A Guide to Patient Satisfaction in the Age of Consumerism

As patients take on increasingly heavy financial burdens¹ for their healthcare through burgeoning premiums, copays, and deductibles, their tolerance for subpar service diminishes. And the standard to which today’s healthcare consumers hold their physicians—not surprisingly—is the quality they experience when purchasing services from any business.

The call to action for physician practices, therefore, is to elevate their own standards for service, convenience, transparency, and communication—keeping in mind that in the internet age, positive or negative word of mouth can spread instantly and be far-reaching.

“Patients are making their decisions behind the scenes before they ever call you,” says Judy Capko, practice management consultant and author of Secrets of the Best-Run Practices.

Invest in an Online Presence

In fact, 80 percent of consumers have used the internet to make a healthcare-related search in the past year, according to a 2018 survey² from Doctor.com, and 60 percent will not book an appointment if they don’t like what they see. Moreover, 81 percent of consumers will still check out a doctor online after being given a strong referral from their primary care doctor, the survey found, while 90 percent reported they frequently change their mind about a referral if the provider has poor or weak reviews. More than 80 percent said excluding quality care, customer service is the most important factor influencing their loyalty to a provider.

As a result, Capko recommends practices take the following steps to manage their online presence:

• Keep practice websites updated with latest practice news and offerings
• Enhance features (e.g., online scheduling, patient portal) as new technology becomes available 
• Review and update clinician directories twice per year 
• Conduct an online search of the practice to evaluate web presence and reputation, but refrain from responding to negative feedback in a public forum 
• Use a 3x5" card to gather feedback from patients at the time of the visit—before they have the opportunity

Capko says these tasks should be included in staff's job descriptions. "Whenever it's everybody's job, nobody does it," she explains.

If administrative employees don't have enough downtime to keep up with the effort, Capko recommends staffing up.

"The cost/benefit ration is tremendous," she says, "even if you add another employee."

Prevent Sticker Shock

A fundamental way to promote patient satisfaction upfront is by providing early and accurate price transparency.

“We like to say, ‘the patient is the new payer,’” says Eric Raup, a senior vice president of product management with Change Healthcare. “We need to think of patients as consumers. We don’t want a poor billing and payment experience to cloud what was otherwise a very positive clinical experience.”

A leading frustration among healthcare consumers is having no idea how much they will owe until after care is rendered and they receive a bill. According to Raup, patients don’t resent the fact that they have to pay for care, per se; what upsets them is sticker shock.

“Let’s say a patient will owe $1,500 for a test or procedure. The same bill, for the same amount, is thought of differently if a conversation is had with the patient before anything takes place,” Raup says. “It’s about setting proper expectations with patients and taking on an educational, rather than adversarial, role.”

With information in hand that provides not just a cost estimate but also a breakdown of the total, patients can make an informed decision about whether to proceed, shop around, or seek alternative treatment options. And with proper insight about a practice’s payment options and policies, patients can decide early on whether they will pay upfront or arrange a payment plan. “The key is having those conversations up front, while the patient has an opportunity to consider all of the facts,” Raup says.

While obtaining good cost estimates for healthcare has historically been elusive for physicians, patientestimation tools are now more abundant than many practices realize, says Raup.

“This is no longer an emerging technology; there are plenty of good estimation tools and services available,” he says. The tools come in many different forms, he adds, many of which practices may not realize are already included in their practice management or revenue cycle management packages.

Some of these products use payer contracts to estimate payments, Raup explains, while others use historical data. Ideally, a tool will also account for patients’ eligibility and where they stand in terms of their annual deductible, co-pay, and outof- pocket limits.

The ideal tool would also include even more layers of decision support, says Gregory Weidner, M.D., FACP, medical director of primary care innovation and proactive health at Atrium Health (formerly Carolinas Healthcare System) in Charlotte, N.C.

“We have to evolve to a point where the physician and patient together can determine not only what’s most clinically relevant and appropriate, but also the financial upside and downside,” he says. “If we ignore that part of the equation, there’s a risk of care avoidance or financial toxicity.”

Foster Practice-Patient Partnership

In addition to obtaining or activating costestimation modules, practice staff and physicians need education in how to use them and explain the benefits to patients. For example, patients don’t always understand the difference between preventive (fully covered) and diagnostic services, notes Kathy Nieder, M.D., a primary care physician with Baptist Health Medical Group in Louisville, Ky. “We’re seeing movement toward better information, but many patients are not empowered or knowledgeable enough to understand it.”

Practices that are most successful at collecting from patients, according to Raup, educate their frontand- back office staff to have a simple, informed conversation that walks people through industry terms, such as co-pay and deductible, in plainspoken language.

To give front-office employees more bandwidth to discuss these issues with patients—and vastly improve practice workflow—Capko recommends taking them off the phones and using a call center.

“When you go to the bank, the teller isn’t answering the phone while processing transactions,” she notes. Using a call center requires the same amount of resources as a traditional practice model but balances them more efficiently, she says.

Meanwhile, practices can further smooth the check-in process by allowing patients to complete forms online at home and/or register using a tablet or kiosk. “Consider all the kinds of services most industries are trying to offer their customers,” Nieder says.

To avoid denials or other problems on the back end, automate eligibility checking before patients arrive, Capko notes.

Patient reminders are another prime candidate for automation, she adds. And it’s important to contact patients in the method they prefer. While some patients like receiving phone calls or emails, text messages are the best way to get a response from others.

“We need to have systems that are flexible enough to not only offer multiple modalities for that communication but also learn based on what individuals have been responsive to in the past,” Raup says.

Finally, offer an array of easy ways for patients to pay their portion of the charges. This means not only accepting cash, checks, and credit cards in person and online, but also being able to offer reasonable payment plans.

While patients appreciate flexible payment options, the practice financial policy should be clear, well understood by staff, and applied consistently, Capko says. It also has to be workable for a practice’s revenue stream. “You can’t agree to let a patient pay $10 a month when they owe $1,000. It will cost you more to collect than you’re ever going to end up with.”

Offer Easy Access

Practices shouldn’t just make it easy for patients to pay; they need to be easier to deal with in the first place. After all, much of what draws patients to retail clinics, urgent care centers, telemedicine providers, and online seeking care is what these options avoid: cost confusion, wait time, and the need to miss work or school.

Fortunately, practices can eliminate or reduce many of these hassles by providing extended hours, online scheduling, and useful resources.

Adding hours can be a tough sell for some physicians, acknowledges Capko. “They’ll give it a try. They’ll open on Saturdays for a month and then say nobody came,” she says. “But that’s often partly because they didn’t market it, have it on their website, or even a sign in their office.”

Not only do extended hours take marketing and time to build momentum, she says, but they need to be offered during peak periods. Practices can learn the best hours to set by tracking their appointment requests and call volume.

Success also takes commitment from physicians and staff, Capko says. For example, in a four-doctor practice, each doctor could cover one Saturday per month and have a different day off during the week. Coverage requirements may vary by season, she adds, noting that primary care needs often surge during fall and winter.

In addition, patients increasingly desire the convenience of scheduling their own appointments online. “So often today, physician practices still don’t have online scheduling,” Raup says. “And the online schedules that do exist frequently aren’t integrated back into the system.”

In other words, these platforms merely allow patients to submit a request for an appointment at a desired time, but don’t allow them to actually book anything. “That isn’t how anything in the rest of our consumer lives works,” he says.

Part of practices’ resistance to online scheduling is fear that patients will book the wrong types of appointments, Capko says. But in reality, the practice can set parameters. For example, it can make the service available only to existing patients, for just follow-up visits, or some other specification.

Help Patients Troubleshoot

Another reality of today’s healthcare consumer is that the service they seek isn’t necessarily in the form of an appointment, Weidner says.

“In many cases, the patient is not looking for a billable encounter, which is healthcare as we’ve traditionally defined it,” he says. “They’re looking to have a problem solved, a question answered, or to get support or insight.”

Thanks to smartphones and the internet, patients have access to a great deal of “DIY healthcare,” Weidner says. “What in the past might have been a billable encounter could today be a Google search or interaction with an online community of people with the same condition.”

Practices can play a key role in providing this support directly. They can guide patients to credible resources by providing links on their own websites and social media channels. Doing so not only helps keep a practice’s web content fresh but can also provide guidance on when patients really need to make an appointment.

Practices and physicians can also deliver useful information to patients directly. A self-proclaimed “geek,” Nieder maintained a blog for some time. She wrote about her personal insights on medical topics and found her patients grateful for information no one else had provided them.

And when public health issues arise, practices are behooved to email patients directly with answers to anticipated questions, Capko says. For example, practices in the vicinity of a wildfire could gather and disseminate key information about air quality, when/whether to stay indoors, what kind of mask to buy, special considerations for those with asthma, and when to seek medical attention.

While curating and sharing health advice may not directly impact revenue, staying engaged with patients is a key to maintaining their loyalty, Capko notes. In addition, “keeping an existing patient is much less expensive than obtaining a new one.”

Provide Virtual Visits

Ultimately, meeting the consumer definition of convenience and access means physicians make their expertise and resources available to patients in the lowest cost, simplest way, Weidner says.

Although the lingering volume-based incentives in today’s healthcare system pose challenges to adopting these changes, consumers paying for their own care will increasingly speak with their feet, Weidner predicts.

Already, reimbursement for telemedicine is improving, Capko says. Follow-up phone or video appointments, for example, “are easy to justify with payers and get reimbursement,” she says. Telemedicine can also be used to screen patients to see whether they need to be seen, she says. “It’s a big patient satisfier to not have to leave work unnecessarily.”

As with any new service, employees have to be trained and committed to using it properly. In particular, these appointments need to be added to physicians’ schedules just as if they were in-person visits. “You don’t just tell them to call at 4 p.m.,” she says. “You have it in your appointment book, so the doctor can review the chart ahead of time and it can go smoothly.”

Monitoring results is crucial, Capko adds. “See if the strategy is working and if there’s anything you can do to improve the experience for you or the patient.”

Make Records Accessible

Meaningful use requires physicians to give patients a summary of their visit before they leave. The summary should include information derived from their EHR, such as medication lists, diagnoses, instructions for self-care, and potential follow-up.

There are benefits to taking that concept a step further and providing patients with direct access to their records through patient portals, Capko says. “There are some wonderful tools out there that practices don’t necessarily use.”

Most EHR technologies allow practices to refine what the patient can access, she says. For example, patients may be able to log in and view the date of their last mammogram or colonoscopy, check lab results, or even view graphs of changes in their cholesterol or weight over time. On the back end, physicians can prevent sharing of test results before they’ve reviewed or discussed them with a patient.

“In general, giving people access to and control over their clinical data from a variety of sources gives them the freedom to understand their health better, gain insight on all aspects of their healthcare, and empower (them) to take appropriate action on their own behalf,” Weidner says.

Have a Plan

The more patients pay for their own healthcare, the higher their expectations of physicians and practices will become. And the rate at which patient responsibility has risen in recent years is significant.

For example, in 2016 unsubsidized customers of eHealthInsurance³ paid an average of $321 per month in premiums for individual coverage, while family plans averaged $833 per month. According to the online provider of health insurance, the average annual deductible for individual plans was $4,358, while the average family deductible was $7,983.

It’s not just patient finances affected deeply by this trend.

“This isn’t a new or rare issue anymore,” Raup says. Practice revenue depends on collecting significant balances from a growing percentage of individual patients, not just the $25 co-pays that dominated collections a decade ago.

To stand up to these new challenges, he says, practices must develop a plan that optimizes processes and technology to deliver an empowering, consumer-oriented experience.

^{1 "High-Deductible Health Plans and Financial Barriers to Medical Care: Early Release of Estimates from the National Health Interview Survey, 2016," Robin Cohen and Emily Zammitti, National Center for Health Statistics, 2017.
2 "Customer Experience Trends in Healthcare," 2018 Consumer Survey, Doctor.com.
3 "Here's how much the average American spends on health care," Bloom, Ester, CNBC.com, June 23, 2017.}