When your cup of coffee at Starbucks doesn't taste right, you can exchange it for another. When what you ordered on Amazon isn't exactly correct, you can send it back for a refund. When you aren't satisfied with your experience at a restaurant or hotel, you get credit toward your next meal or stay. What if the same were true for spine surgery?
At Geisinger Medical Center in Danville, Pa., it is.
When patients aren't satisfied with their spine surgery, they can receive their cop-pay, which can be up to $1,000 as a refund using a mobile app as part of a pilot program. Geisinger's philosophy toward patient care — the ProvenExperience™ model — describes the institution's commitment to the patient experience and service excellence as the hospital's "true north." The providers are focused on achieving excellent patient care, experience and innovating in the field.
That's precisely how the refunds were born. One patient was dissatisfied with certain billing aspects of the experience — the patient's bill was larger than expected — and Geisinger's CEO David Feinberg, MD, decided to provide a refund of the patient's $1,000 copay. Then he directed Jonathan Slotkin, MD, and his team to design a program making this refund available to all patients.
"In our point of view, the patient experience is part of a larger umbrella that includes quality and service excellence in the way everything from billing functions to workflows take place," says Dr. Slotkin, director of spine surgery at Geisinger Health System Neuroscience Institute and medical director of Geisinger in Motion. "Geisinger's stated goal used to be the best service experience in all of healthcare. But that's now not enough and we have abandoned that. Now our stated goal is to have the best service experience in any industry, period."
Dr. Slotkin and his team at Geisinger in Motion developed a mobile app within eight weeks to collect patient feedback, both positive and negative, and allow dissatisfied patients to access the refund. Patients dictate the amount — whatever they feel is fair up to the $1,000 copay.
So what will keep patients honest?
"Our focus is on service excellence, not about trying to determine whether the patients are telling the truth or not," says Chanin Wendling, director, Geisinger in Motion, in the Division of Applied Research and Clinical Informatics at Geisinger Health System. "We may have people abusing the system, but overwhelmingly we trust patients will be honest with us. The ability to make the experience right is worth more than any patients who might want to abuse the system."
The app is designed for patients to give feedback, as well as to eventually provide a space for patient-to-patient discussion. The app and refund are also available for bariatric surgery patients — up to their $2,000 co-pay — and Dr. Slotkin hopes the program will translate to other specialties in the future.
Some worry the focus on patient experience could compromise quality, as the best practices for achieving quality outcomes don't always match with delivering the most comfortable patient experience. However, the two aren't necessarily mutually exclusive.
"Over the last 10 years in spine we have been focused on quality measures and how to score quality," says Dr. Slotkin. "Over the next 10 years I think we'll take the same skills we developed around quality and begin to apply them to patient experience. We'll make the patient experience a hard science."
Several key concerns Dr. Slotkin and his team hear from patients include:
• Environment of care issues: noise, lighting in the rooms
• Food issues
• Inefficient billing functions
• Education on financial responsibility/exact information about deductibles
• Difficulty scheduling an appointment
"Right now it's easier for people to have 15 packages delivered tomorrow morning from Amazon than it is to get an appointment with a major medical system," says Dr. Slotkin. "That's atrocious if you think about it. From an experience standpoint, we are implementing a process system-wide to offer same-day appointments across all service lines; that program is already available in neurosurgery and orthopedics. It demonstrates our commitment to the patient experience."
Geisinger in Motion is also tackling the financial responsibility issues, developing a program to accurately predict the patient's deductible. The deductible is often rolling, which makes the estimate harder to achieve. But the system's rapid cycle innovation philosophy gives developers the time and space to achieve their goals.
"That's one thing that's great at Geisinger — we have a physician-administrative partnership model that really primes the environment for rapid cycle innovation," says Dr. Slotkin. "That allows us to bring a clinical perspective to things rapidly. I have heard from colleagues at other institutions that sometimes clinicians are swamped in the clinics and don't have an excellent administrative partner. I urge clinicians that don't have this partnership to seek them out because their innovations will be implemented more quickly and effectively. I know there are clinicians with ideas as good as ours who are hamstrung by not having time set aside by their administration to innovate. If the surgeon is only loading trucks all day, they can't contribute to the leadership discussions."
Billing transparency is a huge opportunity to open a more active dialog with patients as well. The team hopes to develop an app that will expand that dialogue with patients and provide a public forum for idea sharing.
"It's like an idea forum," says Ms. Wendling. "Having a comment box is one thing, but to allow patients to electronically feed off each other is a great way to open a dialogue that will make healthcare much better."