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


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 billing statements were confusing. That confusion was driving calls into our customer service contact center,” says Kathryne Rouse, system director, customer support, revenue cycle, for Providence, which operates 34 hospitals and 600 clinics in five states.  

Providence’s centralized customer service contact 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 advisory groups including community leaders and patients to get their thoughts.

“They provided feedback that our patient statements needed improvement,” Rouse says. “We needed to make a change.”

See related tool: Abbreviated Providence Health & Services Sample Patient Statement

Patient-Friendly Features

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

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:

  • Patient responsibility or “Total Balance”
  • Payment terms, such as due date
  • Payment options, including financial assistance

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 an online platform as a payment option, where patients can access their medical records and pay their bills,” Rouse says. “That option can be more convenient for patients. They can view their statement, reach out to customer support, and make appointments all from one place.” Also included with the statement is information about financial assistance and alternative payment options such as payment plans and coverage assistance

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 used a legend to help patients know where to look for specific information included on the statement.

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 decided to use an outside vendor.

This proved fortuitous because it reduced the amount of paper and the expense associated with the statements, Rouse says.

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 with state-of-the-art statements so we were able to incorporate new elements for a fresher, simpler feel,” 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. “They also came to visit us to make sure the relationship 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 contact center routinely ask patients about their satisfaction with the billing experience. “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 designs for consideration.

Seek feedback from customer service employees. “We shared draft designs with 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 the patient experience.”

Other advice based on her experience:

Help the vendor be successful. “As you start gathering feedback, provide it to the vendor early on so it can start thinking about how to make those changes,” she says.

Remember that the paper statement must be viewable through the patient portal. “The statement in the portal should mirror what the patient received. To better address questions and comments, customer service representatives should be able to see what the patient is seeing,” 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 with 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 by their medical bills—were achieved with the help of a thoughtfully planned design process. Keys to success were seeking input from frontline customer service representatives and patients, and receiving their guidance to create a patient-friendly statement.


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

Interviewed for this article:

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

Publication Date: Monday, January 22, 2018