Healthcare has not traditionally been a consumer-based market. The view of healthcare as a product to be consumed is a uniquely American twist, and it presents an interesting challenge-- especially when it comes to our rapidly graying population.

With consumer-friendly reform proceeding apace, there will invariably be a bigger push to find a new way of defining “value” in healthcare

The problem of defining “value.”

Now that people and employers who purchase services are being forced to share more healthcare costs, they need a system that will help them to determine what are, or are not, smart buys. Moreover, they want assurances that consumerism will not lead to poor outcomes.

Sites like Healthgrades and RateMDs allow healthcare consumers to anonymously post ratings of their physicians, but like any ratings system that is reliant upon voluntary participation, they are subject to high degrees of bias.

The respondents on these sites tend to be patients who hold strong opinions — good or bad — about their service. As any statistician worth their salt would tell you, that makes the ratings information contained therein next to worthless, at least from the standpoint of developing a truthful picture. And consumers and employers who are being impacted by increased cost shifting can get pretty persnickety now that so much more of their money is at stake.

A recent survey of 1,054 Iowa employers, for example, found that providers in that state earned an average “C” grade, with especially low marks given for “keeping costs reasonable” and “cost transparency. ” In fact, the employers surveyed gave no “A” grades at all to Iowa providers.

 As lead researcher David P. Lind told the Des Moines Register, employers are increasingly asking, “we’re paying beyond world-class prices, and what are we really getting in return?”

Now, providers are fighting back.

As reported by Kaiser Health, doctors at University of Utah Healthcare became alarmed by highly negative, subjective and anonymous reviews they were seeing from some of their patients online. They knew that couldn't be the full story and could scarce afford to let these negative reactions be define their character.

Lacking recourse or redress on commercial ratings sites, U of U began to publish the results of their random follow-up patient satisfaction surveys on its website.

Quoted in Kaiser’s article, U of U Healthcare’s senior director for interactive marketing and web Brian Gresh said, “We knew our patient satisfaction scores were really strong and we had a good story to share with our patients.”

Responsible self-reporting... or marketing ploy?

But critics of the system’s publishing of internal survey results note that the hospitals self-reporting can be subject to a high degree of bias, too— under U of U’s 5-star rating system, no provider listed earned less than a 4. Are we really to believe that there are no mediocre — or even poor — providers in the entire U of U system?

Now, other systems— including Integris Health in Oklahoma, and even Ohio’s vaunted Cleveland Clinic— are in the late stages of rolling out similar ratings publications. These systems also pay online engines like Google and Yahoo to ensure that their internal ratings sites come up first in search results. The incentive for them to do so is powerful.

They naturally want to respond to, and minimize the damage from, strongly-worded, anonymous, or even crackpot reviews that appear on open-access, voluntary reporting sites.

The question is this: where does responsible transparency end and marketing gamesmanship begin? For seniors who are seeking healthcare providers, the results can be contradictory, frustrating and potentially misleading. A person might be turned off to seeking care from an excellent provider by one online troll review, or steered to a mediocre or poor provider by a hospital system seeking to shore up its patient base.

Moreover, even hospital-based surveys are based only on the patient’s emotional reaction to a care encounter; they do little to evaluate a practitioner’s clinical knowledge or competence.

A reliable system may be a long time in developing. But there are proposals floating about.

One potential solution might be to require hospitals and ratings aggregators to publish information on outcomes, as gathered from providers by the states’ Centers for Medicare and Medicaid Services (CMS).

This information is already published on Medicare’s website, but it is not presented in a provider-specific format. It may be, though, that this is needed to provide a complete picture of each provider’s competency and to develop reliable doctor ratings.

Given consumerization’s potential impact on healthcare outcomes, our future care may depend on it.