Give new collectors the tools to succeed

Remember: It's a new role

A certain group of experienced access representatives were chosen to participate in an emergency department (ED) copay collection pilot at Middlesex Hospital in Middletown, CT, reports Margaret Trudel, patient access manager. This team was successful in substantially increasing copay collections in the ED.

"We have since involved other less experienced staff in the pilot, and you can see the difference," she says. "The rate of collection was not as good as it was with the experienced team. That tells me we have to work more with them one-on-one, to get them used to have that kind of conversation."

Trudel is giving staff some additional tools to get them comfortable asking for money, including an online training program and scripting for phone calls. Here are some of her approaches:

• Access representatives give a consistent message.

"The script needs to be the same wherever the patient is seen," Trudel says. "We need to push the same message, so we don't get someone from our Shoreline ED saying, 'I wasn't asked for it at the Middlesex ED,'" she says.

Trudel has overheard some of her staff asking for co-pays tentatively. "As soon as they get any resistance, they back off and offer to bill the patient," she says. Access representatives now use key phrases such as "for your convenience" and "you won't have to worry about anything else when you arrive or at discharge," says Trudel.

• Make it part of the access representatives' evaluation.

Staff are evaluated for copay collection and financial assistance as part of their performance review, says Trudel. When copay collection became part of their role, all access reps were moved into a higher labor grade with a salary increase in most cases, says Trudel. However, this change came with new expectations, she emphasizes.

"The message was delivered that we have confidence in you, and your role is vital to the success of the copay collection process," says Trudel. "We gave them the new job description and the new performance review, and outlined our expectations."

Co-pay collection is now a significant part of the yearly review and interim discussions with frontline supervisors, says Trudel. "You always have your champions who have no problem with it," she says. "Then you have other staff you need to work with to increase their confidence."

Every month, Trudel informs her staff of the percentage and dollar amount of copays collected. "If we have a banner weekend, we share the result first thing Monday morning. That keeps staff motivated," says Trudel. "We haven't gone down the incentive road yet, because we do feel this is a part of their job."

• Give staff the ability to offer help.

"Our self-pay patients are identified upfront," says Trudel. Staff members offer financial assistance during registration and give the application to the patients before discharge, rather than waiting for financial counselors to send out an application at a later date, she says.

There is no dedicated financial counselor in the ED, says Trudel, so access reps are playing that role. "We are educating our staff so they can discuss this with patients with more confidence and give more information prior to the patient leaving," she says.

• Do regular role playing.

Trudel says that when co-pay collection role playing is done, resistant access reps are initially standoffish. "But if you practice on a regular basis, they become more comfortable with it. My plan is to incorporate it into every staff meeting," she says.

If staff are resistant to collecting co-pays, Trudel asks them what happened when they asked for the co-pay. "Usually, their reluctance for not wanting to solicit a copay is because they have had a bad experience," she says. Those are the exact situation that are used in role playing, says Trudel. "If they get some positive responses, and practice dealing with the not-so-pleasant responses, it gives them the confidence they need to pursue co-pays," she says. "I believe it's all in the delivery."