Critical Path Network

Hospital uses bright blue to nurture bottom line

Unscheduled inpatients targeted

A procedure for obtaining copays and deductibles from unscheduled inpatients during their hospital stay is the latest in a series of successful collections initiatives at Hillcrest Medical Center in Tulsa, OK, says Julie Willis, patient access manager.

In line with the growing industrywide focus on nurturing the bottom line, the hospital looks for "every possible way" to bolster collections, she notes. "You have to be creative in the way you do it."

While registrars have been asking scheduled inpatients and outpatients to fulfill their financial obligations during the preregistration process since at least 2003, Willis says, the process for collecting from unscheduled patients began in March 2004.

After financial counselors verify the insurance and determine the copay and deductible for an unscheduled patient, she explains, they fill out a sheet with this message: "Dear Patient: Upon dismissal from the hospital, please stop by registration and pay your deductible or copay. The amount of ____ is due now. We accept cash, check, or credit card." It instructs patients to direct questions to the two financial counselors who handle the process.

The message, printed on bright blue paper, is delivered to the patient's room by a registration representative, Willis says. "We have found that colored paper works well."

At the same time, she adds, the registration rep gives a notice — this one printed on hot-pink paper — to the nursing staff to put on the patient's chart.

The information on the patients' financial responsibility is provided to the nursing administrator, Willis says, in the hope that he will remind nurses to bring patients by the registration desk as they are being discharged.

In some cases, however, all the registration reps have to do is ask, she points out. "It's amazing how [some patients] will just come down and pay $1,000 or $1,500."

Other times, Willis adds, the patient's family comes by later and pays the bills. If the person says he or she doesn't have a credit card or a checkbook, she notes, the registrar leaves a self-addressed envelope and asks that the payment be mailed.

The first year the process was put in place, she says, it brought in an additional $76,000; and in 2005, an extra $109,000.

"In the past, we wouldn't have gotten any money from any of them [at the time of service]. By collecting this, we've reduced the number of bills that need to go out for copays."

Willis says she has observed that the way the patient is approached seems to make a difference in whether a payment is made or not. "When [the registrar] is a cheerful, high-energy person, [he or she] seems to collect more than a timid person."

About 34% of patients who are handed the notices end up paying the copay or deductible before they leave the hospital, she says. "We feel there are more we could collect from. The next step is to have someone assigned to follow up again, probably with a telephone call or an additional visit to the room."

In the case of scheduled patients, Willis notes, staff also call and verify benefits and get copay information, and fill out a colored sheet to let registrars know how much to collect when the patients arrive.

Registrars inform patients of the copay or deductible amount when they call to gather demographic information, she adds. "That works very well," Willis says. "Sixty-eight percent of our total collections are from scheduled patients."

Total collections in 2003, the year staff began asking for upfront payment, amounted to $852,000, she says, compared to $679,000 in 2002. By 2004, total collections — for inpatients, outpatients, and the emergency department — equaled $1.3 million, Willis says.

A self-pay coordinator works all the self-pay accounts, both inpatient and outpatient, she notes. "Basically, with nonurgent procedures, we give the patient an estimated price. The person has to be able to pay a minimum deposit and sign a promissory note."

Self-pay patients receive a 30% discount, Willis adds, if they pay half the bill up front and the balance in 30 days. "A lot of them take advantage of that."

If the person is unable to pay the minimum deposit, she says, there is a medical review to determine if the procedure can be postponed until the financial obligation can be met, or if an exception will be made.