LifePoint Health uses a “secret shopper” program to learn what patients experience when they call for a price quote.


About two years ago, leaders at LifePoint Health were brainstorming ways to make the intake process for outpatient diagnostic services more patient friendly when someone asked the question: What happens when a patient calls a facility to ask about the cost of an MRI or other diagnostic exam?

To find out, staff members started dialing various LifePoint facilities, pretending to be patients seeking price quotes. The callers quickly gathered some important information.

“It was eye-opening to see the responses we got,” says John Kerndl, operations CFO for LifePoint Health, which owns hospitals in 21 states. “Sometimes people couldn’t answer the question, and other times they would quote full charges, which because of our self-pay discounts, isn’t actually what we charge to any patient.”

The exercise highlighted the need for technology that made it easier for revenue cycle staff to create accurate patient-specific price estimates—and overall improvements to the way frontline staff interacted with price-shopping patients.

Today, a price estimator tool is used in all LifePoint facilities, allowing staff to create an out-of-pocket estimate that reflects individual patients’ insurance benefits, deductibles and copayments, and the costs of the medical services they are inquiring about. Frontline staff are trained to use patient-friendly scripts that guide the price-shopping conversations. In addition, a formal secret shopping program helps managers monitor what is working and what needs improvement.

Implementing a Secret Shopper Program

LifePoint contracted with an independent company to conduct its secret shopper program as part of its overall focus on quality and patient experience. “That focus is not just a clinical initiative but it is on quality around every touchpoint,” Kerndl says. “This helps us make sure that when a patient calls one of our facilities to ask about services, their experience with that phone call is a very positive one.”

The vendor makes 120 “shopper” calls a month to various LifePoint hospitals. A surveyor uses a scoring rubric to evaluate each call. At the end of the month, the scores are tallied and presented to LifePoint, along with a recording of each call and the surveyor’s notes about each conversation.

Scoring Each Encounter

LifePoint scheduling staff who field price inquiries are trained to use a script—without being overly tied to it. Staff are expected to engage with the consumer rather than march through a script that doesn’t correspond with a consumer’s questions. “We want the conversations to be fairly structured, but we don’t want to sound robotic like ‘I’ve got to ask these five things,” even when two of them may not be relevant to the conversation,’” Kerndl says.

Surveyors score the staff member on five elements of the conversation.

Conversation opener. Did the scheduler use the appropriate facility introduction and ask the important question? “Instead of just saying ‘Good morning, this is John, Havasu Regional,’ it’s ‘Good morning, this is John Cardinal from Havasu Regional. How may I help you today?’”

Professionalism. Did the staff use the right terms—“may I,” “please” and “thank you” —when asking the patient for information. And did they inform the patient about any lags in conversation? “There can be long periods of silence when they use the estimator tool,” Kerndl says. “We want them to say, ‘Please bear with me while I look that up for you.’”

Soft skills. Was there a smile in the scheduler’s voice? While this element of the conversation is more subjective than the others, LifePoint wants to know whether staff members are sympathetic to patient needs.

Price estimate and payment options. Did the scheduler provide a cost estimate, and was that estimate accurate? The secret shopper will mention prices offered at other facilities, and the scheduler is expected to respond with information about LifePoint’s payment options. “If the patient says, ‘I called the diagnostic center down the street, and my out-of-pocket is going to be less,’ we want to at least be able to engage the patient in a dialogue,” Kerndl says.

Closing statement. The surveyor is listening for two statements: “Is there anything else I can help you with today?” and “Have a nice day.”

Using the Information

The information gleaned from secret shoppers is used for continuous quality improvement as front-end staff adapt to new responsibilities. Until a couple of years ago, patients almost never called seeking price quotes. LifePoint’s estimator tool and scripting are still new.

“This is really intended to be a learning experience and a positive experience for our staff,” Kerndl says.

When a secret-shopping report identifies problem areas, admitting department leaders use that information for training. And recordings of exemplary performance can also be used for training.

“If somebody does a great job, the leader can literally get the crew around the table and say, ‘We had a secret shopper, and Joe knocked it out of the park. Let’s listen to what he did,” Kerndl says.

Measuring Staff Performance

Secret shopper programs should not be established with the idea of catching staff members’ mistakes and punishing them.

“We say, ‘Here are the five things that we have to do well on every patient touchpoint, and we’re going to get everyone to 100 percent,” Kerndl says. “And this is one way that we’re going to be able to do it.”

Not only should the program not be punitive in nature, it should be used as a way to identify top performers. “Patients are calling, and these staff are answering the phone all day long and engaging patients, doing an incredible job, and in the past, we never knew it,” Kerndl says. “This gives us an opportunity to listen to those conversations and circle back with those staff members to say, ‘You are doing an absolutely great job serving our patients.’”

That said, Kerndl recommends that secret shopper programs be structured so that individual performance is measurable. While the soft skills element of LifePoint’s scoring rubric requires the subjective judgment of the surveyor, the other elements can be answered as yes or no.

Having numerical scores allows performance to be analyzed over time and between facilities to spot trends and identify areas that need additional training.

Realizing the Benefits

LifePoint’s secret shopper program identified a missing link in improved customer service—an accurate price estimator. With that tool in hand, LifePoint leaders are training revenue cycle staff to share the price estimates and using the secret shopper results to reward high-performing staff and identify areas for improvement.

Related Sidebar: An Emerging Patient Payment Option


Lola Butcher is a freelance writer and editor based in Missouri.

Interviewed for this article: John Kerndl is operations CFO, LifePoint Health, Brentwood, Tenn., and is a member of HFMA’s First Illinois Chapter.

Publication Date: Wednesday, November 04, 2015