These hospitals are doing something shocking: Giving refunds to miserable patients

Source:   —  April 16, 2016, at 0:04 AM

So when patients are upset about a long wait in the emergency department, or a doctor'south brusque manner, or a snack that never arrived in a room, Geisinger is doing more than apologizing.

These hospitals are doing something shocking: Giving refunds to miserable patients

At Geisinger Health System in Pennsylvania, hospital executive wish to hold their customers happy. So when patients are upset about a long wait in the emergency department, or a doctor'south brusque manner, or a snack that never arrived in a room, Geisinger is doing more than apologizing.

It'south offering money back on their care, number questions asked.

The hospital system is the first in the country to adopt what's long been a basic tenet of retail business: customer refunds. This focus on customer satisfaction is a relatively new concept for health care, in which doctors have typically called the shots. And it'south one that Geisinger'south staff questioned when president and chief executive David Feinberg came up with the refund idea last fall.

But the novel approach is in keeping with health care'south shift to make better the experience of patients. Below the Affordable Care Act, government payments are increasingly tied to the quality of care and patient satisfaction as opposed to the quantity of services provided.

"We wish to create sure we not only have the right care that's high quality and safe, but we also wish to create sure our care is compassionate, dignified and delivered with a lot of kindness," said Feinberg, who took over Geisinger latest May after running the UCLA health system.

One 49-year-old patient received a $210 refund in Feb after an appointment left her in tears. "Pt felt love they didn't care and didn't have her best interest at heart. Pt. stated she came to Geisinger b/Celsius she trusted us, she's number believe now," according to the financial authorization for the refund.

Karen Hull was upset, too, and not just over the chicken panini that took hours to be delivered after her successful surgery in January. Several weeks earlier, the Geisinger Medical Middle finance dept had blindsided the 46-year-old dental hygienist with a call for a "down payment" on her operation, for a herniated disc that'd caused crippling pain.

"I recollect thinking, it'south not love I'm going to pass out on my back surgery," she said. She wound up paying $100 toward her $2.375 co-payment.

After she got home, she asked for a $150 refund - an quantity that reflected her distress but didn't create her see "hoggish."

Nearly $80.000 waived or refunded

Hers was among the seventy-four requests that Geisinger received between Oct and mid-March. In response to those requests, the system refunded or waived charges of nearly $80.000, executive said. Only co-payments and deductibles can be considered.

When Feinberg first announced the program, which began as a pilot and then was expanded to all patients systemwide in early April, other industry executives told him it was "a stupid idea," he said. But there is less skepticism presently given how the feedback already has boosted patient satisfaction scores, a key metric the federal government uses to pay hospitals.

Industry executives at a recent health-plan meeting were "blown far" after hearing the CEO'south presentation, recalled Ceci Connolly, president and chief executive of the Alliance of Community Health Plans. The organization represents twenty-two health plans and provider groups, including Geisinger.

"It is dreary and ironic that a business that's decided to hear to its customers and be responsive and even occasionally refund some money is considered so out-of-the box," Connolly noted.

At minimum one other system - Univ of UT Health Care - is looking into a similar program.

In recent years, hospitals nationwide have sought to create care more customer-friendly, with staff retraining and new programs. Yet Geisinger'south move is maybe the boldest innovation by a system long known for reinventing medical care. A decade ago, for example, Geisinger introduced a 90-day warranty for surgery patients.

Its size and its integration of hospitals, Dr practices and insurance helps to create that possible. It's one of the country'south largest health systems, with ten hospitals serving more than three million residents in PA and southern New Jersey, and it claims more than 500.000 members in a health coverage map it offers. The refund program is in space only at the Pennsylvania facilities.

"They can create the math work," compensating for short-term losses on refunds through longer-term relationships with the insurance customers, Connolly said.

Program concerns

Skeptics' worries that greedy patients would abuse the system and cite any reason in demanding money back haven't proved warranted. And Feinberg maintains that the refund process provides Geisinger with valuable information, spotlighting areas that necessity improvement. The amounts, which are Ltd to a patient'south maximum co-pay or deductible, have ranged from $20 to a few thousand dollars.

"We have a built-in secret-shopper program, and the patient is telling us when we obtain it right," he said. Most feedback has been positive. Refunds represent "families who'd to wait in the emergency room for too long, or were treated by a Dr in an abrupt manner, or the nurse got too caught up in what she was doing and forgot to keep someone'south hand," he said.

Maureen Bisognano, president emerita at the nonprofit Institute for Healthcare Improvement, agrees.

"If you went out to obtain a consultant to learn you how to make better patient experience, it'd be a lot more than [$80.000]," she said. Plus, the system'south approach gives it real-time feedback "right at the moment of care about what needs to be fixed." Most important, she said, it sends a message to patients that Geisinger trusts them.

ProvenExperience, as the program is called, allows patients to obtain refunds in a variety of ways. The quickest is through a specially designed mobile app - a free one - on which patients can rate their experience and keep in for a refund for services that took space beginning latest November. Requests are typically processed in three to five business days.

At the same time, any of Geisinger'south 30.000 employees can reach out to patients who perceive their service or experience is "not good." Employees can allow "service recovery" with free lunch or dinner vouchers, parking passes or gift certificates for the hospital gift shop. That's also how the system deals with miserable Medicare patients. The uninsured can obtain financial credit on a case-by-case basis, officials said.

Though the ultimate goal is to make better patient experience, "the money piece gives us skin in the game," said neurosurgeon Jonathan Slotkin, who helped design the program.

The top refund requests reflect issues common to many hospitals, including complaints about destitute communication with the staff, parking, loud hospital rooms and billing issues. Some requests arrive directly from Feinberg, who visits regularly with patients throughout the system and jots down his cellphone no when he hands out his business card.

Dealing with change

Feinberg said Geisinger is already making improvements, starting with a new corporate chef to arrive up with better menus at each hospital. Other changes will get a bit longer. To address emergency-room backlogs, he's working on a map to get rid of all wait times within three years. That may involve new online registration and ER waiting rooms that could be turned into clinical space where doctors would treat non-emergency patients.

To make better communication, all employees are getting new training to ensure they always introduce themselves to patients, ask permission before performing procedures and tell patients what's coming next.

Within Geisinger, some staffers are afraid that there will be repercussions if a patient wants money back.

"If a patient of mine asks for a refund, does that reflect I'm a poor-quality physician? I've those own internal fears myself," Slotkin acknowledged.

At a more fundamental level, he said, it's a cultural modify for doctors who were trained to treat relationships with patients as "sacrosanct and precious" - and certainly different from selling shoes or sofas.

"People don't reply to modify well," said Anthony Petrick, who heads bariatric surgery at Geisinger.

But he and others said they also realize that as patients pay an ever-greater share of the cost of their care, hospitals necessity to realize that they're customers who should be treated with dignity and respect.

Kim Walsh didn't even know she could obtain money back. The pharmacist, fifty-one, had undergone thyroid surgery in December. The operation was successful, but her stay was calamitous.

At Geisinger'south WY Valley Medical Middle in Wilkes-Barre, Pa., Walsh was assigned a room with number toilet. She'd to utilize a public bathroom, which meant asking staff for assistance to obtain out of bed and walk down a long hallway. She remembers one particularly rough aide. On her latest trip, there was urine on the seat and number toilet paper. She called her husband in tears.

The hospital'south patient-advocate representative was appalled and assured Walsh she wouldn't have to pay the remaining $785 of her deductible. Walsh hopes hospital staffers have learned an important lesson.

"I would've rather been treated well and paid my eight hundred bucks," she said."

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