February 2000 Bulletin

HEART system helps avoid senior citizen’s complaints

Physicians and their staff should be on alert for senior citizens’ complaints regarding billing inquiries or errors–at all times.

But the need to be sensitive to senior citizens’ concerns is heightened by the campaign, "Who Pays? You Pay," launched by the Department of Health and Human Services (HHS) and the American Association of Retired Persons (AARP).

HHS says Medicare patients should call the hotline if they find questionable charges such as billing errors for services or products not received or inappropriate or unnecessary services. If the claims of fraud and abuse are substantiated and action is taken against a provider, the Health Care Financing Administration (HCFA) will provide monetary rewards for the reporting patient.

But why put the whistle in the whistle-blower’s mouth?

"You can avoid a potentially egregious or litigious situation with your patients by using five easy tips, commonly referred to as the HEART staff-modeling system," says Kevin W. Sullivan, partner at Sullivan/Luallin Inc., a national health care consulting firm in Calif., who developed this system.

1. Hear. Persuade your patients that you are listening to them. This conveys caring. Patients are much more likely not to sue or blow the whistle on someone who cares for him or her. Use eye contact when you are listening to your patients.
2. Emphasize. Put yourself in your patients’ place by seeing the problem from their perspective. Tell them, "I can understand why you feel this way." This conveys you are empathizing with them.
3. Ask questions. Ask for details, particulars and to see their bill(s).
4. Review. Tell your patients what you’re going to do for them before they leave your office.
5. Take responsibility for follow-through.

Although the last step is "obvious," says Sullivan, "not all" orthopaedic practices are structured so that the person who receives the complaint is empowered to take responsibility for responding to it. "The most successful organizations in the country have structured themselves so that the person who receives the question or complaint takes personal responsibility for solving it," he says.

"If your staff completes these five easy steps, your patients will believe you’re on their side and that you sincerely want to help," says Sullivan. "The payoff is that the patient will become more loyal to you than if the problem had not occurred," he says. "And you just took the whistle out of the whistle blower’s mouth."

Getting bills processed in a timely matter also helps, says Sullivan. "You must also realize you’re dealing with a group of individuals whose memory may not be so keen. So patience [with them] helps."

In addition, Sullivan suggests practices routinely perform patient-satisfaction surveys to determine their strengths and weaknesses. "If you have valid data on your strengths and your weaknesses, you can bring your staff together to prevent any potential problems," he says.

Although there’s no such thing as an error-free model, Sullivan says, "You don’t want to lose referrals to the orthopaedist down the street."