Factors Influencing Patients’ Perspectives of Radiology Imaging Centers: Evaluation Using an Online Social Media Ratings Website

Abstract

Purpose

The goal of this study was to use patient reviews posted on Yelp.com, an online ratings website, to identify factors most commonly associated with positive versus negative patient perceptions of radiology imaging centers across the United States.

Methods

A total of 126 outpatient radiology centers from the 46 largest US cities were identified using Yelp.com; 1,009 patient reviews comprising 2,582 individual comments were evaluated. Comments were coded as pertaining to either the radiologist or other service items, and as expressing either a positive or negative opinion. Distribution of comments was compared with center ratings using Fisher’s exact test.

Results

Overall, 14% of comments were radiologist related; 86% pertained to other aspects of service quality. Radiologist-related negative comments more frequent in low-performing centers (mean rating ≤2 on 1-5 scale) than high-performing centers (rating ≥4) pertained to imaging equipment (25% versus 7%), report content (25% versus 2%), and radiologist professionalism (25% versus 2%) (P < .010). Other service-related negative comments more frequent in low-performing centers pertained to receptionist professionalism (70% versus 21%), billing (65% versus 10%), wait times (60% versus 26%), technologist professionalism (55% versus 12%), scheduling (50% versus 17%), and physical office conditions (50% versus 5%) (P < .020). Positive comments more frequent in high-performing centers included technologist professionalism (98% versus 55%), receptionist professionalism (79% versus 50%), wait times (72% versus 40%), and physical office conditions (64% versus 25%) (P < .020).

Conclusions

Patients’ perception of radiology imaging centers is largely shaped by aspects of service quality. Schedulers, receptionists, technologists, and billers heavily influence patient satisfaction in radiology. Thus, radiologists must promote a service-oriented culture throughout their practice.

Introduction

Patient satisfaction has become an increasingly applied quality metric for evaluation of physicians and the health care delivery process. For instance, several major health insurance plans, including Medicare, now tie reimbursement to patient satisfaction scores [1]. In CMS's performance-based payment initiative, scores from the Hospital Value-Based Purchasing Program, which includes patient satisfaction, are used to determine whether hospitals receive payment incentives or reductions [2]. In addition, the American Board of Internal Medicine recently proposed to use patient satisfaction surveys as a component for maintenance of certification [1].

Patient satisfaction scores are also included as a performance measure in the US government’s Hospital Compare initiative, which provides publicly available hospital quality information to guide patients’ decisions [3]. Moreover, major ratings websites, such as HealthGrades.com, RateMDs.com, and Vitals.com, use online patient satisfaction reviews as the basis for deriving a physician score [4]. Given such an increasing focus on the patient experience, identification of factors most strongly associated with patient satisfaction is of paramount importance for physicians and practices. Furthermore, as a greater fraction of health care costs are passed on to patients in the form of increasing copayments and deductibles 5, 6, patients will increasingly expect a high level of service from their health care providers.

In radiology, the patient experience is shaped by many factors, including conditions of the physical facility and imaging equipment, as well as actions by schedulers, receptionists, technologists, radiologists, and billers [7]. Many of these components of the patient experience in radiology are service-related factors, which are frequently the main determinants of satisfaction [7]. Although patients often do not choose their radiologist, they do often choose their imaging center, emphasizing the need to strive for high-quality service at the practice level, beyond the provision of high-quality image acquisition and interpretation. Maintaining a favorable public perception of radiology as a specialty requires an overall positive patient experience during imaging encounters.

Patient experience and satisfaction have been measured through surveys conducted by public and private organizations, including Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and Press Ganey. Although these surveys may provide reliable information about the patient experience for individual practices, the ability to gain broad insight into the most important factors shaping the patient experience at the overall specialty level is relatively limited through such traditional approaches. However, this gap is being addressed through the emergence of a new arena for collecting and disseminating information regarding public opinion in health care: social media.

Social media is transforming the way patients make informed health care decisions. Patients are increasingly turning to social media platforms to learn about disease processes, discuss treatment options, and choose their health care providers 8, 9. Social networking sites, such as Facebook, Yelp, and Twitter, allow patients to publically share their experiences with the health care system. These sites have a large user base and are in the public spotlight. In comparison, many patients may be unaware of traditional surveys, such as HCAHPS. Furthermore, standard national performance may not capture elements of patient-centric care that are relevant to radiology practices. Social media provides a platform for patients to share their unsolicited opinions in free-text form, thereby creating an opportunity to gain valuable insights into those factors that are perceived as most important by patients.

Yelp is an online consumer-review website founded in 2004 and has an average of 142 million unique monthly visitors and more than 77 million reviews as of June 2015 [10]. Registered users may contribute reviews that consist of a one- to five-star rating, as well as free-text narrative comments. Visitors to the Yelp website may access reviews for practices through searches by service category and location. The large volume of accumulated online reviews on Yelp provides a potential source of insight into the most important factors on a national level that affect patients’ experiences when undergoing radiology services. Therefore, the purpose of this study was to use patient reviews posted on Yelp to identify factors that are most commonly associated with positive or negative patient perceptions of radiology imaging centers across the United States.