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When my visit is complete, what are my options for sharing the Customer Satisfaction, Financial, and Clinical outcomes of my visit with others?

In some ways, evaluating your medical experience should be similar to any other consumer experience.  Try to follow the same philosophy of ‘if it’s good, tell everyone. If it’s bad, tell those responsible and give them a chance to fix it. Then, whether they fix it or not, tell everyone.’

But in another sense, your medical experience is more complicated than other consumer experiences.  You could think of it as having three different dimensions that may or may not be interrelated;  customer satisfaction, financial outcomes and clinical outcomes.  The customer satisfaction piece is close to other consumer experiences.  But the financial dimension is different, in that you may experience an unpleasant surprise that could completely taint everything else about your experience.  And assessing your own clinical outcomes is even tricker;  did you get the best outcome possible?  If not, who could have or should have made it better?

Why go through the effort to provide feedback?

Two important reasons;

First, we want to believe that every provider wants to make the next patient’s experience better than the last, and you can help with that. The degree to which they’re willing to invest time and energy on this may vary, but keep the faith.

Second, we have the direct ability to help the next person with your similar circumstances make a more informed decision for their own care.  And we can do this regardless of what the provider does, or doesn’t do, with your feedback.

This is specifically important in our current healthcare system that is struggling with transparency on quality, outcomes, costs, and patient satisfaction. Your feedback can be part of the solution.

Unfortunately, evaluating some aspects of your medical experience can be a bit more complex than evaluating other product or service experiences. It’s often helpful to think of three different dimensions to your experience: overall satisfaction, financial, and clinical.

It’s also important to understand the right timing for measuring your satisfaction. That should be after sufficient recovery or therapeutic time for you to have met your peak improvement and after all bills have been resolved.

 

So once you’ve decided how satisfied you are, who should you tell?

Tell us – the rest of the ChooseWell Community!  Share your story  so others can learn and inform their future decisions.

Yelp. That’s right, the same app you used to find a good Greek restaurant when you were visiting a new town. It’s not a typo. You can either enter ‘Doctors’ in the main search window, or navigate to ‘More Categories’, then ‘All Categories’, then ‘Health & Medical’, then ‘Doctors’ followed by their specialty (or another category if something other than a doctor).

If you have a condition, symptoms, or are receiving a treatment, take a look at Patients Like Me.  They provide connections with others like you for education and social support.

Smart Patients is an online community where patients and caregivers can learn from others like them.  This includes information on research, clinical trials, and personal stories.

In the unfortunate circumstance where you feel you've been harmed, go to The Voices of Patient Harm.  Sponsored by ProPublica, who gathered over 1,000 stories from patients and loved ones in all 50 states in an effort to confront the problem of lack of acknowledgement, accountability, or follow-up by providers.  Volunteer journalists can be matched up with sources to research and report in depth.  Also includes advice the harmed patients offer to others to avoid harm.

If you're interested in consumer feedback specific to medications, Iodine is a 'Community of over 100,000 people sharing their medication experience and advice.'

CAHPS surveys ask patients to report on their experiences with a range of health care services delivered in ambulatory, hospital, dialysis, nursing home and other settings.

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In what is believed to be the first large-scale analysis of such data, researchers from the University of Pennsylvania looked at 17,000 Yelp reviews of 1,352 hospitals from consumers. They found that the online information provides a broader sense of a facility than the current gold standard — a U.S. government survey that costs millions of dollars to develop and implement each year."

"The Yelp reviews had information about 12 additional categories that weren't addressed in the government survey. Those include the cost of the hospital visit, insurance and billing, ancillary testing, facilities, amenities, scheduling, compassion of staff, family member care, quality of nursing, quality of staff, quality of technical aspects of care, and specific type of medical care.

For positive reviews they included caring doctors, nurses and staff; comforting; surgery/procedure and peri-op; and labor and delivery. And for negative reviews, they included insurance and billing and cost of hospital visit.

'They relate to the interpersonal relationships of patients with physicians, nurses and staff,' said Benjamin L. Ranard, a junior fellow at the Penn Social Media and Health Innovation Lab and the study's lead author. This is important, he said, because 'prospective patients are likely to want to know how caring and comforting caregivers are in various departments of a hospital.' "

What Yelp can tell you about a hospital that official ratings can't, from The Washington Post

Source Study - Yelp Reviews of Hospital Care Can Supplement And Inform Traditional Surveys Of The Patient Experience Of Care, from Health Affairs

Hospital Safety Score grades hospitals on how safe they keep their patients from errors, injuries, accidents and infections.  From their newsroom:  'Selecting the Right Hospital Can Reduce Your Risk of Avoidable Death by 50%', according to Analysis of Newly Updated Hospital Safety Score Grades.

ConsumersUnion, a policy and action branch of Consumer Reports, sponsors the Safe Patient Project where patients can share their stories.  Topics include Medical Errors, Hospital Infections, Hip and Knee Replacements, and Doctor Accountability. 

Understanding Customer Service Outcomes

Overall Customer Service Outcomes are generally subjective, but it is also the easiest (compared to Financial and Clinical Outcomes) for you to assess.   And bear in mind;  you might get excellent medical care, but awful customer service.  They are not the same.

Customer Service outcomes could be thought of similar to any other service experience.

Consider:

Were you, your Proxy, and your visiting family members treated with dignity and respect?

Were you communicated with openly and clearly on all matters, and were you spoken to in terms you understood?

Were you listened to?

Did your doctors, nurses, and other staff seem to care about you as a person?

Was your environment conducive to healing?  Did the staff avoid unnecessary noise?  Did they avoid waking you up when it wasn’t absolutely necessary?

Based on these and other feelings you had about your visit, you would need to decide whether you were satisfied or not.  If you were dissatisfied with any aspect of your care, make sure you tell someone right away and, if possible, give them a chance to fix it.

Note that many providers will ask you to fill out a patient or customer satisfaction survey.  Please do so, and make your feedback there consistent with any other feedback you share outside of their system.  But also understand that some of the most valuable feedback you can offer (both to the provider and to other future patients) is from questions that the provider may not have asked.   For example, they may ask you how you liked the food, but not whether you were treated in a caring manner or if you were unnecessarily woken up in the middle fo the night.

 

Understanding Financial Outcomes

Financial satisfaction can be tricky to understand, but it can be fairly measured – especially if you did your homework in advance. The key to understanding financial outcomes is having some sense of what to expect, and doing the appropriate preparation to avoid surprises from bills for unanticipated excluded benefits or non-network providers.

 

Some general points …

You deserve to expect that your bill (both to you and your insurance plan) should be error free, and that you should only be billed for services and products that you requested and received.

You should not be balance billed for most services in most states.  Ambulance services in some states are the exception.

If you have questions about your bill, you should expect a contact within the provider organization who will answer your questions clearly and promptly.

If requested, you should receive details about the components of your bill, including a description and CPT, CSPCS, and ICD-10 code if you request them.

If your experience was contrary to any of the above, you probably have a good reason to be dissatisfied.

 

If you went to an in-network provider and all services you received were included benefits …

What you should expect is your out of pocket expense is exactly what’s reflected under your insurance terms. Make certain that your insurer’s Allowed Amounts have been applied to the Provider Charges. With the exception of services (such as preventative visits), you pay for everything up to your deductible, plus co-pays for anything over your deductible up to your out of pocket limit.

If your final bill is consistent with that, you should be satisfied.

 

If you went to an in-network provider (say a hospital) for a service that was an included benefit, but got an unexpected bill from an out of network provider (such as a consulting physician, anesthesiologist, or diagnostic service provider) …

Then …  Talk to your lead physician and/or a billing department representative for the out of network provider.

Was this out of network provider’s care or given under emergency circumstances?  Was there no opportunity to consult with your Proxy?  Or use an alternative in network provider?   If there was no other alternative, then you’re stuck financially, but you should probably also be grateful to have made it through the emergency.  Contact the out of network provider and explain that you had financially budgeted for included benefits from in network providers; (if true for you) that their bill is putting you under extreme financial duress; and ask them for a break.  Could they accept your insurance plan’s Allowed Amount instead of their Provider Charges?  Or a reasonable and customary rate based on prices in your area?  That may be the best you can do.

If your final bill is at or close to the Allowed Amount from your insurance plan, or reasonable and customary rates in your area, you may not be real happy, but you don’t have grounds to be completely dissatisfied.  Financially speaking, that is.  Don’t forget to thank your medical staff for helping you through the emergency!

If it was not an emergency, but you or your Proxy agreed to the provider services in advance, then you’re stuck financially.  Contact the out of network provider, explain that you had financially budgeted for included benefits from in network providers; (if true for you) that their bill is putting you under extreme financial duress; and ask them for a break.  Could they accept your insurance plan’s Allowed Amount instead of their Provider Charges?  Or a reasonable and customary rate based on prices in your area?  That may be the best you can do.

If your final bill is at or close to the Allowed Amount from your insurance plan, or reasonable and customary rates in your area, you probably should be satisfied and even grateful.  Even if you have to pay more, you probably don’t have the grounds to be dissatisfied since you or your Proxy approved the services in advance.

If it was not an emergency, and you or your Proxy were not consulted prior to the out of network provider being involved, did you ask in advance whether all the providers involved in your care were in network? If so you may have a legitimate complaint since you may have been mislead.  Contact the person you spoke to previously and remind them of the conversation, and see what they can do for you.  Start by asking them to waive the bill since you took the right steps to avoid this situation.  If you did not ask in advance whether all providers involved in your care were in network, you may be stuck.   Here is about the only real card you have to play – remind them that you plan on sharing your experience with lots of people, and that you would really prefer to share a completely positive experience.  Hint hint.  If that doesn’t work, could they accept your insurance plan’s Allowed Amount instead of their Provider Charges?  Or a reasonable and customary rate based on prices in your area? That may be the best you can do.

If your final bill is waived, you should be satisfied.  Make sure you Share your Experience.

If you didn’t ask in advance whether all providers involved were in network, and the provider settles your bill close to your insurance plan’s Allowed Amount or the reasonable and customary rate in your area, you should be satisfied and grateful.   Make sure you Share your Experience.

If you did you homework but got on satisfaction, you probably have the grounds to be REALLY dissatisfied.  If you didn’t do your homework, you will likely be dissatisfied.  But in either case if you signed an Informed Consent prior to the procedure and it included language specific to your financial responsibility absent insurance coverage, then you may not have a solid case for legal action.  Consider consulting an attorney if the bill is big enough since the legal cards may be in the provider’s favor.   Make sure you Share your Experience.

 

If you went to an in-network provider for a service that was an included benefit, but got an unexpected bill for excluded benefits …

Then …  Talk to your lead physician.

Was this excluded benefit given under emergency circumstances?  Was there no opportunity to consult with your Proxy?  Or use an alternative included benefit?   If there was no other alternative, then you’re stuck financially, but you should probably also be grateful to have made it through the emergency.  Was the excluded benefit properly coded?  Or was there latitude in how the service was coded that would allow it to be re-coded consistent with included benefits and re-billed?   If none of those work, explain that you had financially budgeted for included benefits from in network providers; (if true for you) that their bill is putting you under extreme financial duress; and ask them for a break.  Could they accept your insurance plan’s Allowed Amount for a similar included benefit instead of their Provider Charges for the excluded benefit?  Or a reasonable and customary rate based on prices in your area?  That may be the best you can do.

If your final bill is at or close to the Allowed Amount from your insurance plan, or reasonable and customary rates in your area, you may not be real happy, but you don’t have grounds to be completely dissatisfied.  Financially speaking, that is.  Don’t forget to thank your medical staff for helping you through the emergency!

If it was not an emergency, but you or your Proxy agreed to the excluded benefit in advance, then you’re stuck financially.  Contact the provider’s billing department, explain that you had financially budgeted for included benefits from in network providers; (if true for you) that their bill is putting you under extreme financial duress; and ask them for a break.Could they accept your insurance plan’s Allowed Amount for a similar included benefit instead of their Provider Charges for the excluded benefit?  Or a reasonable and customary rate based on prices in your area?  That may be the best you can do.

If your final bill is at or close to the Allowed Amount from your insurance plan, or reasonable and customary rates in your area, you probably should be satisfied and even grateful.  Even if you have to pay more, you probably don’t have the grounds to be dissatisfied since you or your Proxy approved the services in advance.

If it was not an emergency, and you or your Proxy were not consulted prior to receiving the excluded benefit, then did you tell your lead provider in advance that you wanted to avoid excluded benefits? If so, and this is a surprise, then you may have a legitimate complaint since you may have been mislead.  This is specifically true if you’re receiving a bill for unbundled, ‘atomic’ components of your care (such as tissues, pill dispensing cups, or the lights in the room) that your insurance plan considers to be part of the included benefit that they’re already paying for.  Contact the person you spoke to previously and remind them of the conversation, and see what they can do for you.  Start by asking them to waive the bill since you took the right steps to avoid this situation.  Here is about the only real card you have to play – remind them that you plan on sharing your experience with lots of people, and that you would really prefer to share a completely positive experience.  Hint hint.  If that doesn’t work, could they accept your insurance plan’s Allowed Amount instead of their Provider Charges?  Or a reasonable and customary rate based on prices in your area? That may be the best you can do.

If your final bill is waived, you should be satisfied.  Irritated, perhaps.  But satisfied.  Make sure you Share your Experience.

If you have to pay, you will likely be VERY dissatisfied, but if you signed an Informed Consent prior to the procedure and it included language specific to your financial responsibility absent insurance coverage, then consider consulting an attorney if the bill is big enough since the legal cards may be in the provider’s favor.  Make sure you Share your Experience.

 

If you went to an out of network provider, and  …

You negotiated reasonable and customary rates ahead of time …

Did you get billed what you expected?  If so, you should be satisfied.  If not, contact the person you spoke to originally and ask them to get involved.

Did you get a surprise bill for other services at the Provider Charge rate?  Ask if they would accept reasonable and customary rates based on prices in your area.  That may be the best you can do.  Whether or not you should be satisfied depends on the outcome of that conversation.

You did not negotiate reasonable and customary rates ahead of time …

You don’t really hold any cards in this particular game, especially if you signed an Informed Consent prior to the procedure and it included language specific to your financial responsibility absent insurance coverage.  Ask if they would accept reasonable and customary rates based on prices in your area.  That may be the best you can do, but either way, you probably don’t have the grounds to be dissatisfied.

 

 

Understanding Clinical Outcomes

Understanding your own clinical outcomes can be more subjective, and even more difficult, than understanding your financial or patient satisfaction outcomes.

 

The key questions after a full recovery include:

Ask yourself; Did you meet your own treatment goals? Ideally, you would have collaborated with your physicians in setting treatment goals that were meaningful to you and unique to your circumstances, and were communicated to all who were involved in your care. Were they met?

Ask yourself: Did you pick the right treatment plan to meet your goal? Ideally, you would have collaborated with your physicians in understanding what was and was not possible, and in choosing a treatment plan to best meet your goals. Now that it’s over, would you make the same choice again? Did you get the outcome you expected? Did you get the best outcome possible? What would you do differently if you had to do it all over again?

Ask your lead physician the same question: Did you optimize your treatment plan to meet your personal goals? Did you get the outcome you expected? Did you get the best outcome possible? What would they advise differently if you had to do it all over again?

Consider asking your lead physician:  Were there any medical errors associated with my care?  The majority of medical errors that occur are never reported to the patient.  But you have a right to know.  Just their body language may tell you alot.

Did you get the best outcome possible?  That is a really, really tough question since you can only guess what might have happened if you’d done something else.  And when is the right time to decide how good your outcome was?  Many hospitals, for example, stop thinking about you once you’re discharged, so their perspective might be that you got a great outcome for your shoulder  surgery if you did not have a post operative infection before discharge, and if you were not re-admitted for the same condition within 30 days.  But what about your perspective?  You might be more concerned with your ability to swing a golf club 60 days after surgery and after physical therapy – a point closer to full recovery.

And whether you did or didn’t get as good an outcome as you’d hoped, who was responsible? Who played key roles? If, for example, you had the shoulder surgery above in a hospital, many people played a role contributing to just how well the procedure went.

They include:

Your surgeon and their surgical team. Sub-optimal surgical procedures are, unfortunately, quite common. But it’s VERY unusual for the patient to actually know that they experienced one. All you can do is ask. If you’ve formed a trusting, personal relationship with your physician leading up to the procedure, you have a better chance of getting a candid answer when you ask them if things could have gone any better.

Your anesthesiologist. It’s not uncommon to have a flawless surgical procedure, yet a horrible recovery experience due to a poorly chosen or administered anesthesia.

Your post-surgical inpatient nurses and other caretakers. You could have a flawless surgical procedure, and no anesthesia hangover, but still have a horrible recovery process. Post surgical infections are, unfortunately, fairly common.

Your post-surgical therapists. You could have a flawless overall inpatient experience, but if your procedure included therapy for recovery, how well this was planned and managed often has as much if not more impact on meeting your treatment goals as the surgery itself.

And let’s not forget your own role.  Was your treatment goal clearly articulated to your care team? Did you collaborate with your physicians to pick the best treatment given your unique circumstances? In this example, you chose a surgical procedure, so did you do everything possible to prepare and to comply with post procedure care?  Did you go to all of your therapy sessions?

Remember:  We coach, support, educate, and empower.  We illuminate options you may not have known you had.  But we don't decide what's right for you in your unique circumstances; only you can do that.  And we don't provide medical, financial, or legal advice; nor do we replace the valuable counsel of those who do.