Revenue Cycle and the Patient Experience

Our medical mystery shopping work for hospitals and medical practices around the country has yielded some eye-opening insights, for both us and our clients. Foundationally, for any organization, it’s virtually impossible to understand the customer experience from the inside; they’re simply too close to the organization. “You don’t know, what you don’t know.” When you’re entrenched in the daily operations of an organization, you can become unaware of seemingly “small things” that impact the patient experience. Habits, traditions, and even sacred cows, permeate every culture; they often exist without question or even an understanding of why they exist. The mantra is, “We’ve always done it this way.” Yet these traditions impact the experience for those who are seeing the situation as outsiders.

Fresh eyes and ears lend a new perspective. Hearing direct patient comments yields emotional insights. For instance, in response to an encounter with a staff member: “She sighed and rolled her eyes. I thought that she was rude.” Or, when discussing the perception of the healthcare environment, “The filthy bathroom made me wonder if they clean their instruments. Hospitals and clinics should be spotless.” These types of comments and the accompanying photos that we share with our clients are impactful. You can’t argue with the facts.

While we tend to think of the value of medical mystery shopping in terms of the clinical or waiting room encounters, there’s another area where these insights can identify untapped opportunities: the revenue cycle!

When people think about revenue cycle, they typically think about the bill and the billing process. But the truth is, the revenue cycle actually begins with the first interaction between the patient and the healthcare organization. That is the time when the medical practice or hospital representative will discuss the services, insurance, and/or other payment options. It’s the perfect opportunity to manage the caller’s expectations about co-pays or other financial obligations in a clear, yet caring manner. There are actually financial touch points before, during, and after care is provided. Each one will have a bearing on the overall experience. Each gives the opportunity to act on behalf of the organization and represent the brand. Yet, many healthcare leaders overlook the opportunity to delve into the patient experience with the revenue cycle.

In the May 11, 2015 issue of Healthcare Finance,, Jennifer Zaino writes, “The U.S. healthcare system has taken a dramatic turn in recent years, as patients increasingly bear more costs in the form of higher-deductible plans and bigger co-payments. As a result, hospitals and health systems are evolving their approaches to collecting self-payments from patients who, given the costs they are bearing, increasingly view themselves as consumers and have greater expectations of the customer experience.”

Higher deductibles and bigger co-pays have made the consumers more discerning about their healthcare decisions. After all, this is their money at stake. When people spend their hard earned money, they want value and service. It is because of these shifts in the healthcare industry and consumerism that The Baird Group has been doing more and more work to assess the patient experience with the revenue cycle. Why? Because there is some solid information that links the patient experience to the patient experience and reimbursement. For instance, staff are not always comfortable asking for copays, or setting expectations about the billing and payment process. They may not be adept at offering financial counseling; they may fail to adequately respond to patient questions about charges, either before the service is rendered, or in response to a bill.

It’s important for healthcare organizations to understand, from the patient’s perspective, what is occurring at the front-end of a patient encounter. What expectations are being established? What information is being conveyed? Is that information conveyed in such a way that the patient clearly understands the payment process? Is it given in a compassionate and empathetic manner that is consistent with the organization’s mission and values? Is the staff tuned into non-verbal cues from the patient that indicate he’s uncomfortable or anxious when discussing the charges?

Just as healthcare “insiders” have a tendency to miss the “little things” that may lead patients to question the quality and safety of their care experience, they’re also likely to overlook those same sorts of “little things” that can impact the revenue cycle, creating misunderstandings that lead to inefficiencies, payment delays, and rework as well as dissatisfied customers. Engaging mystery shoppers will help you to identify opportunities for improvement at various touch points along the revenue cycle continuum.

In one mystery shopping experience, we found that staff was not comfortable discussing pricing information, nor were they consistent in offering financial counseling for patients who openly expressed concern about their ability to pay the bill. In another situation, the registration process was broken with multiple redundancies designed to ensure accurate billing but at the expense of the patient’s convenience.

In more than one situation we encountered staff in the billing offices who were abrupt or impatient with callers leaving them with the impression that, “All they care about is the money.” During one call, the billing clerk very harshly told the caller, “You do know that this is your responsibility, right? You wouldn’t expect to walk out of a restaurant where you have just eaten and refuse to pay.” Comments like that can leave a lasting, bad impression and are not consistent with the organization’s service standards or values.

What you don’t know CAN hurt you. Find out how mystery shopping can help improve the experience with your revenue cycle. Call 920-563-4684 or inquire at

Read more about mystery shopping and what to look for in a firm by requesting the whitepaper here.

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