Should Google Reviews Guide Us to Healthcare?

Let’s be honest: a lot of us use Google Reviews to find healthcare providers. But getting healthcare is different from finding the best restaurant in your area.

We carefully research our $50 dinner reservations but are forced to make blind decisions about medical care that could cost thousands.

Not only do we not know the prices, but we also don’t know the metrics of the outcomes of care.

It doesn’t have to be this way.

Part of the solution is to use unused data to make it easier to find providers. Another part is a CMS pilot program to create a nationwide provider directory.

Google Reviews as a Directory

First, we need to acknowledge Google Reviews limitations:

• Reviews tend to capture extreme experiences—either very satisfied or very dissatisfied patients

• Specialty care and rare conditions are underrepresented

• Some providers have very few reviews, making it hard to draw conclusions

• Review bombing or fake reviews can skew ratings

• Complex medical situations might lead to negative reviews even when care was appropriate

• Lack of knowledge about whether the provider is in network or not

• The best bed-side manner doesn’t equal the best quality of care

Hear me out, though—Google Reviews can be a reliable source for finding active providers.

While the reviews themselves may be iffy data to use, the fact that a user is leaving a review is valuable data.

This is because patients may actively update it based on their real-world experiences. When a doctor moves practices or retires, you may find this information in Google Reviews before it appears in official directories.

Other Directory Sources

These challenges are not specific to Google Reviews.

Provider directories across the healthcare system are notoriously inaccurate.

Insurance company directories? Often outdated.

Even modern platforms like Zocdoc, which aim to solve this problem, face these similar challenges.

Commercial solutions like CAQH DirectAssure attempt to address these issues by having providers attest to their information quarterly.

The closest thing to a national solution is NPIs with the National Plan and Provider Enumeration System (NPPES). Though even the NPPES:

• Providers don’t regularly update NPPES, leading to incorrect addresses and contact details

• NPPES lacks effective tools for connecting related organizations, such as hospitals and affiliated clinics, or linking providers across multiple locations, making it difficult to understand networks of care

• NPPES doesn’t indicate which insurance networks providers belong to, which is crucial for patients and insurers

These challenges can have a particularly negative effect on behavioral health, leading to what experts call "ghost networks" - where insurance directories list mental health providers who appear available but are actually unreachable, not accepting new patients, no longer at that location, or have stopped accepting that insurance plan.

This creates a mirage of mental healthcare access while patients struggle to find actual available providers, often making dozens of calls only to discover that their supposed network of covered providers is largely illusory.

Companies like Headway aim to address this issue by connecting patients with mental health providers listed in their directory.

The Complexity of "Quality" in Healthcare

Before we dive deeper into reviews and ratings, we need to address the complex relationship between patient satisfaction and clinical quality.

Here's an uncomfortable truth: Sometimes, the best medical care doesn't feel like good service. Consider these scenarios:

• A doctor refuses to prescribe antibiotics for a viral infection

• A physician recommends weight loss instead of ordering unnecessary tests

• A provider spends time explaining why a requested treatment isn't appropriate instead of simply agreeing

These are often examples of good medical care—but they might result in negative reviews. It's become a rite of passage for physicians to receive harsh online criticism for making clinically appropriate decisions that don't align with patient demands.

This creates a problem: How do we balance patient experience with clinical appropriateness?

There's an inherent information asymmetry in healthcare. Patients might be experts in their own experience, but they typically can't evaluate the clinical appropriateness of their care. This leads to a complex dynamic where:

• Good bedside manner is crucial for effective care

• Patient communication and empathy matter enormously

A More Nuanced Approach: Combining Data Sources

This is why combining different data sources becomes so crucial.

Using tools from mimilabs (a platform for analyzing and collaborating on public healthcare datasets), I started experimenting with:

1. NPPES Data: For basic provider information and locations

2. Google Reviews: To find active providers found through matching phone numbers on Google Reviews to NPPES

3. Quality Payment Program (QPP) Scores: Measure healthcare providers' reimbursed through Medicare performance on objective clinical quality metrics, assessing factors such as patient outcomes, care processes, and adherence to best practices in order to enhance overall healthcare quality and efficiency

The goal isn't to find providers with perfect reviews.

Instead, I tried to find active providers and linked this information to QPP scores in North Carolina’s Research Triangle area as a test case. I also highlighted the providers with the highest QPP scores in the area (which are the red flags).

Is this methodology the answer to finding providers?

Mostly not, but it starts an interesting thread on how we can enable patients to more easily find providers. Doing so with clinical outcomes and prices attached offers a lot of value.

The Cost of Inaction

The irony is that directories ultimately harm insurance companies too. When patients can't find in-network providers, they might:

• Delay care until conditions worsen and become more expensive

• End up in emergency rooms for non-emergency care

• See out-of-network providers out of desperation

• Get trapped in costly referral cascades trying to find the right provider

There's another crucial cost: inappropriate or poor-quality care often leads to a costly cascade of referrals and additional treatments.

A Path Forward: The CMS Directory Pilot

The good news?

The Centers for CMS recognizes these problems. They've just announced a pilot program in Oklahoma to develop an automated, centralized directory for Qualified Health Plans (QHPs) and providers.

This first-of-its-kind initiative aims to:

• Improve data accuracy

• Reduce administrative burden on providers and payers

• Lower costs

• Support better data exchange

• Enhance both patient and provider experiences

This pilot could be the first step toward a national directory of healthcare—a centralized database that could finally solve many of our healthcare directory problems.

This shift could pave the way for innovation in combining outcomes data and enhancing price transparency.

Which ultimately should enable more patients to have the power in the healthcare decision-making process.