Routing is not gating

A patient is surveyed after the visit. They score you 0 to 10 on the question Bain standardised two decades ago: how likely are you to recommend us to a friend or colleague. Nines and tens are promoters, sevens and eights are passives, zero through six are detractors.^[3] Then the software has a decision to make. Who sees the Google review link?

The commercially obvious answer is the nines and tens. Promoters go to Google, everyone else to a private feedback form in an inbox. Your rating holds and your bad visits stay in-house. Enough reputation tools sold to medical practices ship a version of this that you should assume yours might, and check rather than trust. In the deck it is called smart routing, or protecting your rating.

It has a name already. It is review gating, and Google’s policy is not vague about it.

Google wrote it down

Google’s Maps user-generated content policy has a section on rating manipulation listing what merchants must not do. The relevant line is one sentence: merchants must not “Discourage or prohibit negative reviews, or selectively solicit positive reviews from customers.”^[1]

Read the verb. Not publish, not delete, not suppress. Solicit. The prohibited act happens at the moment you choose who to ask, which is upstream of anything a patient ever writes. A gate that never sends a link leaves no trace in your review corpus at all, and it is still the thing the policy names.

The part practices miss sits a few lines away on the same page, where Google states what merchants may do: “Solicit or encourage the posting of content that does represent a genuine experience, without offering incentives to do so or attempting to influence the rating or the contents of the review.”^[1]

The permission and the prohibition sit in one document. Asking is explicitly fine, in a policy that is otherwise a list of things that will get your profile penalised. Choosing who you ask is what breaks it. I think the confusion between those two costs the profession more than gating does, because the practices that read the policy carefully and get nervous respond by asking nobody.

What the FTC rule does and does not say

The federal backdrop is the Rule on the Use of Consumer Reviews and Testimonials, 16 CFR Part 465, effective 21 October 2024.^[2] It reaches fake and false reviews, buying positive or negative reviews, insider reviews, company-controlled review websites, fake indicators of social-media influence, and review suppression.

Be precise about that last one, because it gets stretched in both directions. Section 465.7 has two halves. The first covers threats and knowingly false accusations used to stop a review being written or to get one removed. The second prohibits a business from materially misrepresenting that the reviews displayed on its own site represent most or all the reviews submitted, when reviews are withheld on the basis of their rating or their negative sentiment.

That second half is aimed at the review widget on your own website rather than at your Google Business Profile. If you are hunting for a single federal sentence reading “do not gate your Google asks,” it is not there in those words. What is there is a federal rule treating the engineering of which reviews the public sees, on the basis of how good they are, as within its scope. Set that beside Google’s policy, which does speak to solicitation directly.

I am not a lawyer and none of this is legal advice. If your setup branches on score, show the configuration to counsel rather than taking my reading of it.

Gating changes who gets asked. Routing changes where the conversation goes.

Under gating, the score decides whether a patient is invited to review you in public. Detractors are dropped from the ask list, silently, and nobody in the practice notices the absence.

Under routing, the invitation does not depend on the score. A 3 gets the same ask a 10 gets. What the 3 also gets is a person, fast, while the visit is still recent enough to fix. There is one honest exception and it is worth naming, because it is the shape a gate hides in: a patient in the middle of an open complaint does not get an automated review ask landing on top of it. The ask waits for the complaint to close. It does not disappear. Deferring while a human is mid-conversation and never sending at all look identical on a slide and completely different in a send log, which is why question three below asks for the log.

Practices hear that and assume it is the same trick with better manners. It is a better product, and the gap is not close. A complaint reaching your practice manager on Tuesday is a patient you can call, re-book, refund or simply apologise to. You get no such chance from a one-star posted on a Sunday, and nothing at all from the one-star never written because nobody asked. That patient did not save you a star. They walked out with an unresolved problem, told you nothing about it, and will tell someone else.

It compounds. If the patient posts anyway, a routing practice already knows the story and can reply with facts rather than from a standing start (see how to respond to negative reviews in healthcare). A gated practice arranged never to hear the complaint first.

Three questions to put to your vendor, in writing

You can audit whatever you run today without a consultant. Send these three by email, keep the reply, and read the answers literally.

1. Does a patient who scores us a 3 receive the same Google review link as a patient who scores us a 10? Ask to see it in your own account, on a real record: the message that went to one of your patients who scored you low last month. A policy page is not evidence; a send log is. A bad answer is any answer describing intent without opening the record.
2. Is the link withheld, delayed, or de-emphasised for any score band? Name all three, because the last two are where it hides. “We follow up with unhappy patients first” is a reasonable sentence and also the exact shape of a step that quietly never sends. Ask what the timer is and what happens when nobody clears it.
3. What proportion of surveyed patients received the public review link last month? Two numbers, not one: the rate for your promoters and the rate for your detractors. Non-response, dead mobile numbers and opt-outs pull both bands down together. A gate pulls only one down. If the detractor rate sits materially below the promoter rate, that gap is the gate, whatever the policy page says. Ask for the denominator too — “surveyed” and “responded” are different numbers and it is tempting to quote whichever flatters.

Question three is the one that actually finds it. Gating rarely lives in the policy page; it lives in the configuration, and the two drift apart without anyone deciding to lie. Somebody set a filter to reduce noise. Somebody added a review step during a bad quarter and left it in. The policy still says everyone is asked; the send log says otherwise. Ask for the number, not the intention, and ask monthly.

The honest case for gating

Gating works. That is why it is still sold, and pretending otherwise would make this a less useful post.

A practice that gates will post a higher average rating next quarter than an otherwise identical practice that does not. Fewer detractors reach the public profile, so the mean holds. Judge the two programmes on average rating alone and gating wins. Anyone telling you the short-run numbers go the other way is selling something.

Two reasons it is still a bad trade.

The first is what is at stake. Your Google review corpus is years of patient goodwill sitting inside a platform that publishes the rules, enforces them at its discretion, and removes content and suspends profiles without asking you first. That is a large asset to expose for a small gain.

The second is that the number being protected has stopped doing any work. In our own 2026 dataset of 15,061,473 Google reviews across 142,417 US medical practices, 68.2% of rated practices already sit at 4.8 stars or better and 46.7% hold a perfect 5.0, while the median practice holds 19 reviews. Two thirds of rated practices are already at 4.8 or better. The rating has stopped telling anyone anything. Gating spends real platform risk defending the number that no longer separates you from the practice two blocks away, and does nothing about the one that does.

This is how applaud is built, and it was not a hard build. Every patient who visited is enrolled and invited. Nobody is screened out on the strength of their answer. A frustrated patient does not get an automated review ask landing on top of an open complaint; that conversation goes to a person on the practice’s team with the detail attached, and the ask resumes once the complaint is closed. The link, when it goes, opens straight into Google’s review composer.

The strongest argument against gating was never the policy or the rule. It is that a practice which only hears from patients who already liked it has bought an expensive way of learning nothing. The rating goes up. The practice does not get better. Ask everyone, then answer the people who are unhappy. That is the entire system, and all the software has to do is make it survive an ordinary Tuesday.

Sources

1. Google. “Prohibited & restricted content.” Maps User Generated Content Policy Help, “Rating manipulation” section. support.google.com/contributionpolicy/answer/7400114. Merchants must not “Discourage or prohibit negative reviews, or selectively solicit positive reviews from customers”; merchants may “Solicit or encourage the posting of content that does represent a genuine experience, without offering incentives to do so or attempting to influence the rating or the contents of the review.”
2. Federal Trade Commission. “Trade Regulation Rule on the Use of Consumer Reviews and Testimonials,” 16 CFR Part 465. Published 89 FR 68034, August 22, 2024; effective October 21, 2024. Review suppression at § 465.7. ecfr.gov/current/title-16/chapter-I/subchapter-D/part-465. Business-facing guidance: ftc.gov/business-guidance/resources/consumer-reviews-testimonials-rule-questions-answers
3. Bain & Company. “Introducing: the Net Promoter System.” Loyalty Insights. bain.com/insights/introducing-the-net-promoter-system-loyalty-insights. “Customers’ responses to the first question allow you to classify them as promoters (9–10), passives (7–8) or detractors (0–6).”