Geisinger CEO Dr. David Feinberg talks 1 year of patient refunds

Geisinger Health System in Danville, Pa., implemented a satisfaction-guaranteed patient refund program in November 2015 under the mantle of President and CEO David Feinberg, MD. After one year of refunds, Dr. Feinberg says the health system could have actually returned less money to patients compared to years prior.

Under the ProvenExperience initiative, patients can request refunds if they are dissatisfied with their hospital experience. Refunds work on a sliding scale, meaning patients can seek refunds as little as $1 to more than $2,000.

As of August, Geisinger had returned more than $400,000 to dissatisfied patients through the ProvenExperience initiative. Compared to the size of Geisinger's sprawling system — which includes 12 hospital campuses, two research centers and more than 30,000 employees — $400,000 is less money than some might expect.

Dr. Feinberg spoke with Becker's Hospital Review about lessons learned and insight gained through Geisinger's satisfaction-guaranteed refund program.

Target areas for improvement
The ProvenExperience program grew out of a desire to evolve Geisinger's patient engagement practices, Dr. Feinberg says. Patients' specific, detailed complaints guided Geisinger's subsequent work to improve patient experience across its continuum of care.

Dr. Feinberg listed some of the most common patient complaints filed in the program, including long wait times in the emergency room, poor communication with their caregiver and environmental complaints, like noise level.

Geisinger also received a stream of complaints regarding financial interactions. As consumers emerge as a critical payer group, patient financial interactions have presented a significant problem for some organizations. Sometimes even providing patients with all the correct financial information still isn't enough to guarantee understanding and satisfaction.

Dr. Feinberg described several instances where Geisinger staff explained all relevant financial and insurance information to patients via email, and patients still complained when an unexpected bill arrived in the mail. Each patient was issued a refund because even though the system didn't err, Dr. Feinberg believes it still failed to connect with and properly educate the patient. This revealed pain points in Geisinger's revenue cycle and bill design, which the system is working to address. 

Dr. Feinberg believes the ProvenExperience program gave Geisinger a much more intimate knowledge of their patients which the system used to institute effective, long-term change. The refunds are effectively a tool that helps Geisinger continue advancing the standard of quality patient care. "When the complaints begin to go down, we know we've found a solution," Dr. Feinberg says.

Patients just want to be heard
Prior to launching the program, some industry peers voiced concern. They said patients with illegitimate complaints would take advantage of Geisinger, demanding refunds as a way to reduce their out-of-pocket expenses.

The health system found patients largely reported valid, authentic grievances. But Dr. Feinberg admits the administration has considered implementing some caveats after encountering some "suspicious" cases.

"A man called and wanted a refund for his son's spine surgery from 1993," says Dr. Feinberg. "We gave him the refund, but we decided to put some time constraints on the program."

Geisinger Health System also received some complaints from patients post-cosmetic surgery that elicited skepticism among program administrators. The health system has not decided whether it will discontinue the refund program in its cosmetic practice.

Dr. Feinberg wasn't necessarily surprised by patients' overwhelming goodwill and honesty. But he was surprised to find patients rarely, if ever, requested a refund in full. The program gave patients a meaningful way to express and validate their dissatisfaction, rather than an opportunity to save money.

"People just want be heard. We're in this industry to take care of people and treat them with compassion. Patients recognize and honor that commitment," Dr. Feinberg says.

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