The Most Important Phone Call a Hospital or Health System CEO Will Never Make

I never watched an episode of Undercover Boss, but I’m not always part of the mainstream. The first season of the reality show about bosses posing as employees premiered after the Super Bowl in 2010, and the show went on for 10 more seasons. The show was popular because it showed bosses firsthand how their businesses were being operated.

I wonder who watched the show more — bosses who didn’t trust employees, employees who didn’t trust bosses or middle managers who didn’t trust either.

Hospital and health system CEOs sometimes cosplay this idea, the ones who “round” on floors to see what’s going on with patients and staff. We’re sold the story like it’s so special that it makes the CEO special. Maybe it’s so rare that it is special. It really doesn’t take much effort, and it seems like the bare minimum any CEO should do.

I bet the only time most CEOs can relate to what goes on in the healthcare organizations they run is when a family member (or the CEO) is seriously sick or injured. Only when they become a real patient — treated like everyone else, like the stars of Undercover Boss — do they experience what it’s like to navigate a system designed for everyone except patients. Of course, your smart CEO will pivot the experience into a storytelling device. CEOs are going to CEO.

What prompted these thoughts is a short but telling study published last month in Health Affairs Scholar. Six researchers with the USC Schaeffer Center for Health Policy and Economics in Los Angeles wanted to find out if they could get basic financial information from hospitals over the phone. They set up a “secret shopper” study to find out.

Posing as patients shopping around for knee endoscopy surgery and who are underinsured because they are in a high-deductible health plan, they called hospitals to find out four things:

• Does the hospital offer a financial assistance plan?
• Does the hospital offer a payment plan?
• Does a hospital-affiliated third party offer a payment plan?
• Does the hospital require a deposit before the procedure?

The study pool was 249 hospitals in 45 states. About 82% of the hospitals were affiliated with systems, and about 77% were not-for-profits. The average bed size was 226. The researchers called the hospitals between June and November 2023 and they called each hospital three times, minimum.

Here’s where the whole thing veers off course from the original objective of the study. The researchers had a hard time getting through to the hospitals, and an even harder time getting answers to the questions. We’re not even talking about the actual answers to the questions yet.

Here’s the crazy:

• 45 hospitals, or 18.1%, never connected the caller to an actual person or responded to a voicemail message.
• Callers made a total of 513 calls, and the hospitals transferred them 613 times.
• The average number of transfers was 2.5 times per hospital.
• The average time on the phone for “reachable” hospitals was 13.4 minutes.
• The average time on the phone for “unreachable” hospitals was 8.4 minutes. (Callers hung up after a maximum of 20 minutes.)

Even more crazy, most callers couldn’t get answers to the four basic questions from one person or one department. To wit:

• 203 hospitals, or 81.5%, shared financial assistance information.
• 201 hospitals, or 80.7%, shared hospital-administered payment plan information.
• 190 hospitals, or 76.3%, shared third-party payment plan information.
• 186 hospitals, or 74.7%, shared upfront payment requirement information.

“Patients currently have to make phone calls and typically speak with multiple hospital representatives to acquire this information,” the researchers said. “These burdensome encounters could exacerbate existing inequalities if patients who are less proficient in navigating administrative red tape cannot access important information about payment options.”

I don’t have the time, space or patience to detail all the information callers got when they reached the right person or department. I’ll work that into another blog post at some point.

Instead of rounding photo ops or getting sick or injured, maybe hospital and health system CEOs can get all the information they need — or not — about their organization by simply making a phone call.

Thanks for reading.