In the retail world, a money-back guarantee is offered as proof of quality and a dedication to customer service. Why can’t the same reasoning be applied to healthcare?
That is the idea behind Geisinger Health System’s ProvenExperience, a program that offers refunds to patients whose expectations weren’t met based on kindness and compassion. President and CEO David T. Feinberg, MD, MBA, unveiled the Danville, PA-based health system’s mony-back guarantee recently.
“The way I see it, if you go into Starbucks and you’re not happy with your order, they don’t sip your latte and argue that they made it correctly. They just take care of you on the spot,” Feinberg says. “What matters to me is that every patient is satisfied with their treatment and so I started thinking, ‘What is our guarantee? What is our refund?’ We need to be disruptive to move the practice of providing great patient experience forward and so the decision was made to give unsatisfied patients their money back.”
A pilot of the program has been introduced at Geisinger Medical Center, the health system’s main campus in Danville. A key component of the program is a patient app developed by Geisinger that allows certain surgery patients enrolled in the pilot to determine the amount of the refund they want based on their copay. (For another health system’s patient satisfaction app, see story in this issue.)
For example, if a spine surgery patient paid a $1,000 copay and they weren’t pleased with how office staff treated them, they can log into the app and select from a sliding scale how much of their co-pay they want refunded. They can choose from $1 to $1,000 and the refund request is processed within 3 to 5 business days.
MORE ABOUT BEING HEARD
Feinberg doesn’t anticipate the system will be abused and instead foresees patients sticking to the honor system.
“Ultimately, they just want to be acknowledged and to spare other families any pain they might have experienced,” he says.
Feinberg explains that ProvenExperience is an evolution of Geisinger’s ProvenCare portfolio, which gained attention in 2006 by proving that applying evidence-based protocols could reduce mortality rates, improve outcomes, and reduce costly readmissions. Some called it “surgery with a warranty” because if certain surgery patients are readmitted within 90 days with a preventable complication, they are taken care of at no extra charge.
“Historically, Geisinger’s reputation has been based on transforming the way healthcare is delivered,” Feinberg says. “We’ve been held up as a national model for providing both high-quality and cost-effective medical care and our ProvenCare program has garnered national — and international — praise for eliminating unwarranted variation and applying scientific best practices. Now is the time to focus on compassion.”
He predicts ProvenExperience will transform the healthcare industry. But he acknowledges that the idea of giving money back to patients, without asking questions, will seem radical to most healthcare leaders.
“In the beginning, I talked to other health system CEOs and industry leaders about ProvenExperience and they all said, ‘Don’t do it.’ I really felt dejected,” Feinberg explains. “Then I thought about Kodak executives discussing digital photography. And Blockbuster talking about online video options. Were they also told ‘Don’t do it?’’ That’s when I said to myself, ‘We’re doing it.’”
PATIENT INPUT STEERED PROJECT
The guarantee is in keeping with the philosophy that Geisinger has always had toward patient satisfaction, notes Susan M. Robel, RN, BSN, MHA, NEA-BC, executive vice president, system chief nursing officer, and system chief patient experience officer. The health system has long had a policy of waiving a patient’s copay when it seemed Geisinger had not fulfilled its promise to provide the best possible patient experience, Robel says. That process was reactive, however, in that the patient had to first complain and then Geisinger would look into the claim.
“We wanted to know how we could further engage our patients and put our trust in them, to help us do better,” Robel says. “Sometimes we believed those phone calls to a patient advocate came when the patient was very frustrated and emotions were running high. We wanted to be much more transparent and proactive in letting patients tell us that they were not satisfied, without waiting until it reached that point.”
Geisinger put together a team to develop the app, including clinicians, IT professionals, risk managers, and representatives from billing and reimbursement. The initial ideas for the app were presented to the health system’s patient advisory council, which provided useful feedback. (For more advice from Geisinger’s patient advisory council, see the story later in this issue.) The patient representatives said the app should be simple and easy to use, and it should provide a way to contact someone about the patient’s experience.
“We found that sometimes patients just want to tell their story,” Robel says. “They want someone who cares and wants someone to listen to them. They said this is not really about the refund; it’s about someone listening and wanting to fix the issue. That was a big wow for us, so we wanted to incorporate that process into the app.”
Geisinger began with a pilot aimed at bariatric and some spinal surgery patients. The limited roll out was intended to test and refine the technology before offering it to all patients. The surgeons in those areas agreed to participate in the pilot, and their patients were made aware of the app and the offer for a refund. The app was designed to be simple, asking patients if they were happy with their surgery. If the patient selects happy, there is an option for providing information about a particular staff member or aspect of the experience that improved the experience.
If the patient is not happy, there is an option of describing why and then to choose the refund amount.
“As a nurse leader, I have a huge commitment to staying in touch with both our patients and our employees,” Robel says. “The more leaders can stay in touch and solve problems to allow staff to take the best care of our patients, the better the overall patient experience is going to be. The app is one of many ways that we are trying to do that.”
