Reward staff for meeting collection goals with patients now paying 'less than ever'
Reward staff for meeting collection goals with patients now paying 'less than ever'
Pressure to increase collections is growing
There is no doubt that an incentive program can result in increased upfront collections. There's also no question that it's more important than ever for patient access to get results.
"While collections has always been a priority of the patient financial service department, we have seen a higher degree of focus on improving collections," says Kym Clift, director of patient accounts for PeaceHealth's Whatcom Region in Bellingham, WA.
One challenge the department is dealing with is how to determine quickly if the patient is able to pay, and if so, how likely he or she is to pay.
"Often we are not able to determine this prior to or at time of service, so we chase this information on the back end of the collection cycle," says Clift. "With the state of the economy, the reality in today's self-pay segment is that more patients are able to pay less than ever before. The earlier in the revenue cycle that we can make this determination, the more focused we can be with our resources to collect from the patients that can pay."
Craig Pergrem, MBA, CHAM, corporate director of patient business at Orlando (FL) Health, says that his department "has definitely been challenged this year to improve our collections." Pergrem says that the biggest obstacles that he is seeing this year involve high-deductible plans and the lack of education for the patient population on exactly how high of a dollar amount they will owe.
"We are seeing $5,000 to $10,000 deductibles more frequently. The patients are either unaware, can't bear that large of a cash burden, or both," says Pergrem. He adds that the hospital also has seen a drop in elective procedures as the year has progressed. "Some of that, I believe, is due to the higher co-pays and co-insurances. But I also think it might have something to do with those patients that are employed not being comfortable taking six to eight weeks from their jobs off in these economic times," says Pergrem.
Orlando Health's patient access staff are "definitely seeing our charity and bad debt increasing as the job market shrinks," says Pergrem. "COBRA may be available, but there aren't a lot of people out there that can afford to pay those high premiums with no income coming in."
Pergrem reports that "collections for us have remained flat in 2009. With the economic conditions, there are more people that have lost insurance or just don't have the means to make payments in full."
If procedures are elective and not a medical necessity, payment is requested prior to surgery. "If the patients cannot pay prior to service, we ask that they reschedule when they have the appropriate funding," says Pergrem. "We have seen a spike in our bad debt over the past two months. We know this is related to fewer people having insurance, as well as the high-deductible plans."
Pergrem says he tries not to put individual patient access staff members under unfair pressure. "They know there is money out there to be collected and they do a great job, but we also continue to raise the bar for them," he says. "Our patient access areas are sitting with these patients face to face on a daily basis. They hear the stories that these patients are struggling with. There are many of our own representatives that are having the same issues of a spouse losing a job or losing hours themselves as we flex staffing to adjust to our scheduled appointments."
Debby Cornett, RHIA, corporate director of patient access, transcription, and health information management at Jewish Hospital and St. Mary's HealthCare in Louisville, KY, says that her organization is developing an incentive plan. The decision was made as a result of hearing several success stories from other hospitals that increased collections after implementing incentives.
The incentive program will give team members the opportunity to receive incentive pay, and also improve their salary. "In addition to implementing an incentive program, we are going to balance quantity with quality," says Cornett. "Therefore, we are also planning a quality program related to cash collections."
Direct observation will be done, as well as patient questionnaires. "We are also going to include quality checks in regards to patient estimates," says Cornett. "We want to make sure that team members are utilizing the tools they have been given, such as scripting, to obtain our goals, as well as assist our patients."
Don't set goals too low
Pergrem says that his staff are challenged every year to improve collections, and this year is no exception. Currently, Orlando Health has a structured incentive program built around these three areas within its access departments:
1. total collections for their individual department;
2. total corporate patient access collections, with all access collections combined;
3. total collections of patient accounting.
"Some months you may hit all three of these and receive the entire incentive. Some months you may only receive a partial incentive, and there are months that no incentive pays out at all," says Pergrem. "The goals are very aggressive, and the team members know that it takes a big effort to obtain those goals."
Pergrem thinks that one potential pitfall with incentive programs is that goals are set too low. "Often once they are obtained, there is a slacking off of collections to try to save for the next month," says Pergrem. "By making the goals aggressive, you make the team members stretch to reach them. At times, some areas feel that a goal isn't attainable. But when you look at the numbers of what is out there to collect compared to what is collected, it usually opens their eyes."
Pergrem says that over the years, various incentive structures have involved many different aspects of the job, including maintaining high customer service scores. "In review of those a few years back, we determined that cash collection goals got us our best bang for the buck," says Pergrem. "Our collections hit the bottom line, and we are a huge part of the revenue cycle so we felt incorporating the patient access collections was key. Collecting at time of registration allows them to spend time on more challenging accounts."
Pergrem says that it's also clear that "good quality gives way to clean claims; that can make a huge difference in our A/R days. A few of our corporate areas, like scheduling and pre-registration, have some of their incentives tied to queue times and maintaining daily productivity standards as well."
Jodie Martin, director of admitting and registration for the department of revenue management at University of Kentucky Healthcare in Lexington, says that her patient access department plans to focus on the performance appraisal process to set individual employee collection goals.
Currently, small gifts occasionally are given to access staff by leaders. "Their main purpose is to reward excellent behaviors, but the management staff that report to me also use them to reward top cash collectors and employees with high registration audit scores," says Martin. "We don't have a formal incentive program for access staff, but we hope to formalize and standardize the criteria for the awards at some point."
Rewards for financial counseling
Katrina Reynolds, health care system administrative director for Chapel Hill, NC-based UNC Health Care System's office of revenue cycle management, says that her biggest challenge currently involves the increases in self-pay balances. These, she says, are due to the current economic conditions and the increase in uninsured patients as a result of insurance programs offering lower monthly premiums at the cost of increased co-payments and deductibles beyond what the patient can afford.
"More people are having a difficult time paying for their medical care," says Reynolds. "This affects our ability to deliver quality and cutting-edge medical treatment to the citizens of North Carolina."
Instead of collections, UNC Health Care's reward program is based on the number of patients counseled. The goal is to minimize the number of patients receiving care in the organization who do not get the financial counseling they need.
"We reach out to target patients proactively," says Reynolds. "We monitor the gap in how many patients we are not able to contact before the appointment and spot check the number that go uncounseled after their appointment." The top three financial counselors are awarded each month with modest tokens of appreciation, such as a certificate and a small monetary reward.
Uniform standards are used
UNC Health Care's performance standards require financial counselors to collect a certain percentage of the total yearly team collections to obtain an "achieves" rating on their annual evaluation. "We encourage staff to collect for both the hospital and physician balances," says Reynolds. "The benefit of having uniform productivity standards for the counselor is that they have unambiguous guidelines for what constitutes acceptable and exceptional performance."
The information is displayed for the group monthly, which engenders a healthy sense of competition. During monthly meetings, the performance of each team member is reviewed against the standard, with goals set for future performance.
"The pitfall inherent in this system is that the same cash collection metric applies differently to different departments," says Reynolds. "All things equal, a counselor in pediatrics will simply never collect the same dollar amounts as a counselor in surgery."
For this reason, an effort was made to identify the opportunity for collections that is appropriate for each counselor, and then measure the percentage of collections against that opportunity. "But we were not successful in getting sufficient or appropriate data from our information systems in real time," says Reynolds. "We have adjusted our metric over the year and a half we've been tracking. We determined that what works for us is tying the individual financial counselor goal to a team goal and to a percentage of total collections."
Reynolds says that incentive programs for collections, in her experience, are most effective when they involve goals based on the individual's clinical location and their opportunity. "As long as the collective sum of the individual goals equals or surpasses the team goal, we are comfortable and focused on rewarding individual accomplishment through annual evaluation ratings and increases and collective accomplishment through team recognition," says Reynolds.
[For more information, contact:
- Kym Clift, Director of Patient Accounts, PeaceHealth Whatcom Region, Bellingham, WA. Phone: (360) 715-6509. E-mail: [email protected].
- Jodie Martin, Director of Admitting and Registration, Department of Revenue Management, University of Kentucky Healthcare, Lexington. Phone: (859) 323-5808. Fax: (859) 257-2184. E-mail: [email protected].
- Craig Pergrem, MBA, CHAM, Corporate Director-Patient Business, Orlando (FL) Health. Phone: (321) 841-8261. E-mail: [email protected].]
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