Critical Path Network
Program helps to boost copay collections
Program includes courtesy discounts
An innovative program at Children’s Hospital of Alabama (Birmingham) has led to an increase in copay collections, from about $300,000 to more than $2 million. The initiative, which includes a combination of staff incentives, a "courtesy discharge" program, and a patient satisfaction survey, also has led to an A/R (accounts receivable) average of 33.7 days for 2005.
The initiative was spearheaded by Linda Benson, division director of patient access, who joined the facility about five years ago. "I worked with the director of human resources; she is a strong advocate of incentive programs for selected areas," she notes. "Our CFO at the time really didn’t like the idea; I had to really sell him and convince him we could make it work."
The program Benson and her staff put together included the following:
- "Courtesy discharge" program: Those patients owing a copay are called and visited by a facilitator, who collects the copay at the bedside. This allows the family to not have to stop at the cashier’s desk at the time of discharge.
- Patient satisfaction survey: Conducted via telephone by New South Research, it assesses how satisfied patients are with care and compassion of the registration staff; staff responsiveness to requests; communication during the registration process; friendliness and courtesy of registration staff.
- Staff incentive program: The incentives range between 3% and 6%.
Getting staff on board
Benson recognized winning staff support for any new program would be a challenge. "Taking people who already had an overwhelming day and adding this was a somewhat uncomfortable task," she concedes. That’s where the incentive came in. "Knowing they had something to benefit from really got them going," says Benson.
Incentives are available to all staffers in the access center, which includes scheduling, pre-registration, outpatient and emergency department registration, inpatient administration, bed control, clinics, financial counselors, and the central cashiers. They must meet these four minimum requirements to receive a quarterly incentive check:
- A/R days must be fewer than 40.
- Average wait time before registration process begins must be fewer than 10 minutes.
- At least $425,000 has been collected.
- A minimum of 80% of respondents say they were "very satisfied" with staff performance in the aforementioned areas.
Some of these minimums represent a "moving target" for example, the original minimum for collections was $375,000, Benson recalls. "When we established that amount, the staff were fully aware it would be adjusted as we saw that certain targets were too easily achieved," she explains.
Still, Benson says, these are "very objective measures" the staff are being asked to meet; and she was careful to "spread the wealth" among all access center staff.
"This was my biggest struggle," she says. "How could we do this in a fair way, since we were using two different measures — money and customer service? It seemed to me it would not be fair to reward those just in a position where they could actually collect money, so we flat out said the incentive would apply to everyone in the access center."
Why did she include the satisfaction component in the first place? "It’s just as important to provide good costumer service as it is to collect money," she asserts.
As for collections, while goals are either met or not met collectively, the supervisors also track collections on an individual level — how much each staff person is collecting. "That specific number is used on their yearly performance evaluation," Benson explains.
Education was key
Ensuring the program’s success took much more than just telling staff they would be rewarded for good performance. At the outset, it had to be communicated to all 120 people in the department, which included different facilities such as the ED, clinics, and so forth. "We have a global e-mail address for all the staff," says Benson, explaining how she spread the word. "We have continued with ongoing communications when we feel the staff need some cheerleading or extra motivation."
A good deal of training was involved, she continues. "We had to teach them how to speak to patients," she notes. "For example, we taught them that instead of asking, Would you like to pay your copay?’ the staff should say, Your copay is $50; will you be paying with cash, check, or credit card?’" (In sales jargon, this is called the "assumptive close.")
The bottom line, says Benson, was that it was important to make staff understand how critical is it to the health system to try to get the money up front. The four supervisors, she adds, were "very supportive and instrumental" in helping to roll out the plan.
Reasons for success
Perhaps the most detailed element of the plan was the courtesy discharge. "We have financial counselors who review all inpatient and observation patients; they verify insurance benefits. In the process of doing that, they obtain any deductible or coinsurance information," Benson explains.
"We were not electronic at this point with transfer of information to the cashiers who do the collecting; we used a patient folder," she notes. "Written on the outside was, patient owes X’ dollars.’"
This was done the day after admission and given to the main cashiers, who separated them out based on payer type. "For example, Medicaid patients don’t pay, so they are automatically a courtesy discharge," Benson says.
In the beginning, staff used to go to the floor and stamp "courtesy discharge" on the chart, but this proved too time-consuming. "I convinced nursing it needed to be electronic," says Benson. "Now, it’s as simple as looking at one field; you put it on the discharge screen, if it comes up yes,’ the staff know the patient is free to go. If the courtesy discharge is valued no,’ they need to be taken to the main cashier’s office." In either event, she emphasizes, "Our goal is to address this quickly."
Why has the program been so successful? "Obviously, a big part was the incentive, the personal reward for employees," says Benson. "Then, you had a good management team that all strongly believed in this process. The staff have just embraced it. And when we have new hires, it’s now very much part of their job."