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At Greater Baltimore (MD) Medical Center, patient access managers use extensive training, scripting, and role-playing to increase point-of-service collections in the emergency department (ED).
"There is a fine balance between being compassionate toward a patient that is in pain or someone worried about their loved one, and still making an attempt to collect without seeming pushy or uncaring," says Cherie Patterson, CHAA, CHAM, patient access operations manager,
In contrast to other hospital settings, many ED patients don’t expect to be asked to pay upfront. "Educating the patient in a customer service-oriented way can be challenging," acknowledges Patterson. Some staff members might feel uncomfortable asking for money.
"As much as we all dread role-playing, that tactic, as well as practice with scripting, really does help," says Patterson.
Here are examples of ED scripting used by patient access employees:
• "Mr. Smith, according to your insurance, you have a $50 copay due. How would you like to pay? We accept personal check and all major credit cards."
• "Mrs. Johnson, we have verified your insurance benefits and see that a $75 copay is due for your son’s visit. How would you like to pay? We accept personal checks and all major credit cards."
"The general script conveys that we’re honoring the patient’s insurance copay requirement," says Patterson. "The main point is not to ask if the patient would like to pay, but how."
When role playing, patient access employees take turns being "difficult" patients and collecting from one another. "I always approach the subject of copay collection as an opportunity to help the patient," says Patterson.
She explains to staff that the patient won’t have to worry about a bill later. "This results in less stress for the patient and less cost for the hospital. It’s a win-win situation," says Patterson. Here are two scenarios used during role-playing:
• A registrar pretends to be a busy, worried mother bringing her child into the ED.
Staff explain to the "mother" that paying the copay upfront means she doesn’t need to worry about getting a bill later, which allows her to focus on her family. "This exercise shows how to be compassionate, but also conveys that we need to collect," says Patterson.
• A registrar pretends to be a self-pay patient who is very worried about how he or she will pay for the hospital bill.
"This exercise gives us the opportunity to let the patient know about our financial assistance program," says Patterson. "We also ask the patient to pay whatever they can toward today’s visit."
Staff offer information about financial assistance and point out to the patient that there are several options for payment. If the patient asks the amount staff want to collect, staff members ask for $50. "However, if the patient can only pay a few dollars, we will collect whatever they offer," says Patterson.
At University of Utah Hospital in Salt Lake City, financial counselors and ED registrars are trained to collect payments.
"This ensures there is someone always available to collect, even after scheduled financial counseling hours," says Ischa Jensen, MHA, CHAA, supervisor of financial counseling and inpatient access services.
Each collector in the ED receives an individual cash collection goal for the year. "Progress toward these goals are sent to the teams weekly," says Jensen. "They are able to see how their collections are contributing to their own goals, as well as our department goals."
An important change was made to the scripting used by staff when collecting. "Instead of saying, Can you pay your copay today?’ we now present with, How would you like to pay your copay today?’" says Jensen.