Laura Markowski is in charge of Carilion Clinic’s social media and reputation management. (Stephanie Klein-Davis for The Washington Pos)

Laura Markowski used to worry every time a text alerted her that a patient had posted a negative review online of a doctor at her health-care system.

She’s in charge of “reputation management” at a group of hospitals and clinics in Virginia, and it’s her job to monitor complaints about rudeness, long waits, lack of face time with a doctor or something more serious.

But after several months of reviewing comments in real time on nearly a dozen Web sites, including, and Google Plus, as well as Facebook and Twitter, she’s calmer.

Most reviews have been “one-offs for different physicians,” she said, not focused on just one doctor or group practice that would raise a red flag.

Markowski is part of a new and urgent effort by hospitals and health systems to track and control their online reputations. As out-of-pocket costs for health care have risen, people are increasingly shopping for their medical care and comparing reviews. And younger consumers who have grown up on Yelp and Rate My Professors expect the same seamless, digital experience with health care that they have used in other aspects of their lives.

At a recent meeting of the American Hospital Association in Washington, D.C., Nancy Agee, the chief executive of the Carilion Clinic health system in Virginia, showed this commercial to poke fun at the way health-care has long ignored the patient experience. (Cox Business)

Patient satisfaction, long ignored by the health-care industry, is a strategic priority for another simple reason: It’s playing a more important role in determining how the federal government pays hospitals. In the last three years the government has been taking into account patient satisfaction data when determining how much to reimburse hospitals for Medicare patients.

But putting hospitals and doctors into the online rating world is fraught with possible problems. For one, patients and doctors have widely differing expectations.

When patients are asked to rate how doctor quality should be measured, clinical outcomes, such as getting cured of a disease, rarely come up, said Lisa Suennen, who advises health-care companies. Patients talk about whether a doctor or nurse was kind to them, or whether their experience was fast and convenient. It’s assumed that the doctor is going to treat their illness or condition.

Physicians, on the other hand, go straight to the clinical. The cancer is gone. Or the person can walk again. “They don’t even talk about the other stuff,” Suennen said. The two groups “are really disconnected.”

Physicians are not eager to be rated like restaurants. It’s hard for them to wrap their minds around the process, because taking care of patients is exceptionally complex, said Adrienne Boissy, the chief experience officer at the Cleveland Clinic.

“We don’t have consumers, we have patients,” she said. “Health care isn’t necessarily like shopping at Target.”

And some experts fear that the focus is more on burnishing the online reputations of doctors and hospitals than improving delivery of care.

When one of the doctors at Carilion Clinic receives a rating of 3 or below (out of 5) on one of several online rating sites, this text message shows up on Laura J. Markowski’s phone. (Courtesy of Laura J. Markowski)

“My wish is that less effort would go to trying to look good and more effort in actually being better,” said Bob Kocher, a former health-care adviser to President Obama who is now an investor in health-care IT.

Information in real time

At the Roanoke, Va.-based Carilion Clinic system where Markowski works, new technology has allowed her to see real-time information about more than 500 doctors since March.

On average, Markowski gets about two negative reviews a day. (A score of 3 or lower, out of 5). Some days there are none. A few weeks ago, she received seven negative reviews, all for doctors who hadn’t been rated before. One scored 1.9 out of 5 because the patient waited more than 45 minutes and had only a few minutes with the doctor. Another review complained about a rude receptionist. Most negative ratings have to do with wait times and scheduling.

How Carilion will share that information is still being decided. But doctors will be aware that the system is monitoring the ratings sites. “If a trend is established, it will be addressed,” she said.

Another option: Carilion may use the technology to survey patients and then push positive comments back out to the ratings sites. That way, an Internet search may display the newest positive comments ahead of older negative reviews.  

“Right now when we get positive feedback, we just send it to the physician or practice,” Markowski said. “We don’t share it with everybody else, and that seems like a missed opportunity.”

Binary Fountain, the McLean, Va., company that provides the software to Carilion, analyzes online consumer feedback and divides it into 37 categories, including office staff and bedside manner. “If someone writes that ‘Dr. Smith seems very smart but he only spent 3 minutes with me,’ ” the doctor scores a 5 for competency but maybe 3 on beside manner, said Ramu Potarazu, the firm’s chief executive.

Even the Cleveland Clinic, one of the country’s most prominent medical centers, felt the digital pressure. It rolled out its own doctor rating site in April for more than 1,550 doctors. Responses are drawn from a patient satisfaction survey required by Medicare, which many hospitals use internally to target areas for improvement.

Unlike some sites that rely on one or two reviews, Cleveland Clinic displays only ratings for doctors who have been reviewed by at least 30 patients. Ratings — one to five stars — are updated weekly and include negative as well as positive comments.

Doctors such Eric Klein, 59, a urologist, had misgivings at first. “Occasionally, patients have sometimes unrealistic expectations about the medical outcome,” he said. But instead of a flood of negative comments and scores, doctors have had “overwhelmingly positive” ratings, he said.

Other health systems that now have their own ratings site include the University of Utah, Piedmont Healthcare in Atlanta and Integris health in Oklahoma. At the University of Utah, which operates four hospitals, officials have cut wait times and significantly boosted patient satisfaction scores.

Some companies are trying to help doctors improve ratings by keeping them better connected to their patients. HealthLoop, a Mountain View, Ca.-based company, offers doctors daily follow-up with patients through “virtual visits.” Patients are e-mailed set questions, advice and reminders tailored to their illness or condition — a knee surgery patient will be asked about new swelling and shown photos of how to keep the leg elevated — and can e-mail questions and photos back to the doctor’s office. This allows doctors to zero in on the people who need immediate attention.

The result makes for happier patients, said Todd Johnson, HealthLoop CEO. When HealthLoop asks them to post their positive experiences to doctor rating sites, they willingly do so.

“It becomes an amazing marketing engine,” he said. One large West Coast hospital recently raised its patient satisfaction scores by 11 percent after signing up with HealthLoop, he said.

Focus on social media

Markowski, 31, used to juggle several duties at Carilion, but it was a struggle to keep up. Now social media is her sole focus from the moment she wakes up to right before bedtime.

Much of her time goes to answering online questions from people such as Laura Thomas, an ophthalmic assistant who needed help finding an obstetrician last fall. Thomas heard positive comments about a doctor from a friend but hadn’t found online reviews. She posted a question on Carilion’s Facebook page, Carilion responded with a telephone number, and Thomas called it to follow up.

Thomas, 24, who lives south of Roanoke with her husband and young son, also found her primary care doctor by scouring online sites. She has been happy with that doctor and with Carilion. One time, the doctor had called in a prescription before Thomas arrived for her appointment. And it was the doctor, not the nurse, who responded.

Online reviews are second nature for Thomas’s generation. People who may be reluctant to share feedback face-to-face may find it easier now to do so anonymously, with one swipe through an app on their phone.

“A lot of times people don’t know what avenue to take to express their feelings about their treatment,” she said. “Nowadays you just go online and hit 5 stars or whatever as you’re walking out the door. You just pull it up on your phone. It’s so instantaneous.”