A new study of 20 of the best-known hospitals finds that 63% of Yelp reviewers rate hospitals between one and three stars on a five-star scale.

Some of the country’s biggest hospitals might be well known for their quality of care—but in the world of social media and online reviews they are not so much known for customer service.

A new study of 2,679 consumer reviews for 20 of the best-known hospitals by Denver healthcare marketing, research and consulting firm Vanguard Communications & Healthcare Process Improvement finds that 63% of Yelp reviewers rate hospitals between one and three stars on a five-star scale.

Those hospitals ranked by U.S News & World Report as the 20 hospitals including well-known names including Mayo Clinic, Cleveland Clinic, Johns Hopkins Hospital, Massachusetts General Hospital, UCSF Medical Center, University of Michigan Hospitals and Health Centers, Ronald Reagan UCLA Medical Center, New York-Presbyterian Hospital, Stanford Health Care-Stanford Hospital and University of Pennsylvania-Penn Presbyterian.

The patient experience is much harder to gauge.

The overall rating for the 20 hospitals was 3.2 stars. Nearly nine in 10 (84%) complaints consumers posted on Yelp cited non-clinical service issues as the main source of their dissatisfaction, ranging from chronic billing problems, to poor phone and follow-up communications, to wait times of one to four hours or more to see a doctor.

Patients who post a review on Yelp tend to like their doctor and the quality of care they receive for treatment while in the hospital or using a hospital service. A 2016 Vanguard analysis of 34,748 online healthcare reviews showed that two out of three patients (66%) give doctors either four or five stars on social media.

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But it’s a different story when consumers on Yelp talk about their experience as a patient or in dealing with customer service, Vanguard says. For example of 10 of the 20 top hospitals only two—Mayo and Cleveland Clinic has four stars on Yelp. In comparison, John Hopkins, Massachusetts General Hospital, University of Michigan Hospitals and Health Centers, UCSF Medical Center and University of Pennsylvania-Penn Presbyterian had 3 to 3.5 stars while Stanford Health Care-Stanford Hospital only had 2.5 stars.

“Most reviews on social media by patients focus on outcomes and judge the quality of clinical care while they are being treated in the hospital,” says Vanguard CEO Ron Harman King. “The patient experience is much harder to gauge.”

Most negative reviews about the big hospitals consumers posted on Yelp had to do with complaints over billing, waiting too long on the phone or not getting a return call, Vanguard says. “It’s a wakeup call,” Harman King says. “Customer service is easier for a hospital to fix than morbidity.”

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