February 11, 2019 -- There's no denying that patient consumerism in healthcare is a growing trend. But is that something we really want -- as radiology administrators, as hospitalists, as physicians? Because with true consumerism, healthcare delivery will shift to a true retail business, manifested amidst quality, price, and location shopping.
Within radiology and other healthcare specialties, there is now greater transparency, including widespread utilization of preservice price estimators and physician quality scores published on Medicare's Physician Compare website, vitals.com, and zocdoc.com, among others. However, a potentially more hidden precept of the retail business that is forthcoming is the patient refund.
Considering Patient Refunds
Should you be afraid of or should you embrace patient refunds? Here's an example from a rural Pennsylvania health system.
Based in Danville, PA, Geisinger Health System has gone to great lengths in its quest to improve patient satisfaction. Now well into its fourth year of implementation, Geisinger has a no-questions-asked money back policy of up to $2,000 per episode of care.
Only co-payments and deductibles are eligible for patient refunds. Between October 2015 and April 2018, Geisinger refunded $997,806, with the majority of patients not asking for a complete refund. The nearly $1 million in refunds over three years is a small cost to the health system as it has received valuable patient feedback throughout the process in terms of how to elevate patient care and improve patient loyalty, all while garnering plentiful amounts of media coverage.
Patient satisfaction rates within the Geisinger Health System have increased since the adoption of the refund process. With a portion of Medicare and Medicaid payments increasingly tied to patient satisfaction, the direct financial benefit can be realized even before the elements of loyalty and new customers are tallied.
Improving Patient Satisfaction
Paying meticulous attention to the customer is something we have seen implemented more and more often over the past decade. Although issuing patient refunds for dissatisfaction in care is not yet rampantly spreading throughout the U.S., patient satisfaction surveys have become more prevalent within healthcare delivery while serving a dual benefit.
In addition to helping practices better understand the needs of their consumers, implementing a patient satisfaction survey can meet the requirement of the high-weighted Clinical Practice Improvement Activities (CPIA) within the Merit-Based Incentive Payment System (MIPS). The CPIA represents 15% of the total MIPS score. As practices are trying to attain the maximum Medicare incentive reimbursement, they are also tapping into what their patients want to see changed and what they like about where they are receiving care.
According to the InstaMed 2017 "Trends in Healthcare Payments Eighth Annual Report," 40% of consumers fear the cost of the illness more than they fear the illness itself. Perhaps Franklin Delano Roosevelt was speaking in the parlance of his times when he famously said, "The only thing we have to fear is fear itself." This quote may have been revised if he was witnessing the anxiety associated with our modern-day healthcare payment models.
So what steps can one take to alleviate consumer fear? In surveying patients, one option quickly gaining in popularity is payment plans, with a 56% year-over-year increase in use between 2014 and 2017. In addition, in that same time frame, automatic payments have increased by 196%.
It is clear that consumers want to make payments through health plan websites or online portals, yet it is not time for practices to rest on their laurels simply because they offer both payment plans and portals to accept payments. According to this same study, only 21% of patients use payment portals regularly. Potentially of greater concern, only 30% of patients who use those portals were able to find an answer in the payment portal without the need for a follow-up phone call.
These findings may lead to another exploratory question: How can practices promote the use of a payment portal while alleviating the patients' need to ask additional questions? Here are a couple of suggestions:
The implementation of a photo bill pay for a more tech-savvy consumer is a viable method that many practices are embracing to speed up payment processing time and to increase the amount of time the patient spends interfacing with the platform.
Responding to patients who post reviews on physician-rating websites may also be a way to improve the online reputation of the practice. Any chance to hear the feedback of a patient is invaluable to drive change throughout the complete experience. Specifically, a baseline is required within the patients' cycle of care, encompassing how payments are accepted, how the amount owed is communicated, and how patients are treated by the entire staff from the physician and technician to the scheduling department and billing representatives. All of these employees are crucial to the patient feeling that the service performed was worth the time and their money.
The use of real-time demographic databases provides eligibility verification for the patient's current health insurance. Additionally, these portals will provide a detailed benefits package tailored for each patient that outlines the out-of-pocket expenses following the insurance payment. These are necessary tools to help eliminate patients' questions connected to their financial responsibility.
Overall patient satisfaction -- and its correlation to payments, refunds, or nonpayment for service delivery -- is becoming more critical than ever in a pay-for-performance world.