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April 18, 2016

$80,000 in refunds: What Geisinger has learned from its money-back guarantee

Daily Briefing

    When Geisinger Health System CEO David Feinberg started offering money-back guarantees to dissatisfied patients, his fellow industry executives though it was "a dumb idea," he tells the Washington Post.

    Staff were skeptical, too. Some worried patients would abuse the initiative, under which they can request a refund of some or all of their out-of-pocket costs in a variety of ways, including through a smartphone app.

    However, the success of the first-of-its kind program in improving patient satisfaction scores and informing improvement initiatives has quieted the skeptics, and the University of Utah Health Care is considering starting a similar program, the Post reports.

    Just 74 refunds

    The vast majority of the feedback from patients through the app has been positive, and Geisinger has shared the comments to praise specific staff members for their performance.

    Meanwhile, very few dissatisfied patients have asked for refunds. Between October—when the system began testing the program—and mid-March, just 74 patients asked for their money back, leading to refunds or waived charges totaling about $80,000. That has been money well spent, Feinberg tells Healthcare IT News.

    "Over the past six months," he says, "we've spent $80,000 on the best secret shopper program ever."

    Feinberg says two aspects of the program have surprised him.

    First, most patients who have given negative feedback have clicked the option to give positive feedback, too.

    Second, nearly all patients who ask for refunds request only a portion of their money back, even though Geisinger will give full refunds, no questions asked. (At Starbucks, Feinberg observes, "If you don't like the cappuccino, they don't sip it and say, 'We made it right, we're not giving you a new one.'")

    Is a Starbucks-style loyalty program right for hospitals?

    Most refund requests have pointed out clear opportunities for improvement, he notes. "The negatives, by and large, if you read them you'd say 'Oh, we messed up,'" with common topics including care coordination, communication, billing issues, parking, and noisy hospital rooms.

    Feinberg has submitted some refund requests himself after talking with patients on the rounds he makes nearly every day.

    Geisinger sees "refunds as more of an opportunity than as a bad thing" and has already started acting on the patient feedback, Feinberg says. For instance:

    • To improve food options, the system hired a new corporate chef to create improved menus at each of the system's hospitals;
    • To improve communication, all staff are receiving new training to ensure they introduce themselves to patients, request permission prior to performing procedures, and inform patients about what will happen next; and
    • To reduce concerns about ED backlogs, Feinberg is creating a plan to eliminate wait times in three years.

    On a more fundamental level, Feinberg believes the money-back guarantee—which started as a pilot program and expanded to the entire system in April—will help advance a needed culture shift for the system.

    Before the initiative, Geisinger was providing "probably the best care as far as quality and safety, [but] it wasn't particularly or consistently compassionate and kind," says Feinberg, who took over as CEO last May. The century-old organization had doubled in size in the past few years, and "there was a lot of focus—you could say distraction—on our growth. We had lost our way around that, connecting with patients in a very intimate and privileged way."

    The new program, Feinberg adds, will help "make sure we not only have the right care that is high quality and safe, but [that] ... our care is compassionate, dignified, and delivered with a lot of kindness" (Sun, Washington Post, 4/15; Miliard, Healthcare IT News, 4/12).

    The keys to building patient and consumer loyalty


    The word "consumer" hasn't been in the health care lexicon for long. Yet it's undeniable that today's patients have more places than ever to shop around for health care.

    Getting patients in the door—and keeping them coming back—means providing both a 21st century consumer experience and a top-notch patient experience.

    To build loyalty, you need to understand a person's needs on both sides of the coin. The good news? Patients and consumers are more alike than they are different. Focus on three key values to win them over.


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