Geisinger’s Money Back Guarantee Targets Patient Experience

January 6, 2016 11:20 am

Patients use an app to voice their concerns and request a refund of their copayment.

In 2015, Geisinger Health System, Danville, Pa., initiated a program that allows patients to get their money back if they are not satisfied with the level of kindness and compassion they receive from Geisinger providers. Called ProvenExperience, the program lets patients choose the amount of the refund—up to the full amount of their copayment for the service.

Geisinger president and CEO David T. Feinberg, MD, came up with the warranty idea because he believes every patient should be satisfied with the level of service they receive at Geisinger.

Feinberg says that according to current measures, even a hospital that ranks in the 99thpercentile in patient satisfaction scores means that only about 85 percent of patients are satisfied. He thinks health care should do better. “Our benchmark is really low,” he says. “I’m not looking for the 99th percentile. I’m looking to get it right for every patient.”

Ultimately, Feinberg says he wants the health system to be the best in customer service, not just in health care, but among other types of organizations and industries as well.

Testing the Guarantee

Geisinger ran a pilot program using a smartphone app in conjunction with the ProvenExperience program at Geisinger Medical Center’s main campus in Danville and at Geisinger Wyoming Valley Medical Center in Wilkes-Barre, Pa., through the end of 2015. The app is scheduled to roll out systemwide this year.

In the pilot, patients who underwent lumbar spine or bariatric surgery could use the app, developed by Geisinger, to find out the amount of their copayment for the surgery. Patients logged into the app, voiced their concerns, and chose the copayment amount, if any, they wanted refunded. The refund request is then processed within three to five business days, and patients are mailed a check. A bariatric surgery patient, for example, may be refunded any portion of a $2,000 copayment.

“We are using the initial app launch for some of our most expensive services. We wanted to try it out where it really counts,” Feinberg says.

Although the number of spine and bariatric surgery patients eligible to use the app is small, Feinberg says many of those eligible are using the app, and the feedback is generally positive. ‘Most patients aren’t actually interested in a refund. Most patients who are upset with care want two things.” They want an acknowledgement that something went wrong and an understanding that the health system is trying to fix the issue so other patients and family members do not have the same negative experiences,” Feinberg says. “This isn’t about refunds. This is about learning from our patients where we’re not doing well. And fixing the problems,” he says.

Feinberg says the refund is a small token of appreciation to the patient for providing information that can lead to better customer service. “I wish more people would tell us exactly how we’re doing because that’s how I think we’re going to get better,” he says.

In one negative comment, a patient who was otherwise pleased with the service provided by Geisinger, noted a nurse who seemed unpleasant and uneasy in having to assist the patient to the bathroom. The patient also voiced concerns about an IV that hurt for several hours and construction noise that lasted longer than the hospital staff had anticipated. Although the patient was eligible to receive a $2,000 refund, the amount requested was $100.

Feinberg says most patients who request a refund ask for a small amount, although the highest refund request was for $2,000 from a bariatric patient.

A Learning Experience

Feinberg sees little risk in offering patients a refund or in patients abusing the policy. He says retailers offer similar refund policies, and most consumers do not take advantage of those. “I have no concerns. I think our business is really people caring for other people. That’s the core of what we do. To be successful in that business, you’ve got to believe in humanity,” he says.

Feinberg says if it turns out that Geisinger is issuing a high dollar amount in refunds, but for legitimate concerns, then the policy will do what it is intended to do: Teach providers what they are doing wrong. If patients abuse the policy, however, then it will have to be rescinded.

“If it becomes too much of a financial issue, then we’re performing poorly, and it’s legitimate, then we’ll get better,” he says. “If we get scammed, then we’ll stop it.”

Others in health care agree that patient abuse of the policy is not a concern. “What the policy really emphasizes is Geisinger asking itself the question: Are we kind and compassionate to our patients?” says Terry Allison Rappuhn, leader of HFMA’s Patient Friendly Billing project, and director, Akorn Pharmaceuticals, Nashville, Tenn. “Because when you put a policy like this in place, you’re putting some skin in the game.”

Thomas Lee, MD, chief medical officer at Press Ganey and chairman of the board for Geisinger Health System, says the guarantee program really speaks to the patient relationship that Geisinger is striving to reach. “Ultimately, it’s not about the money, it’s about the relationship between patients and providers. The goal is to make clear to patients that we, meaning Geisinger, are serious. We’re not just giving this lip service,” he says.

Lee says that although other healthcare systems may not exactly follow suit and start a money-back guarantee program, Geisinger’s efforts are likely to encourage healthcare leaders to consider patient experience improvements in their organizations. Whether initiatives involve guarantees, transparency of quality, or a combination of the two, clinicians must be encouraged to work together more effectively and deliver care that is empathetic. “If you don’t do those things, you’re going to have trouble staying viable in the marketplace,” Lee says.

Karen Wagner is a freelance healthcare writer and frequent contributor to HFMA publications.

Interviewed for thisarticle:

David T. Feinberg, MD, is president and CEO of Geisinger Health System, Danville, Pa.

Terry Allison Rappuhn, is the leader, HFMA’s Patient Friendly Billing® project, and director, Akorn Pharmaceuticals, Nashville, Tenn., and a member of HFMA’s Tennessee Chapter.

Thomas Lee, MD, is chief medical officer at Press Ganey, Wakefield, Mass.; chairman of the board for Geisinger Health System, Danville, Pa.; and a member of HFMA’s Massachusetts-Rhode Island Chapter.

Discussion Starters

Forum members: What do you think? Please share your thoughts in the comments section below.

  • What are the pros and cons of a money-back guarantee?
  • Is a money-back guarantee a viable option that most hospitals and health systems can offer? Why or why not?


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