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Registrars need “de-escalation” techniques to respond to patients who are unhappy or upset due to financial obligations, scheduling problems, or other issues.
“I didn’t see it written anywhere before I was serviced that I would have a copay.”
“I refuse to talk about money being owed while I’m receiving treatment.”
These are some patient responses reported by registrars to Victor O. Odoh, pre-access manager of surgical and pre-registration operations at Florida Hospital in Orlando.
While collecting at the bedside isn’t new for the department, the approach has changed somewhat. In the past, a single registrar had the patient sign consents, reviewed insurance benefits and financial obligations, then collected any payment owed.
“The process has now changed to two separate individuals,” explains Odoh. The first registrar collects insurance information and obtains consents. A second registrar reviews financial obligations and collects.
Some inpatients are just not willing to discuss money during their hospital stay, however, and aren’t shy about saying so. “Patients express frustration due to lack of price transparency or because payment is the furthest thing from their mind,” says Odoh.
The person who gets the brunt of their dissatisfaction isn’t a payer representative or hospital administrator, of course — it’s the registrar.
Some patients learn their insurance coverage still leaves them with high out-of-pocket costs. Most have no idea of their financial responsibility for a hospital stay. “So when a registrar approaches a patient about their financial obligation, they are blindsided,” says Odoh. Scripting helps registrars to respond.
The scripting is based on the AIDET (Acknowledge, Introduce, Duration, Explain, and Thank) model. Here is a typical conversation:
“Good morning/afternoon/evening/ sir or ma’am. My name is Victor. How is your visit thus far?” (Acknowledge patient’s response).
“I will be here with you for five or 10 minutes talking over your visit’s financial responsibilities. I am here to answer all of your financial questions or concerns.” (Have conversation about financial responsibility.)
“Thank you for your time. Can I assist you in anything else?”
Odoh also developed “patient experience” training, which instructs registrars to do these three things:
As the hospital’s patient experience coordinator, Odoh does “patient-centered rounding” on 150 ED patients each month. “I take note of their complaints, then set up a skills lab that specifically addresses the top reasons for complaints,” he says. Staff are graded based on how they respond to these three scenarios:
Odoh asks patients these four questions:
“I keep track of these responses, along with the names of nurses and physicians associated with the patient,” says Odoh.
Rebecca Steve, training manager for revenue enhancement at Hennepin County Medical Center in Minneapolis, says registrars usually “get caught in the crosshairs” in these three scenarios:
Steve created a “de-escalation” course to teach registrars these techniques: actively listening to the patient, allowing a patient to vent, calming the patient, validating what the patient is saying, problem-solving, and giving the patient space.
Registrars are given these techniques to keep patients, and themselves, calm:
The class members do some role-playing, with the instructor playing the part of an agitated patient. They are given these phrases to use:
Registrars also participate in “non-verbal” role-playing exercises. “This helps them understand the effect that non-verbal behavior has on any situation,” says Steve.