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Do You Have Patients or Customers?

Op-Med is a collection of original articles contributed by Doximity members.

Satisfied patients are the true measure of health care quality. — Dr. Donald Berwick, former administrator of CMS

For those physicians who see patients daily, it is increasingly clear that there has been a noticeable shift in how patients perceive themselves within the health care system. Patients do not see themselves only as medical care recipients but also as health care consumers. They are expecting customer experiences similar to other consumer experiences and are progressively asserting their preferences for value and convenience. Many physicians have been slow to adapt, preferring to think of patients strictly in terms of their medical needs as opposed to their customer wants. This way of thinking hark back to the "golden age" of medicine and a more paternalistic system.

However, that way of thinking might be harming your practice's fiscal bottom line. There’s a clear link between patient satisfaction and profitability as a practice. Perhaps just as important, there’s also a clear link between poor patient experiences and financial failure. A Medical Economics article claims a 17-27% variation in finances based on patient perception. Patient satisfaction scores tying to financial performance isn't isolated to private practices. A paper from the Public Library of Science, titled “Correlation between hospital finances and quality and safety of patient care,” found that “strong financial performance is associated with improved patient-reported experience of care, the strongest component distinguishing quality and safety. These findings suggest that financially stable hospitals are better able to maintain highly reliable systems and provide ongoing resources for quality improvement.”

Another recent study by Deloitte, after controlling for hospital and local area characteristics, found that hospitals with high patient-reported satisfaction scores have higher profitability. They determined that the association of hospitals with high patient-reported experiences and better hospital financial performance is likely due to earning disproportionately more than they spend, having highly engaged staff, and receiving value-based performance incentives. Among the factors most associated with high patient satisfaction were staff engagement measures including staff quality, staff communication and responsiveness, and ease of appointments. 

Of course, these findings are correlational in nature, not definitive proof of causation, which calls into question the age-old chicken vs. egg dilemma. That said, we suggest that if you want to frame “exceptional medical care” as priority #1 for you as a doctor or clinician, just make sure you also frame “patient satisfaction” as priority #1 for you as the proprietor of a health care practice.

Patients nowadays have more information and greater choices of health care provider (doctor, medical practice, facility, and hospital) at their disposal. As such, it would behoove you to begin thinking of them as customers also, not just patients. 

An exercise we encourage all practice owners to undertake in order to ensure your patients have an excellent consumer experience is to map out your patients’ customer journeys. According to Gartner, a research and consulting firm, “A customer journey is a tool that helps marketers understand the series of connected experiences that customers desire and need — whether that be completing a desired task or traversing the end-to-end journey from prospect to customer to loyal advocate.” Since a customer journey might be new to some of you, here’s an example of a patient’s customer journey in pictorial format, as well as a written description with sample questions to consider.

We start with awareness of the practice, which includes all the ways patients are introduced to a clinic’s services: online, print, mail, word of mouth, etc.

  • How do patients learn about your practice? 
  • Is your messaging consistent? 
  • Are you successfully reaching your desired target audience?

The patient then moves on to scheduling an appointment.

  • How easy is it for patients to make an appointment? 
  • Are phone calls answered promptly?
  • When is the next available appointment?

Impressions upon arriving at the facility are next. 

  • Is there prominent signage?
  • How easy is it to find parking?
  • Is the facility clean and appealing?

Because the time patients spend with physicians is shrinking across specialties, staff interactions are becoming increasingly important. Optimizing registration can help make a great first impression.

  • Is registration online, in-person, or both?
  • Are patients able to provide insurance and other check-in information prior to arrival?

The actual delivery of care has historically been the most analyzed, and rightfully so. Quality metrics and evidence-based care are paramount, but other customer concerns should also be accounted for.

  • How long is the wait to be seen?
  • Are patients involved in the decision-making process?
  • Is the treatment plan communicated to the patient in a comprehensible fashion?

Attention should also be given to post-care testing and departure from the facility.

  • What is the timeliness of results reporting?
  • Do patients know when the appointment is over?
  • Are the parking fees low, or even better, complimentary?

The back-end processes of a medical practice like insurance billing and patient billing are common friction points and should be carefully analyzed in terms of the patients’ touchpoints with these functions. 

  • Are the coding and submissions accurate and timely?
  • Are there options for online payment and statement options?
  • How does the practice handle collections?

Finally, a keen eye on retention of patients is the last step to consider.

  • Are you soliciting honest patient feedback for genuine process improvement?
  • Is your staff proactively reaching out to schedule follow-up appointments or to re-book missed appointments?

Ultimately, what does thinking of your patients as customers look like? It means imagining every single step they take as they interact with your practice. Going through this process honestly, thoroughly, and with a fresh set of eyes can be very revealing. You may also want to repeat this exercise from the perspective of multiple different patient personas or avatars.

Both of us have each operated our own medical practices, and found that considering the customer journey through the lens of our patients was incredibly instructive. By asking the question, “What would the ideal patient experience look like for this step?” we were able to identify several pain points to address. Patients were frustrated by the inability to get calls through to the right department, whether it be for appointment scheduling or medication refills, and also by delays and errors in the claims processing by outsourced billing. Accordingly, we created local call centers and brought billing in-house. Although there was an initial steep learning curve, and the process was somewhat tedious at times, insourcing those two functions ultimately allowed us to dramatically improve patient satisfaction and, interestingly enough, our bottom lines. As a bonus, we also found that when a patient's overall experience exceeded their expectations, it provided our clinics with what we termed a “customer service cushion.” Whenever they encountered a future minor issue, having a positive set of prior experiences at our clinics provided a buffer and they were more willing to give us some grace.

Our hope is that by taking all of the above steps and ideas into consideration that you will be able to create a patient-focused customer experience that will not only improve your patients’ medical health, but also your practice’s financial well-being.

What does your patients' customer journey look like? Share how you'll improve it in the comments.

Stephen W. Chang, MD, MBA and Mark P. Eid, MD, MBA are Co-Founders and Managing Directors of Acts Financial Advisors, an SEC-registered wealth management firm with over $100 million in assets under management. Dr. Chang trained at Memorial-Sloan Kettering as a breast radiologist before pivoting to medical practice management. Prior to co-founding Acts Financial Advisors, he also ran a diagnostic laboratory, founded and sold a multispecialty practice, managed an allied health school, and consulted for McKinsey & Company in their health care practice. Dr. Eid is a Hopkins-educated and fellowship-trained Mohs surgeon who founded, grew, and ultimately sold his multi-location dermatology practice to a large dermatology platform. He also heads a real estate development and consulting firm, EGE, which has transacted and advised on deals worth hundreds of millions of dollars.

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