Is Geisinger's Offer of Refunds to Dissatisfied Patients the Ultimate Satisfaction Tool?

The Pennsylvania health system guarantees a high level of patient care, and if patients leave unsatisfied, the organization will give back their copays.

It was during a conversation over lunch in a hospital cafeteria that Greg Burke, MD, FACP, and Geisinger Health System CEO David Feinberg, MD, MBA, developed a completely new approach to patient satisfaction.

Burke, Geisinger’s chief patient care officer, pitched the concept of ProvenExperience — the idea that the Geisinger Health System will guarantee a high level of patient care, and if patients leave unsatisfied, the hospital will give them a refund of out-of-pocket expenses.

“If you have a bad experience in our system, if we don’t serve you well and you are paying money for that, then we are going to give you your money back,” says Burke.

Although it is uncommon to offer refunds in the hospital world, the idea is not entirely new at Geisinger. Its employees have always been able to offer refunds to patients who have had complaints or grievances in the past. The practice is a part of the system’s approach to service recovery — the process of winning back trust after a patient becomes dissatisfied.

“I think the big difference here is what had been permitted in the past was now being promoted — and no other health system had ever done that,” Burke says.

Greg Burke

Burke says the idea of ProvenExperience was based on the system’s existing policy of ProvenCare. In the same way that Geisinger guarantees 100 percent compliance with the best standards of practice for surgical and medical conditions, it also strives to guarantee compliance with the best practices of patient experience.

The Geisinger Health System, which is made up of 12 hospital campuses in Pennsylvania and New Jersey with about 30,000 employees, which includes nearly 1,600 employed physicians, first explored the idea of ProvenExperience with a pilot study.

The study focused on patients undergoing two surgical procedures: lumbar back surgery and gastric bypass surgery. A group of 16 patients participating in the study were presented with an app that could be downloaded to their smartphones to review their hospital experience, ask questions and - if they felt dissatisfied with their care - request a refund.

Karen Hull, a dental hygienist and lifelong Geisinger patient, participated in the pilot study during her lumbar back surgery.

Overall, Hull was very pleased with her care, but she did experience a couple of minor disappointments. When she arrived in her hospital room after the surgery, the food she had expected had not yet been delivered. She also received an unexpected phone call from the hospital’s finance department before the surgery asking for a down payment, which she says blindsided her.

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Hull asked for a $150 refund to compensate for the inconveniences, and the refund was granted by Geisinger.

“I didn’t want to sound piggish, because my actual care for myself was not in any way, shape or form, I felt, neglected,” Hull says. “It was top-notch care.”

Hull says the refund and her experiences in Geisinger have left her satisfied with the care she has received. As a dental hygienist, Hull has a unique perspective on the responsibilities of health care professionals, and at Geisinger she felt the employees all treated her with respect and kindness.

“When you are going through a troubling time, and you have a lot going on in the hospital, every little smile or action counts,” Hull says. “We are all human beings, and we all want to be treated with love and gentleness and respect.”

Though Geisinger has received positive feedback from patients, transitioning to the ProvenExperience approach has not come without challenges. For example, the fear of fraudulent claims has been an ongoing concern, but Burke believes that if people are willing to trust their lives with Geisinger, it can trust its patients to be honest.

“There’s a number of concerns that many people raise that are legitimate, but the overall thrust we thought was so right to do and sort of had an ethical imperative, that it made a lot of sense,” he says.

There have also been unforeseen situations, like a refund request from a patient who was dissatisfied with a service from 22 years ago. The new policy, however, is not retroactive. Geisinger tells patients that it can’t make promises for the past.

Since the patient refund announcement was made in November 2015, about 100 refunds have been requested. Many of those are for smaller amounts; the larger ones range from $1,000 to $2,000. Most complaints are reported because of dissatisfaction with access, wait times and communication issues.

The number of complaints Geisinger has received went up after the first year — Burke suspects it was a 40 to 50 percent increase.

Though the changes have been a little painful, Burke believes they are a sign of good things to come.

“I use this metaphor, maybe because I’m a doctor: If you have an infection or a boil, you open it up and initially you don’t like what you see, but it’s part of the healing process,” he says.

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Burke says that Geisinger is the first to market patient refunds in this way, and he believes others are hesitant to follow suit because the process is complicated. But internationally, the idea is beginning to make waves. A gene therapy treatment from pharmaceutical company GlaxoSmithKline was marketed with a warranty: a refund for patients if the treatment was unsuccessful. The one-time treatment, called Strimvelis, is used to cure a rare disorder commonly known as “bubble boy disease.”

Several institutions in the United States have also contacted Burke with questions about the program, but Burke says Geisinger is less concerned with competing with other hospitals and more concerned about the treatment it administers.

“Our ultimate competition here is the diseases and the suffering that our patients have to deal with and that we are trying to help them with — that’s our competition,” he says.

Hannah O. Brown is a freelance journalist based in Florida.