Health Policy$ense

Can Yelp Reviews Identify Better Skilled Nursing Facilities?

Assessing the wisdom of the crowd

A new study suggests that hospitals, payers, and patients might learn something useful about the quality of skilled nursing facilities (SNFs) by checking online Yelp reviews. These reviews could provide important information beyond publicly reported ratings to inform decisions about postacute care.

In JAMA Network Open, Kira Ryskina and colleagues studied 1,536 SNFs with 8,548 online reviews posted between January 1, 2014, and December 31, 2018. They assessed the relationship between SNF rehospitalization rates, Yelp ratings, and Medicare Nursing Home Compare (NHC) website ratings. They found that facilities with the highest (best) rating on the two review websites had 2.0% lower rehospitalization rates than the SNFs with the lowest rating on both sites. SNFs with the best ratings on both sites had slightly lower rehospitalization rates than SNFs with the best rating on NHC alone.

While Yelp reviewers rate SNFs on a five-point scale, they also provide text comments about different aspects of their experiences. Using natural language processing, Ryskina and colleagues analyzed these comments to identify specific topics consistently associated with SNFs with the highest and lowest rehospitalization rates. They found that the comments often captured perceptions of experience with SNFs that were not publicly reported in Medicare’s Nursing Home Compare or elsewhere—such as the quality of physical infrastructure and equipment, staff attitudes, and communication with caregivers.

Specifically, in SNFs with the lowest rehospitalization rates, reviewers commented about caring, helpful, and professional staff and fresh food, nice meals, and private rooms. To illustrate in a word cloud, SNFs with the lowest rehospitalization rates generated reviews like this:

In contrast, reviewers of SNFs with the highest rehospitalization rates commented on waiting for call backs, lack of choice and autonomy, and poor administration and billing. The word clouds for these SNFs looked like this:

These findings can be useful to many stakeholders: to hospitals seeking to select high-quality SNFs as a destination for patients needing postacute care; to patients and families wanting to identify an SNF that rates highly in aspects that matter to them; and to regulators who might consider adding these aspects to the NHC reporting process.


The article, "Association of Online Consumer Reviews of Skilled Nursing Facilities With Patient Rehospitalization Rates," was published in JAMA Network Open on May 14, 2020. Authors include Kira L. Ryskina, MD, MSHP; Anietie U. Andy, PhD; Kirstin A. Manges, PhD, RN; Kierra A. Foley, MA; Rachel M. Werner, MD, PhD; and Raina M. Merchant, MD, MSHP.