  Fertility centers can also benefit from online reviews--good, bad, or neutral--by using them to deeply understand and adapt to patient habits. By carefully examining the online reputations of the most highly rated fertility specialists in the country, we have further decoded the messages that patients are sending loud and clear.

We know from initial research that the success of an individual's treatments using Assisted Reproductive Technology (ART) greatly influences how they write their review of their fertility clinic. Positive fertility clinic reviews are three and a half times more likely to mention a baby or pregnancy than to mention lack of success or make no mention at all. Equally, negative reviews are three times more likely to reference leaving the practice before success than to mention a baby or to make no mention at all. We also know that positive fertility center reviews outnumber negative reviews by more than 2 to 1. Getting some ideas from Joseph Davis, DO of RMA of New York, we wanted to dig beyond these observations to try to answer more questions: 

  1. Do the same patterns apply to fertility doctors with almost no negative reviews?
  2. Does an REI's rating correspond to his or her practice's success rates?
  3. Do the clinics with the highest success rates have high online ratings?
  4. What is the correlation between an REI's gender and his or her online reputation?
  5. Are younger docs rated more highly than their veteran colleagues? 

Limits to the data

First,  several review sites are popular for rating fertility doctors, and they are not uniform. Some sites, like Healthgrades, offer only star ratings without qualitative responses. Other sites likes Fertility Authority, Vitals, Google, and Zocdoc have the option to leave star ratings with or without comments. Yelp and RateMDs include qualitative responses with their reviews. Yelp tends to be more deeply populated by place (practice) reviews as opposed to reviews for individual doctors. In the latest phase of this research project analyzing fertility doctor reviews, I chose to use RateMDs because it is the easiest platform to search by sub-specialty.

There are 2,264 reproductive endocrinologists listed on RateMDs, mostly from the United States and Canada. We can search them by both highest-rated overall and per metropolitan area. Still, RateMDs isn't a perfect source. There are many duplicate profiles and only 1,205 (53%) of the physician profiles have any reviews at all. Furthermore, the rate of adoption for every review site varies widely by market. On RateMDs for example, there are 929 reviews of reproductive endocrinologists in Toronto, but in a very similarly-sized market, Houston, there are only 380. Lastly, you may be listed as an OBGYN, and not as an REI (or both in the case of duplicate listings). With that said, when we check someone's RateMDs rating (if they have ten or more reviews) against reviews on other platforms, we find they are consistent. 

I'm really excited by a newer review site that Dr. Dan Nayot brought to my attention, called Fertility IQ. You may have thought it was my site if I sent you the link to your listing. It isn't. Though I sometimes wish it was, because much of the data that I aggregate manually, they will soon be able to export with the click of a button. Most doctors don't yet have enough reviews for meaningful comparison, but I see this site becoming very popular over the next six to twenty-four months. The user experience (UX) for patients is outstanding and the site validates patient authenticity. Both the qualitative and quantitative questions are more in-depth than any other channel. Above all, there is a market need for a uniform, clean, and extensive platform to compare fertility doctors and clinics, and I hope this is it. In the meantime, I manually scour reviews for data like a cyber caveman.

Fertility IQ's home page

Fertility IQ's home page

Of course, there are limits to ranking clinics by IVF success rates as well. Partly because the Society for Assisted Reproductive Technology (SART) appeals that success rates not be used to compare clinics. Consequently, they don't rank them in a spreadsheet that we can easily pull. So we use the site, fertilitysucceessrates.com. While Fertility Success Rates makes it easy to check the top 25 clinics in the United States, some clinics are missing from the site's overall listings, even though their data can be found in the annual CDC report. Despite the limits in our data, we continue to notice some interesting patterns. 

1). Do the same patterns apply to doctors with almost no negative reviews?

Yes...and no. I analyzed the first ten reviews of each of the top 25 rated reproductive endocrinologists. Of the 250 reviews

  • 164 explicitly referenced a baby or pregnancy
  • 70 contained neither a reference to a baby or pregnancy nor mention of lack of success
  • 1 mentioned a lack of IVF success
  • 10 described that they were still in treatment
  • 3 referenced treatment other than ART
  • 2 were negative reviews
Top 25 fertility doctor reviews mention pregnancy

So these doctors were actually even more likely to have their reviewers mention a baby or pregnancy than their colleagues at large, 66% compared with 60%. What's interesting is that their reviewers were also almost twice as likely to make no mention at all, 28% to 16%. The difference came from those who described still undergoing treatment; 14% for all positive fertility clinic reviews and only 4% for these top 25. Only 1% of these reviews were negative or explicitly referenced a lack of success in treatment. What could be the reason? We know these doctors don't enjoy IVF success rates of 99%. Let's come back to this after we investigate how clinical success rates impact online reputation.

2). Does an REI's rating correspond to his or her practice's success rates?

No. Watch as we take the top 25 ranked reproductive endocrinologists on RateMDs. Then we check them against the top 25 clinics from the 2013 SART reports. Do you have any guesses of how many doctors appeared in both spreadsheets?

Randle Corfman, MD of the Midwest Center for Reproductive Health was the only one. In other words, while success of ART treatment largely predicts how someone will leave a review, success rates do not directly correlate to a physician's online reputation. 

These are the highest rated reproductive endocrinologists on ratemds.com 

These are the highest rated reproductive endocrinologists on ratemds.com 

3). Do practices with higher success rates have higher online ratings?

Not by much. It should be stated that practice ratings can be even more difficult to garner than individual physician ratings. For those in the top 25 in success rates, I used the review site that offered the most ratings per clinic. If there were less than ten responses for a clinic on any one review site, I left their rating blank. In a rating scale of one to five, the ratings of 19 of the top 25 clinics in success rates ranged from 2 to 4.5. The mean rating was 3.7 and the median was 3.5. The median for fertility centers at large lies between 3 and 3.5. 

Top 25 U.S. fertility clinics by 2013 success rates

Top 25 U.S. fertility clinics by 2013 success rates

4). What is the correlation between the gender of the REI and his or her online rating?

The correlation (or lack thereof) of a physician's gender to fertility doctor reviews will be interesting to further explore.

  • Do patients have higher standards of judgement for one gender?
  • Does each gender tend to employ different communication styles that are more or less effective?
  • Do patient biases cause a message to be received differently from one gender than another?

This is what the current data show us:

  • Of the top 50 rated REIs on RateMDs, 22% are women and 78% are men.
  • Of the bottom 50 (of those with a minimum of ten reviews), exactly 50% are men and 50% are women. 
Top 50 rated fertility doctors in US
*Of those with ten reviews or more

*Of those with ten reviews or more

To try to offer some context, Valerie Baker, MD, President of the Society for Reproductive Endocrinology and Infertility (SREI), references a recent REI workforce study published by Fertility and Sterility. 38% of the respondents were female and 61% were male. 

5). What is the correlation between ratings and years in practice?

I often hear people say that new physicians coming out of residency and fellowship are more savvy of their online reputations than are veterans in the field. I don't know that we have a sufficient way of being able to validate or disprove this inference at this time. We would have to know the year that every REI completed her or his fellowship and their ages; data that isn't easy to find. I can only offer some marketing insight.

I see at least three doctors in the top 25 who I know are under age 40. Two of them are the top rated fertility doctors in metro areas of larger than six million people. Newer doctors can leverage a high online rating to negotiate a partnership plan with a recruiting practice because they can build their online reputation and social media loyalty to become the highest rated fertility doctor in their area before they even complete their fellowship. Conversely, recruiting clinics can look at a physician's online rating and social media presence to make more educated personnel decisions. 

Decoding the bigger picture

What lessons are we left with? No clinic and no physician can boast IVF success rates of 99% or anywhere close to it. Yet we count at least a few dozen doctors whose negative reviews are less than 1% of their online reputation. When we look even closer, we see that while success of individual ART treatments influences patient reviews, clinics' success rates don't necessarily predict their online ratings.

This shows us that we are not destined to have a third of our patients report dissatisfaction. As success rates majorly improve across the field, we see that patients still expect more from their care experience than just clinical treatment. Patients who haven't found success through ART may not leave rave reviews or promote their practice on social media and we can appreciate that. Still, if we can deliver to them a better experience than they ever would have had without us, they may not feel as though their only recourse is to express their disappointment online. Analyzing how fertility clinic ratings relate to ART success rates helps us understand exactly to what patients hold their fertility centers accountable.

 

What Are We Doing? An Interview on Forming Social Media Policy with Paul Anderson

By Griffin Jones

This is the eighth interview in a series that explores the implications of patient privacy and the effective use of digital media. This piece centers on the importance of forming a social media policy. Paul Anderson is director of risk management publications at ECRI Institute.

Paul A. Anderson

Paul A. Anderson

Jones: You don’t tell practices that they have to be on social media, but what do they need to consider?

Anderson: Your patients, colleagues, and even your competitors are using social media. You want to know what patients are saying. If it’s positive, you want to thank them and share that. If it’s negative, you want to be aware of what they’ve said. If you’re not participating in social media, you’re missing part of your constituency. If you’re not using it, they’re going to sail right past you. You’re not in the space where people are talking.

There is often worry from physicians about participating in that space where people are talking. What about the risk? What about privacy?

Providers have a lot of misconceptions and fears about HIPAA. And of course, there is cause for concern. You don’t want to identify a patient in any way without their authorization. It is much better to get patients to tell their own stories, because patients can tell their own story to whomever they want. Practices should consult someone who is experienced with HIPAA compliance. I also recommend thoroughly educating someone in the practice on compliance issues, and having that person in charge of advising the social media policy. That person can be the word of caution and help the practice be smart about what they are doing. The first thing an agency will look for when investigating a privacy complaint is to see if there was a policy in place. The second thing they’ll look for is, “did we teach anyone about it?”

Many fertility centers participate in social media, but have yet to put a policy in place. Where do they start?

They first have to identify their goals. “Are we just going to monitor or are we going to engage people? Who’s going to approve content? Who’s going to post? What is our voice? Is it formal and academic? Or informal and casual?” Depending on the size of the practice, an individual or a committee should be placed in charge of initiating and enforcing the policy. Someone needs to be in charge of posting, because if a practice has a social media account, but never posts anything, that doesn’t look very good. I’m in favor of being active by posting and promoting content. You only do that when you have a well-defined reason for doing that and goals to employ.

How should practices respond to negative reviews?

One first has to be aware of the risks. If the review is too hostile to address productively, it’s perfectly reasonable to just leave it alone. If it’s negative commentary, take that conversation offline. There’s a lot of high emotions. You don’t want to inflame the situation.  Your response may be as simple as, “We hear your concern. We value your feedback. We’d like to talk to you. Here’s our phone number.” You can get a sense pretty quickly if the situation is resolvable. If it’s not, you have to disengage and try to balance that with positive reviews.

How about responding to positive reviews?

It’s never bad to say thank you, or when someone’s said “thank you” to say “you’re welcome.” Keep it simple. You don’t want to say too much but you’ve got to engage. Social media is a marketing tool that isn’t one-way.

Who is a healthcare provider with an exemplary social media policy?

The folks at the Mayo Clinic really have one of the best social media presences in all of healthcare. They have a center for social media and educational boot camps and social media trainings for employees. They’re very active on social, you can follow them almost everywhere. Their policy and their practices in place are really great resources.

But how does a small fertility practice implement a good social media policy?

Whoever’s going to spearhead this initiative better know how to use social media. Familiarity with the platforms and their nuances is necessary in order to be able to use them to effectively communicate. Define why you are going to use social media, first. If you can articulate that clearly, that will drive the rest of your conversation.

Paul Anderson is the director of risk management publications at ECRI Institute, an independent, non-profit, research institute that works with all sizes of healthcare providers from single practitioners to large research hospitals. They help practices with risk, quality, and patient safety management. You can learn more about ECRI Institute and their services here


Avoid Common HIPAA Violations: An Interview with George Indest

By Griffin Jones

This is the seventh interview in a series that explores the crossroads of the Health Insurance Portability and Accountability Act (HIPAA) and digital media.

George Indest

George Indest

George Indest practices healthcare law in Florida and across the country. Mr. Indest’s comments don’t provide legal advice, but they do offer us some insight on how the Health Insurance Portability and Accountability Act (HIPAA) impacts digital media for fertility centers. I asked Mr. Indest about some of the more common mistakes that practices have made to lead to a HIPAA breach.

Indest: Very often, breaches are inadvertent disclosures of protected health information (PHI) to people who didn’t have authorization to view it. Unauthorized disclosures may even include the patient’s immediate family members. Unless the patient has signed a HIPAA authorization for their family members to be able to view their information, the provider cannot release those records. There are several inadvertent mistakes that lead to HIPAA breaches, often including unintended recipients of patient information. This can include sending or forwarding an e-mail to the wrong person, replying to all instead of to an individual, or sending a fax to a recipient whose number is only one digit different from the intended recipient.

What happens when a patient releases their own information on a blog, place page, or social media channel operated by the practice?

The patient is free to release whatever information they want. That in no way effects the practice or the covered entity. I know of no legal obligation to take down patient posts. If the channels are open to the public, it’s the patient’s right and decision to disclose that information. That’s not covered by HIPAA. But, if the channels are open to the public, the covered entity needs to make warnings available that the practice does not have control over who can see that information.

What are the implications when the practice responds to the patient? Does a general response disclose a patient-physician relationship?

I don’t think there’s any sort of violation at all in a response that doesn’t contain PHI. Social interactions take place between patients and physicians all the time. There’s no breach of anyone’s confidentiality unless medical information is discussed. With that said, I have read of breaches wherein a practice responded to a patient’s Better Business Bureau (BBB) complaint and disclosed some of their records to refute the complaint. This is an unauthorized disclosure of PHI and a clear HIPAA violation. The patient is free to release whatever information they want, but that doesn’t authorize the practice to do the same. Even if it is a positive review, where the practice wants to share or retweet information that the patient has already made public, it would be on the safe side to get HIPAA authorization.

What should healthcare providers be doing right now to ensure HIPAA compliance?

The Office of Civil Rights (OCR) and the Department of Health and Human Services (HHS) have indicated more HIPAA audits and investigations. There are more law suits and more complaints of breaches than ever before. Personnel need constant training. They need constant reminders of HIPAA risks. Go overboard in your risk assessment and risk management. There are plenty of plaintiff attorneys looking for suits and there are plenty of things that shouldn’t be occurring. Personnel not directly involved in a patient’s care should not be viewing that patient’s records, and it’s a risk that happens far too often. Education and training need to be provided on an ongoing basis.

George Indest is the principal of the Health Law Firm in Altamonte Springs, Florida. The Health Law Firm, concentrates in representing health care providers, exclusively. Their attorneys include those Board Certified in Health Law. If you would like to learn more from George’s legal expertise, you can contact him here.

Preparing for HIPAA Compliance Audits: An Interview with Valerie Breslin Montague

By Griffin Jones

This is the sixth interview in a series exploring the implications of the Health Insurance Portability and Accountability Act (HIPAA) as it relates to digital media.

Valerie Breslin Montague

Valerie Breslin Montague

Valerie Breslin Montague is an attorney who specializes in HIPAA in Chicago, IL. Ms. Montague’s comments do not contain legal advice, but they do educate us about some of the risks that face fertility centers with respect to HIPAA and social media. I started the interview with a topic that we are all very interested in--what are the implications when patients include their own information on a practice’s website, blog, place page, or social media channel?

Montague: Generally, under federal and state privacy laws, when a patient is forthcoming with their own information, that’s not a disclosure by the practice. Anything posted by the patient would be their disclosure. With that said, it would be wise for practices to include that publicly in their social media policy. Patients should know that social media channels and review sites are public places, and anything posted on the internet should be considered permanent. The practice should inform the public that they do not have control over who can see that information, once posted. When responding to patient comments, it would be wise to do so in a general manner (such as “thank you” or “we appreciate that”). I wouldn’t confirm the patient’s visit, or add any new information.

Is there a danger of disclosing the physician-patient relationship even if it’s a basic acknowledgement of the comment?

I don’t think there’s any guidance here, but I don’t believe that’s something that would be enforced as a HIPAA violation. I think the government would have a hard time arguing that was a breach of PHI. If the government wanted to be very overreaching, I suppose they could, but I don’t see a very big risk there. The practice wouldn’t want to do anything to amplify or further share the patient’s message, such as adding a hash tag, tagging another person, or retweeting or sharing the post, without a proper HIPAA authorization.  The practice can directly message or e-mail the commenter, to ask them to complete a HIPAA authorization. Then they can share the posted content for purposes agreed upon in the authorization.

Why don’t the department of Health and Human Services (HHS) and the Office of Civil Rights (OCR) issue guidelines on practice engagement on digital media?

Hopefully OCR will in the near future but its focus now is on enforcement and audits.

Tell us about the pending round of HIPAA compliance audits.

OCR has been warning of a second round of audits for more than a year. The first round of HIPAA compliance audits took place in 2012. This time, the audit will include both covered entities (healthcare providers and health insurers) and their “business associates” (EHR providers, billing companies, etc.) The agency has said they will audit a large scope of entities from large health systems to small practices.

What are common vulnerabilities that might be exposed for healthcare providers during these audits?

 It’s very common to have HIPAA policies in place for privacy obligations. Providers have been doing a pretty good job of keeping up in that respect. Some smaller or newer business associates may need more help. Where I’m concerned that many people may fail to meet compliance is their requirement to do a security risk assessment. They need to check the security of everything that impacts PHI. Once strengths and weaknesses have been analyzed, a risk management plan has to be implemented.

Not having a “business associate” contract in place is also a risk for both the healthcare provider and the business associate. The arrangement, not the agreement, determines if the relationship exists, and both parties are culpable if a signed contract is not in place.

What should healthcare providers be doing right now to ensure HIPAA compliance?

Providers should be prepared for risks before any incidents might occur. It is much easier to correct security weaknesses before an audit or investigation, and much more difficult to do so in the midst of one. Our firm (Nixon Peabody) works with providers and their vendors to review HIPAA compliance programs and implement any necessary updates before issues arise. OCR will definitely investigate any mass breach that involves over five hundred people and they may investigate smaller breaches and complaints, especially if it is a high profile case.

 It’s important to be proactive to determine where your practice stands, relative to compliance, before a complaint or breach requires it.

Valerie Breslin Montague focuses her practice on regulatory compliance, nonprofit governance and tax exemption, and HIPAA/health information privacy and security. She is a partner at the firm, Nixon Peabody, in Chicago. If you would like to learn more about HIPAA compliance and risk management, you can contact her here.


A Look Into Practice-Wide HIPAA Education with Ashley Trotto

By Griffin Jones

This is the fifth interview in a series exploring the implications of the Health Insurance Portability and Accountability Act (HIPAA) as it relates to digital media.

Ashley N. Trotto

Ashley N. Trotto

Ms. Ashley Trotto practices health care law in Knoxville, Tennessee. Ms. Trotto’s comments do not contain legal advice, but they do educate us about some of the risks that face fertility centers with respect to HIPAA and social media. The reason I’ve reached out to Ms. Trotto and other experts in healthcare law is because there is surprisingly little guidance online about HIPAA and social media. Much of the information available is vague or may even be incorrect. I asked Ms. Trotto why there is so little information on the subject.

Trotto: The information that is online is often gray, which is understandable because the Department of Health and Human Services (HHS) and the Office of Civil Rights (OCR) have not issued guidelines regarding social media and HIPAA. But it’s coming. We don’t know when, but the agencies will have to issue guidelines eventually.

The greatest unknown for healthcare providers in social media may be when a patient posts their own information. I think we all know to never post protected health information (PHI) on our websites or social media without express written consent.

You would think it’s common knowledge not to post patient information without authorization, but apparently it’s not as common as we might think. If you read some of the briefs of these breaches, most of them are inadvertent. There are 18 different identifiers that are addressed in HIPAA’s privacy rule. A staff member may believe that they are not publishing patient information, but many factors can be used to identify a patient. There have been breaches where the practice or staff members have shared information without the patient’s explicit consent. While any consent would be better than none, HHS has specific regulations regarding what is needed for a HIPAA authorization.

For this reason, I recommend against publishing any patient information whatsoever unless accompanied by a HIPAA authorization for the explicit use of marketing and social media. What happens when patients post their own information to a fertility practice’s blog, place page, or social media channel?

Physicians can’t stop patients from posting their own information. A big concern would be if patients posted content that included information about other patients. The practice would want to take that down, but a patient is free to talk about their own information wherever they like.

Is acknowledging a patient comment or review with a simple “Thank you”, or “We take your concern very seriously, please call us at…” disclosure of the patient-physician relationship?

 Generally, no. I wouldn’t be concerned about responding where the patient has already disclosed that information. However, that the doctor or practice must be very careful not to offer medical advice or include any additional information that the patient did not.

What should healthcare providers be doing right now to ensure HIPAA compliance?

The greatest action a practice can take to prevent a breach of HIPAA is to implement team-wide education. We need everyone in the practice to know what HIPAA is, what PHI is, and what a breach is. Practice-wide education is key, and policy drafting is second. Practices need to have a privacy officer who is in charge of HIPAA compliance so it may make sense to bring in outside firms who can help explain the complex law and implement training procedures.

Generally, I think the biggest thing is just being aware. The smallest mistake could be a breach. There is a recent example of a HIPAA breach where a medical practice used an online scheduling calendar in which users could see the names of other people who had scheduled appointments, and their appointment times. The breach wasn’t intentional, but the calendar was not secure, and the practice was found in violation.

To name just one HIPAA risk to look out for would be extremely difficult. But to name one thing that you can do to protect your practice—that would absolutely be education and training for the entire team.

Ashley Trotto focuses her practice on Affordable Care Act (ACA) compliance. She practices with the firm, Kennerly Montgomery, in Knoxville, Tennessee. If you would like to learn more from Ashley’s expertise, you can contact her here.

Start With The Law: An Interview on HIPAA and Social Media with Paul Hales

Paul Hales

Paul Hales

This is the fourth interview in a series exploring the implications of the Health Insurance Portability and Accountability Act (HIPAA) as it relates to digital media.

Paul Hales is an attorney from St. Louis, who specializes entirely in HIPAA law. Mr. Hales’ comments do not contain legal advice, but they do educate us about some of the risks that face fertility centers with respect to HIPAA and social media. Mr. Hales gives us some background on the Act.

Hales: We have to start with the law. My focus is on enabling practitioners to make use of social media and comply with the law. HIPAA was passed in 1996 with two objectives;

  1. To be able to keep insurance when switching from one provider to another.
  2. To have a uniform code for information and payment

It has had further additions since.

  • The privacy regulations were added in 2003. 
  • The HIPAA security rule was added in 2005 
  • HITECH was passed in 2009. 
  • In 2013, the Omnibus rule was added to HIPAA to extend liability to “business associates”.

What is a business associate?

A “business associate” is a person or entity that performs certain functions or activities that involve the use or disclosure of protected health information on behalf of, or provides services to, a covered entity.

What are common areas in which covered entities and businesses associates fail to meet HIPAA compliance?

  • Protected Health Information (PHI) is made up of 18 identifiers, including but not limited to name, e-mail address, full face photos, and date of birth. 
  • Under HIPAA, every health care practice or organization must designate a privacy officer. The privacy officer must perform a risk-analysis.
  • Health plans and covered health care providers are required to develop and distribute a notice that provides a clear explanation of privacy rights and practices with respect to patients’ personal health information.

What about when a patient posts their own information on a blog, social media channel, or place page operated by the practice?

It’s important to look at how HIPAA defines a website, which is any site that provides information about a covered entity’s services or benefits. Therefore, if a patient posts their own information to a site that’s owned by the practice, that is unauthorized PHI on the practice’s site. The practice has to obtain HIPAA authorization before allowing any patient content to be published to its sites.

What is necessary in a HIPAA authorization?

HIPAA Authorizations have six core elements:

  1.  A specific and meaningful description of the information to be used or disclosed.
  2. The name or other specific identification of the person(s), or class of persons, authorized to make the requested use or disclosure.
  3. The name or other specific identification of the persons(s), or class of persons, to whom the covered entity may make the requested use or disclosure (i.e., the intended recipients).
  4. Description of each purpose of the requested use or disclosure. 
  5. Must contain an expiration date or an expiration event.
  6. The signature of the individual and the date.

 

A HIPAA authorization must also include three statements.

  1. Individual’s right to revoke the Authorization.
  2. Clarification that the covered entity is not permitted to condition the provision of treatment on the execution of a valid Authorization. 
  3. Explanation that there is a potential that the information may be re-disclosed by the recipient of the information and that the recipient may not be required to comply with the Privacy Rule.

What should fertility practices be conscious of right now to minimize risk of HIPAA violations?

Recently, there has been more enforcement, and soon there will be audits. On February 16, 2016 the Office of Civil Rights (OCR) settled an enforcement action against Complete P.T., Pool & Land Physical Therapy, Inc. for impermissibly disclosing patient information in the form of testimonials on their website. HIPAA is a very extensive law. There is a lot of information on the internet that is simply wrong. HIPAA regulations are very demanding and products cannot ensure compliance. No product can be HIPAA compliant. It’s how a covered entity uses a product that makes it compliant or not.

Paul Hales is an attorney who provides legal services and consultation regarding HIPAA compliance. His software, the HIPAA e-tool helps covered entities and business associates with a complete HIPAA compliance solution. If you’re interested in an educational webinar with Mr. Hales, you can register here.

Legal Considerations When Responding to Online Patient Reviews: An Interview with Eric Goldman

Eric Goldman

Eric Goldman

This is the third interview in a series which explores digital media and the law, including questions about HIPAA and online engagement.  Eric Goldman is a professor at Santa Clara University School of Law. While Mr. Goldman's answers don't provide us with legal advice, they do give us some insight into how fertility practices might consider the law when responding to patient reviews online.

Jones: Should physicians respond to reviews written about them online? Why or why not?

Goldman: In most circumstances, physicians either should not respond to online reviews or respond generically by thanking the reviewer and indicating that the physician appreciates and carefully considers online feedback. It rarely makes sense to get into substantive discussions with reviewers online. Not only could such discussions implicate HIPAA, but physicians often look thin-skinned and petty when they attempt to debate fact matters online. Furthermore, increasing the number of comments to a review may actually cause search engines to rank the content higher (a counterproductive result if the review is negative). If the physician chooses to engage a negative review about the facts (which is rarely if ever advisable), the response should discuss the office’s general practices and not discuss how those practices were applied in the reviewer’s specific situation.

J: What information should physicians never include in their responses to reviews?

G: Given the boundaries of HIPAA, there are few circumstances where a physician can discuss any individual facts about the reviewer. Indeed, it is potentially problematic to even acknowledge that the reviewer is a patient.

J: Are there different implications for responding to patients when their identities are public (ex. Facebook) vs. when they are anonymous (ex. RateMDs)?

G: I couldn’t think of any.

J: Are responses to reviews considered protected health information (PHI) if the patient posted the information?

G: It’s a risky practice for physicians to confirm information that a patient or family member voluntarily publicly disclosed.

J: What should physicians and practices always be wary of regarding online reviews and their public reputation?

G:

  1. Prospective patients are increasingly looking at other patients’ reviews when selecting physicians. I know many physicians wish this weren’t true, but there’s no point pining for an alternative universe.
  2. Prospective patients are savvy enough to discount outlier reviews. If one negative review is surrounded by multiple positive reviews, it will have minimal effect on the physician’s reputation.
  3. Patients’ reviews of their physicians are overwhelmingly positive, i.e., in some cases 90%+ of patients’ reviews are positive.
  4. If a physician deals with dozens or hundreds of patients, inevitably there will be a few unhappy patients who will vent online.For these reasons, physicians should be actively encouraging their patients to review them online. This will better inform future prospective patients, and it usually will help create a base of positive reviews that will insulate the physician from the occasional negative reviews that inevitably will come.

G: A final thought: getting negative feedback never feels good, but it can provide a candid insight into the patient’s experiences. If the physician can overcome the emotional sting of a negative review, there may be valuable customer feedback that can help physicians do a better job meeting their patients’ needs.

If you would like to read a short essay by Mr. Goldman which explores how doctors and other healthcare professionals have responded to patient reviews of their services and addresses how they should deal with patient reviews in the future, you can find it here.