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Taking on collection role can be a help to patients
Culture change is necessary
When Joan S. Braveman, director of patient access and financial services at Tallahassee (FL) Memorial HealthCare (TMH), started point-of-service collections in her department about five years ago, she encountered a lot of resistance.
"It was not met with open arms. It was contrary to a lot of people's philosophy of what a hospital was," she says. "One supervisor said to me directly, "I'm not going to ask my patients for money. We're here to take care of people, not squeeze money out of them.'"
At the time, the supervisor was collecting about $10,000 a month on average. Over a year's time, this amount increased to $22,000 and is now at $52,000, says Braveman. The supervisor was extremely pleased with his progress, says Braveman. She attributes the change in his attitude to "a lot of culture change not just with the community, but also the staff."
The supervisor realized that patients actually appreciated being told what they'll owe, as patients have become accustomed to being asked for money upfront, says Braveman. "People come in with a credit card out, ready to pay, or a check already made out," she says.
When making rounds in her department, Braveman often heard her staff saying to patients, "Your copay today is $100. Do you want to take care of that today?"
'If someone asks you if you want to pay your bill now, it's very easy to say, 'No thank you,'" says Braveman. "Patients frequently stated, 'TMH always bills me afterward.' So we've eliminated that language."
Staff now say, "Your copay today is $100. We accept cash, check, or credit card. How would you like to pay?" says Braveman.
Opportunities for patient
If an uninsured patient is scheduled for a service, staff contact this individual ahead of time, says Braveman.
"We look at opportunities for the patient," she says. "There are certain questions that staff ask, to see if the patient would qualify for Medicaid."
Braveman gives the example of a woman scheduled for a total hysterectomy. "Typically, there is going to be cancer involved. The patient will need some long-term treatment, whether radiation or chemotherapy," she says. 'In that case, we start a charity application file for them."
Braveman has had several patients bring in documentation before their surgery, including tax returns, unemployment statements, or other requested paperwork, to determine their eligibility for assistance. "We have found that it gives patients peace of mind. Instead of worrying about how much debt they are incurring, they can just focus on the hospital taking care of them," she says.
Staff inform any recently unemployed patients that he or she still might have time to apply for COBRA, says Braveman. "They would rather pay the $300 or $400 monthly premium than the $50,000 hospital bill," she says. "We've had this experience already a number of times."
One patient lost her job in late September and came to the hospital in early November, and she was surprised to learn she still was eligible for COBRA. "We helped her to call her former employer to get the paperwork sent again to be submitted," says Braveman. "This stopped the woman's insurance from having been terminated, so she was not without coverage"
For more information, contact:
Joan S. Braveman, Director, Patient Access and Financial Services, Tallahassee (FL) Memorial HealthCare. Phone: (850) 431-6202. Fax: (850) 431-6737. E-mail: Joan.Braveman@tmh.org.