How Geisinger's refund program is faring amid patient experience crisis

In the middle of a patient experience crisis, the logical assumption for a health system that gives patients the opportunity to request a refund is that those expenses will skyrocket. Geisinger has seen the opposite, with patient refunds on the decline in recent years. 

In late 2015, the Danville, Pa.-based system rolled out the ProvenExperience program, which gives every patient the option to claim a full refund, no questions asked. The program works on a sliding scale, allowing patients to determine how much of their copay they'd like back if their service or experience expectations weren't met. 

"This is recognizing the consumer side of medicine, but even beyond that, that if you promised to provide a certain service and fail — and [patients] paid money for it — that's considered just good business and relationship practice to say, 'Well, we should give your money back,'" Greg Burke, MD, Geisinger's chief patient experience officer, told Becker's. "I think any small businessman would understand that principle, and that brings credibility to our work." 

ProvenExperience refunded $320,141 in financial year 2016. In 2020, Dr. Burke said Geisinger refunded about $84,000, and the program refunded $40,000 in 2021 — a surprising trend, given a national drop in patient experience satisfaction measures throughout the pandemic. Findings from a Press Ganey survey in November 2021 found patients' overall rating of hospital care fell 4 percentage points, and the likelihood of recommending their hospital fell 4.5 percentage points. 

"For those who aren't familiar with how patient experience data moves, this is a huge drop," Rick Evans, chief experience officer and senior vice president of NewYork-Presbyterian Hospital, wrote in a piece for Becker's after the findings were published. 

COVID-19 complicated hospitals' ability to uphold certain expectations on the patient experience side, and that was no exception at Geisinger. The health system saw an increase in the number of complaints surrounding communication issues, access and hospitality as the pandemic progressed. 

Amid the rise in complaints, refunds still decreased, perhaps because commitment to the ProvenExperience program has created an acute awareness of the patient experience that drives constant improvement. 

"Whenever you make a service guarantee, you're willing to take some risk onto yourself," Dr. Burke said. "I think that really requires … that we continue to improve our processes and not ignore even the small pain points that patients are feeling that are diminishing their experience of healthcare," Dr. Burke said. 

Experience issues tied to refunds are always paired with an action plan to prevent other patients from experiencing the same shortfalls. Once a communication or other failure is identified, both operational and frontline leaders develop a plan. 

"Part of learning is not just knowing what went wrong for a particular patient or family, but then finding ways to fix it," Dr. Burke said. "There [always has to be] an action plan associated with failure. That benefits the system and also benefits the patients, because then we're continually improving." 

ProvenExperience has helped shape a culture of accountability at Geisinger, with the majority of refunds over the last few years having been proactively offered by the Geisinger team and taken care of on the back end, rather than a patient or their family having to formally request one. And for those requested by patients, the "vast, vast" majority have been honest. 

"Much like a very good hotel or restaurant would recognize [a failure], before the patient asks for a refund, we'll offer it," Dr. Burke said. 

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