Executive Summary
Role-playing exercises can help patient access employees to be comfortable collecting from patients, because they’re able to repeatedly practice what to say to patients.
- Give positive reinforcement if employees appear nervous.
- Have leaders start the role-playing first.
- Use scenarios that come up often, are challenging, and that have the biggest financial impact.
Every patient access department has its struggling collectors: employees who just can’t seem to collect, despite it being part of their job description. For some, the problem could be as simple as a lack of practice.
“Role-playing can guide team members to be prepared for many different situations,” says Roxanne Gagliardo, senior director of access services at Adreima, a Jacksonville, FL-based firm that provides revenue cycle services to hospitals. “It enables them to respond quickly and appropriately when approaching patients to collect a fee.”
Gagliardo recommends covering various scenarios repeatedly before a patient access employee collects from an actual patient. (See list of scenarios the department uses during role playing in this issue.) “Oftentimes, there are situations that may catch a team member off-guard with a patient,” Gagliardo explains. “If the employee has practiced a response to a similar situation during role-playing many times, he or she is much more likely to respond the same way with an actual patient. Some team members are nervous role-playing in front of others, so positive reinforcement and encouragement is used immediately. In order to break the ice, leadership will always start first.”
Gagliardo has seen employees become much more confident asking for money after role-playing. “The more a team member exudes self-assurance and experience, the more likely the patient feels a sense of responsibility to make a payment up front,” she says.
Patient access leaders should use these three scenarios for role-playing, recommends Doug Fielding, vice president of product strategy for ZirMed, a Louisville, KY-based provider of web-based revenue cycle management solutions for healthcare:
- those that are similar to the real-world scenarios your staff will face most frequently;
- those that are the most challenging;
- those that have the greatest financial impact on your organization.
“Those might all be one and the same, but they might not be,” says Fielding. “It all depends on your patient populations and the states in which you operate.”
For example, the most frequent situation might simply be patients covered under a high-deductible health plan who need help understanding how their costs count toward that deductible. Many patients might want to know what payment plan options are the best fit with a health savings account.
“The most challenging situation might be collecting from patients who are genuinely surprised to learn their insurance doesn’t cover the care they received,” says Fielding. In this case, the first step might be walking the patient through their coverage details and explaining the steps that the provider has taken to attempt to bill the payer for the service provided. “This clarifies that the provider is on the patient’s side,” says Fielding. “It assures the patient that everything that could be done, has been done.”
To make role-playing more effective, Fielding suggests patient access managers take these steps:
• Conduct an audit of collections best practices.
Fielding says to answer these questions: What should staff be saying? Are they saying it? Is it working?
“This exercise helps management identify key role-playing scenarios,” says Fielding. “It clarifies whether staff would benefit from refresher training, or whether current ‘best practices’ simply aren’t working and need to be updated.”
He suggests using metrics such as the results of collections activity. “Then, identify communications commonalities within these segments,” says Fielding. “Compare these against the current best practices that collections staff are coached to adopt.”
Beware of observation
Direct observation of staff also can be helpful. “But this can skew the data,” warns Fielding. “The presence of an observer can sometimes change or influence staff behavior.”
• Do role playing one-on-one, or one-on-one with a small group of peers who observe but don’t participate until they’re asked for suggestions or ideas.
If various individuals need to improve different specific skills, “one-on-one role-playing will be more effective,” says Fielding. “The person you’re coaching won’t feel singled out.” Also, employees won’t be forced to sit through training that doesn’t apply to them.
“If there’s a small group present, it’s natural for everyone to provide constructive, more informal feedback at some point during the process,” says Fielding. If it’s one-on-one, the person playing the patient should provide the feedback directly. “The only thing I don’t recommend is for the feedback to be interpreted and delivered by a manager who wasn’t present,” he says.
• Have someone play the patient who regularly, and currently, hears what patients are saying.
“This should be based on recent real-world interactions, not best guesses at what patients might say,” says Fielding. “The realities for patients are subject to change, and so are the realities of collections.”
A patient whose employer recently began offering only a high-deductible plan might have been insured for 20 years under a traditional PPO. “So while they’re very well-versed in the healthcare world, in some ways they have more in common with new entrants: those who need help understanding and navigating their financial obligation,” says Fielding.
