By Brian Chou, OD, 
FAAO
Jan. 20, 2016
Online ratings and reviews tend to evoke strong emotions from practitioners, good and bad. Like it or not, Yelp and Google increasingly determine if prospective patients choose your business.
Maybe it’s time healthcare providers start rating patients.
While consumers are largely free to say what they want about you online, patient privacy laws prohibit doctors from publicly discussing a patient’s protected health information. However, doctors can still rate their patients for internal use and apply this information for their practice’s well-being.
During my fellowship training in Los Angeles in 2000, I had my share of high-profile patients: Hollywood actors, pop stars, pro athletes and coaches, and wealthy philanthropists. Their files, which were on paper at the time, had star stickers over their folders. The more stars, the more important the patient. These patients got preferential treatment with extra doctor time, greater staff attention and shorter waits.
I objected to this star system because right out of optometry school, I felt that all patients should get superb treatment regardless of their stature in society. In retrospect, I was idealistic. With real-life experience, it’s obvious that there are politics to play. In the academic setting, a philanthropist supporting research programs and the department’s financial needs rightfully earns the gratitude of the clinic’s constituents. Wealthy and famous patients can disproportionately support the business of the clinic by spending big and lending their public endorsement.
Just like in the airline industry where there’s first class and coach, stratification of the client base rewards the elite clients by internally identifying them to receive an elevated level of service and comfort. The concept is simple – spend more, get more. Additionally, patients with the potential to spend more or promote the practice also get more.
On the other end, I’ve heard anecdotes from other clinics where disagreeable and rude patients get flagged in the exam records by shorthand such as “VIP” (very irritating patient) or “PITA” (pain in the ass). I personally do not use, nor recommend, this sort of documentation since it can backfire with the release of medical records and forced disclosure to explain the shorthand, for example, during a deposition. Furthermore, to be clear, I do not suggest withholding appropriate care or reflecting rudeness back toward irritating patients.
In today’s digital world, star stickers and written acronyms seem sophomoric. You’d believe that electronic medical records and practice management software would offer sophisticated intelligence to help staff identify patients with desirable characteristics so that they are appropriately attended. For example, there could be a simple metric, like a credit score, which accounts for multiple factors including: longevity in the practice, frequency of coming in without no-shows or last-minute cancellations or rescheduling, the amount of out-of-pocket expenditures, the proportion of eyeglass and contact lens prescriptions filled in your practice, and those who are friendly, pleasant and low-maintenance.
Analogous to tending a garden, flowers (i.e. highly-rated patients) should get plenty of water with extra fertilizer and sunshine (i.e. extra attention and care). However, the weeds (i.e. low-rated patients) should just get adequate water and sunshine (i.e. standard care). In select cases, it may even be appropriate to pull out the nastiest weeds from your garden (i.e. discharge the lowest-rated patients from your practice).
Interestingly, I have not yet found software in our industry that comes close to getting patient ratings right. Wouldn’t it be nice if your staff could at the time of scheduling automatically identify a patient with a history of repeated no-shows and last-minute cancellations, so that they don’t offer them a prime Saturday appointment? As another example, your optician would have an easier job if the practice’s electronic system discreetly indicated if the patient tends to fill prescriptions in your office, and the type of spender they are (e.g. frugal or lavish). This can guide the best approach to capture the prescription and also present eyewear with the knowledge of the patient’s spending habits.
As a final example, wouldn’t it be nice if your new employee could pull up the information for Mrs. Smith and immediately recognize her unique stature in the practice because she’s referred in 12 other patients and buys expensive eyeglasses? That way, the new employee would accommodate Mrs. Smith, and hopefully go the extra mile to provide an exceptional experience.
To be sure, there are electronic systems that attempt to rate patients based on scheduling, purchase history and other factors. Yet the information I’ve seen isn’t always presented in the right time and place, in an intuitive manner. One of the major electronic medical records I used cataloged a patient’s scheduling history, but it did not distinguish between an appointment cancellation that was initiated by the patient or staff. For that reason, if the staff cancelled the appointment since the doctor was sick, the electronic system would make it appear as if the cancellation was the patient’s fault. It seems to me that many of the electronic medical record and practice management software companies still do not proactively solicit the business needs of successful private practitioners.
Practitioners can only hope that developers for our industry software will incorporate intuitive and relevant metrics to objectively rate patients based on a patient’s history in the practice, and to display this information in an intelligent and easily accessed user interface. Doing so will serve the interests of our patients by customizing their care, but compellingly help our practices, too.
Do you think there should be a way to rate patients? Would doing so benefit both patients and practice? Do you currently have an internal system for rating patients?
Brian Chou, OD, FAAO, is a partner with EyeLux Optometry in San Diego, Calif. To contact him: chou@refractivesource.com.
