Steal this Idea: Geisinger CEO David Feinberg explains how giving back money is his system's most valuable expense

Leo Vartorella - Print  | 

What if the CEO of your organization went to your executive team within their first 90 days on the job and said they wanted to offer patients the option to claim full refunds with no questions asked?

That's exactly what David Feinberg, MD, did when he assumed the role of CEO at Danville, Pa.-based Geisinger Health System in 2015.

"I think they thought I was crazy," Dr. Feinberg says.

Early in his tenure, he received an email from a man who had recently undergone spine surgery at a Geisinger hospital. The man argued that his $500 copay was unfair and had not been imposed in previous years. Dr. Feinberg consulted with team members who told him that all the system's literature clearly outlined the payment structure and should not come as a surprise.

This response did not make the patient any less upset. When the team asked if they should give the patient his copay back, Dr. Feinberg made sure not to be prescriptive with his advice. Instead, he answered with a question of his own: did they think Geisinger should give the money back?

The team decided to offer the man a full refund of his copay. The patient was so surprised that he went to his spine surgeon and asked what he should do. The surgeon suggested he accept a partial refund, which provided Geisinger with the idea for a sliding scale mechanism that has become one of the hallmarks of its ProvenExperience program, which rolled out in November 2015 and gives every Geisinger patient the opportunity to request full refunds, no questions asked.

The germ for the ProvenExperience program began long before Dr. Feinberg's arrival, when a team of Geisinger cardiac surgeons gathered to standardize their heart surgery procedures. If patients were readmitted, suffered an infection or had any other adverse outcome, they wouldn't be charged for the surgery. This ProvenHeart standardization was eventually applied to other specialties across the system, including lung and hip surgeries.

Dr. Feinberg says ProvenExperience would have been impossible without the groundwork laid by these other programs, which not only prepared clinicians for the process of standardization but also gave Geisinger's legal team practice dealing with the complicated legal ramifications of words like "warranty" and "guarantee."

The benefits of ProvenExperience have touched many aspects of Geisinger's business, according to Dr. Feinberg. Not only did the system receive millions of dollars in earned media coverage when it unveiled the program, but refunds have actually decreased since its inception. Geisinger did not keep official records of refunds prior to ProvenExperience, but in financial year 2016, ProvenExperience refunded $320,141. In 2017 that figure grew to $411,325. The system had refunded $266,340 in FY 2018 as of March.

The program has also allowed Geisinger to cut down on hefty consultant costs, instead receiving feedback on what isn't working directly from the source: patients.

"The first thing we learned is that it's an amazing secret shopper program. In the small pilot we saw that patients told you what was going well and what wasn't going well. Every single patient left positive information, never just negative," Dr. Feinberg says. "If there is negative feedback, it's always coupled with the positive. And then they can ask for a refund, and almost every patient who asked for money back only requests a partial refund."

Above all, Dr. Feinberg has said the program's greatest reward is improved patient satisfaction rates. Dr. Feinberg does not attribute increased rates of patient satisfaction solely to the refund option, but to the steps the system has taken to standardize care since the program started. Efforts in standardization range from color-coded uniforms for every employee to a structured conversation program that outlines the way Geisinger clinicians engage with patients.

The CICARE structure ensures all clinicians begin an interaction by calling the patient by name, introducing themselves, communicating what they plan to do, asking permission, responding to any questions and ending with excellence. To maintain necessary level of quality among support staff, Geisinger utilizes the same Talent Plus hiring tools the Ritz Carlton uses to asses potential employees. This tool looks beyond resumes and certifications and instead finds if individuals possess the service-minded mentality to go the extra mile for patients. Dr. Feinberg says these extra steps have slowed the system's hiring process, but increased the quality of care.

For those who believe ProvenExperience's track record may have something to do with the moralistic, down-home values of the system's rural central Pennsylvania patient base, Dr. Feinberg points out the same initiative has been rolled out at Geisinger's Atlantic City, N.J. campus with the same results.

Dr. Feinberg has not been shy about sharing the beneficial results of the ProvenExperience program, but there are still critics who say it all sounds too good to be true, and believe that similar efforts at their own systems would lead to patients falsely claiming refunds for effective care.

Dr. Feinberg does not have time for such critics.

"I would say people who believe patients will take advantage of them should go into a different business. These are the same people that are getting naked in front of us and allowing us to poke and prod them," Dr. Feinberg says.

"They're telling us the most intimate details of their life. If you don't believe in humanity, you're in the wrong business."

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