How a hospital used expansive patient questioning to improve their experience

A pivotal change that led to breakthrough improvements in the patient experience at the University of Texas Southwestern Medical Center was the realization that patients form their impressions based not only on the care they receive but on the entire continuum of their interactions with the provider.

“We considered in our journey, not only looking at just the day of treatment but also the pre-care, preparation and discovery process, and just as importantly the post-care experience, the billing experience or the patient financial experience,” said Mark Meyer, CFO of the University of Texas Southwestern Medical Center.  His insights came during a July 17 session of the HFMA Digital Annual Conference titled “Diagnosis Financial Strain: One Organization’s Approach to the Patient Financial Experience.”

The hospital sought to understand its patients “true needs” and expectations by starting with a survey of 1,500 healthcare decisionmakers among their recent patients in four primary regions in Texas where they were looking to grow.

The effort aimed to move beyond traditional Press Ganey scores, where the organization scored in the 98th or 99th percentile, because those did not encompass the non-clinical experience.

“We have a very good clinical reputation but we haven’t always had the same opportunity to get feedback and understand what was lacking in the revenue cycle experience,” said Kelly Thornton, vice president for revenue cycle at the University of Texas Southwestern Medical Center.

The survey examined: Details of their last healthcare experience; Preferred financial experience; and Demographic details to understand their effect on net promoter scores.

Overall findings include 33% were willing to switch providers based on their financial or access experience.

Findings based on three age groups (18-34, 35-54, 55+) included:

• Similar results on whether they preferred estimates from the provider or an online source
• Similar results on whether they preferred online or in-person registration
• Similar results on whether they preferred online to mail-in bill pay
• Older group strongly preferred customer service through telephone calls instead of text
• Older group strongly referred to check in through in-person instead of through smartphones
• Middle group most wanted estimates and price transparency

The data allowed the hospital to shift its efforts from one-off responses to patient complaints to a “more wholistic view,” Thornton said. Also, there was a need to shift it revenue cycle optimization from a one-size-fits-all approach to one that was customized to patient details, like age, in order to improve it.

Responding to patients

To lead the response to the findings, the hospital used a 15-executive steering committee, which importantly included seven physicians.

The hospital aimed to move beyond its price transparency efforts, which it already provided through its digital platform, toward a “patient financial wellness” focus.

“We had staff that were empowered to work with the patients to make sure that they felt taken care of from a financial wellness perspective,” Thornton said.

One initiative that aimed to improve the overall patient experience resulted in working with vendors to offer a digital tool, since named Hello Patient, to let the hospital know if they were running late or if their clinician was behind schedule.

“With social distancing this became an imperative, versus a year ago when this was ‘Nice to have,’” Thornton said.

The initiative also switched immediate post-exam lab testing to one that used scheduling, which gave the hospital time to provide patients with estimates in advance.

Patient financial flexibility was added to take into account the recent surge in unemployment.

“Making sure that in an age where people may have lost their insurance or may not have a job that their financial wellness takes precedence in our discussions with our patients,” Thornton said.

That included extending payment plans, discussing their COBRA benefits, offering more generous charity care options and making sure they are well-educated on their options to pay their bills.

The hospital also realized that it needed to upgrade its financial and customer service employee training to move beyond just providing technically comprehensive information to emphasizing quality interactions. That led to it emphasizing patient interactions that had a problem-solving focus, instead of just stating the relevant financial issues.

Ongoing feedback

Such changes were credited with an eight-week increase from 60% to 69% in patients describing their interactions as high quality.

“That they feel like they were treated well—those are the interactions we are looking for from our patients, not just that we gave them the right information,” Thornton said.     

To move its elective procedure billing process beyond just providing patients with upfront payment options, the hospital worked with a vendor customize their experience based on their preferences. That included allowing patients to skip upfront prices when they preferred simply to get a bill afterward.

The hospital also added the ability to provide immediate patient follow up when a patient phone call “didn’t go as planned,” instead of waiting for a patient complaint.

The hospital aims to continue to monitor it changes through feedback from selected patients as they move through their care and through a new patient advisory panel.

“And so, patients do have many options that we have presented to them,” Meyer said.