Yawning doctors? Bored clerks? How Geisinger's 'money-back guarantee' is helping it spot problems early.

Editor's note: This popular story from the Daily Briefing's archives was republished on Nov. 9, 2018.

Rude clerical staff and yawning doctors are a few of the reasons why Geisinger Health System has refunded patients more than $1 million over the past three years, Joe Sylvester reports for The Daily Item.

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About Geisinger's refund program

About three years ago, Geisinger launched the ProvenExperience initiative. Under the ProvenExperience initiative, patients rate their experience on a mobile application, and if they're dissatisfied with their care, they can request a refund of up to $2,000 of their out-of-pocket costs. Geisinger gives patients their full requested refund, no questions asked.

But Geisinger uses the poor rating as a learning experience: A patient advocacy team examines every complaint to assess its legitimacy and takes steps to ensure related problems don't happen again.

Since the start of the initiative in 2016, Geisinger has refunded over $1 million dollars to patients and patient satisfaction ratings have improved. "The first thing we learned is that it's an amazing secret shopper program," said David Feinberg, Geisinger CEO.  He added, "In the small pilot we saw that patients told you what was going well and what wasn't going well."

The issues that lead to refunds

Jonathan Slotkin, medical director of Geisinger in Motion digital services, broke down exactly what Geisinger has learned. For example, he said "less than 5%" of patient complaints are related to "provider behavior." He continued, "We think that's good news."

The most common patient complaints are related to issues with "communication, access to care, the ability to get an appointment, communication on test results, environment of care," Slotkin said. For example, some patients cited poor communication about the status of their care, while others listed rude front desk clerks as the reason for their dissatisfaction, Sylvester reports.

The health system typically sees about 122 refund requests per month that averaged $460 each. For about 80% Geisinger resolves the issue through reduced bills, while about 20% are straight forward refunds, Sylvester reports.

"[The refund] could occur up front or after an event, even if the patient hasn't requested it and we found out about it," Greg Burke, an internal medicine physician and Geisinger's chief patient experience officer, said. "Some people, it could be an office visit $20 copay, and they had a very bad experience with a doctor." For example, one patient's "bad experience" involved a doctor that seemed "disinterested" in their condition, because they yawned during the patient's appointment, Sylvester reports.

But learning about those rare experiences, allows the health system to improve, Geisinger officials say. "We never are to question the patient experience," Burke said, adding, "It's basic business principles. It shows integrity on our part, as well" (Sylvester, The Daily Item, 9/6).

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