“Always listen to your patients and customers. If you’re being told by your current vendor that something can’t be done, challenge them.”


Providence Health & Services saw many benefits from its new electronic health record (EHR) system, which integrates revenue cycle and clinical information that historically had been maintained in separate systems. But one thing did not improve.

“We started getting patient feedback that our statements were confusing and that was driving calls into our customer service call center,” says Kathryne Rouse, system director, revenue cycle, customer support, for Providence, which operates 34 hospitals and 600 physician clinics in five states.

Providence’s centralized customer service call center, which serves all its hospitals and clinics, fields more than 100,000 calls every month so reducing avoidable calls is always a priority.

The customer support team reached out to various community ministry boards—hospital-specific advisory groups composed of community leaders—and a patient advisory committee to get their thoughts.

“They provided feedback as well that our patient statements needed improvement,” Rouse says. “So we felt like we needed to make a change.”

Patient-Friendly Features

When the new statements rolled out in April 2016, they featured many changes.

See related tool: Providence Health & Services Patient Statement

Overall look and feel. The design team sought to make the new statements simple and easy-to-read with bold design elements that drew patients’ attention to three items:

  • Current amount due
  • An “Important Message” copy block that says “You are responsible for the amount listed by the ‘Total Balance;’ Payment is due within 20 days; Balances of $500 of greater may qualify for a prompt pay discount if paid in full online or by phone; Financial Assistance may be available to those who qualify.”
  • Payment options

Improved “Payment Options” section. The new statement includes eye-catching icons—a computer icon next to “pay online,” for example—for each of the four payment options. “We even added a MyChart activation code to the statements specific to that patient or guarantor,” Rouse says. “That drives more patients to use MyChart online to pay their balances, which has been hugely successful.”

Better family billing information. Providence has provided family billing—services rendered to all members of a family are billed on one statement—for several years, but the information was confusing to some readers. The new statements provide the following information about each service being billed:

  • The patient’s name
  • The provider’s name
  • The site of service (hospital or clinic)
  • Location of the service
  • The amount that the patient’s insurance paid for that service
  • Balance owed for that service

A user guide. A one-page “Guide to Your New Providence Statements” was inserted into each envelope when the new statements were introduced. It uses a legend to help patients know where to look for specific information included on the statement.

See related tool: Providence Health & Services Patient Statement User Guide

Design Process, Step-by-Step

Historically, Providence produced its patient statements in-house. When revenue cycle leaders started exploring their options for new statements, they found that its in-house production shop had too many limitations, prompting the decision to use an outside vendor.

This proved fortuitous for two reasons, Rouse says. Unlike the in-house print shop, the vendor can print on both sides of a piece of a paper, which reduces the amount of paper—and the expense—associated with the statements.

Furthermore, the vendor’s experience with other clients, both in healthcare and other industries, gave the Providence team fresh ideas to consider. “The vendor had clients that have really state-of-the-art statements so we were able to incorporate some things from those examples,” Rouse says. “We took bits and pieces from different examples to come up with the best solution to meet our patients’ needs.”

After the vendor was selected, Providence leaders traveled to the vendor’s facility to see its production operation first-hand. “Then they came to visit us as well to make sure we had a good partnership and this was a good fit,” Rouse says.

The design team included Rouse, the customer service director, the customer service manager and a few business analysts, along with a vendor representative. They used a multi-step process to come up with the new design.

Solicit initial input from customer service employees. The “caregivers” who work in Providence’s call center routinely ask patients about their satisfaction with their billing experiences, so they had the best insight into problems with the existing statements. “Number one, and most importantly, we asked our frontline customer service team members to summarize what they were hearing from our patients,” Rouse says.

Work with the vendor to develop a draft statement. Using suggestions and preferences identified by the design team, the vendor produced a few alternative designs for consideration.

Seek feedback from customer service employees. “Once we had some possible formats, we brought them forward to the entire group,” Rouse says. The design options were posted in the office to allow the frontline staff to review them at their leisure, vote on their favorite statements, and offer feedback.

Seek feedback from patients. After all staff changes were evaluated and incorporated into a draft statement, Rouse and her colleagues met with a patient advisory committee at a Providence hospital. About 20 patients reviewed the proposed draft, compared it to the previous statements, and gave feedback and suggestions for fine-tuning.

Tips and Lessons Learned

Rouse’s top takeaway from the experience: Patient statements can be patient-friendly, and don’t accept those who say otherwise.

 “Always listen to your patients and customers. If you’re being told by your current vendor that something can’t be done, challenge them,” she says. “There are always different partners out there willing to work with you to enhance your patient experience.”

Other advice based on her experience:

Help the vendor be successful. “As you start gathering feedback about changes that will need to be made, provide that to the vendor early on so it can start thinking about what it needs to do on its end to make those changes,” she says.

Remember that the paper statement must be viewable through the patient portal. Providence encountered a challenge in getting its EHR system updated to import the statement images back into the patient portal. “You want that statement image to mirror what we're mailing out, so your customer service representative can pull up the statement image and look at it while they are supporting a customer over the phone,” Rouse says.

Expect a lot of back-and-forth communication. The overall process took about four months, Rouse says. During that time, the designs went through both major changes and minor tweaks. “You should be patient through the process,” she says. “These things don't happen overnight.”    

Patient-Friendly Statements

Providence’s two goals—to increase patient satisfaction and to reduce incoming calls from patients who were confused about their medical bills—were achieved through a carefully planned design process. Keys to success were seeking input from frontline customer service representatives and patients to identify problems with the old statement and guidance from them to create a patient-friendly replacement.


Lola Butcher is a freelance writer and editor based in Missouri.

Interviewed for this article:

Kathryne Rouse is system director, revenue cycle, customer support, Providence Health & Services, Portland, Ore., and is a member of HFMA’s Oregon Chapter.


Publication Date: Thursday, November 16, 2017