Starting in 2015, Geisinger Health offered a refund for poor patient experience outcomes as part of a general service recovery commitment. The refund was limited to co-pays, deductibles and co-insurance in both the inpatient and outpatient settings.
Taking a lead from consumer markets, a “no questions asked” refund policy was integrated into the system’s overall mission to make everything it does be part of “caring”. It was argued that if failures occurred in communication, empathy, efficiency, or hospitality, a patient should have their financial contribution forgiven or adjusted. Issues revolving around quality, safety and medical management were excluded. Frontline patient advocates were empowered to manage refunds at the earliest entry of the complaint. Office managers, front desk assistants and inpatient leaders were given the authority to make real time decisions to provide a refund when asked or when the situation demanded it.
Ultimately, the system desired to show an ethical commitment to its patients and families that poor service was unacceptable and financial risk would be incurred by the system for such failures. To use a common phrase, the health system would now have “skin in the game”. Difficult cases would be mitigated by leadership in the patient experience department to make sure the promise was applied with integrity and in consistency with its goals.
The refund promise remains active at Geisinger and has prompted ongoing discussion on service recovery and has set an example to other systems worthy of imitation. Its guiding purpose is to put the patient at the center of the interaction and demonstrate healthcare’s responsibility for the totality of the experience a patient and family encountered.