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One of the most successful changes with ED copay collections at CoxHealth in Springfield, MO, was also the simplest: Ask every patient for a copay at every ED visit.

“The consistency brings success with ED POS [point-of-service] collections,” explains Roger Stone, system manager for admission services, patient registration, and central access at CoxHealth.

Increase of 20%

Total ED point-of-service collections at CoxHealth have increased by 20% since 2014.

“Our teams have done a lot of work to get to this point,” says Stone. One of the most important changes — simply asking all patients — isn’t as easy as it sounds. People often come to the ED very sick or seriously injured.

“One of the largest challenges for any ED, in regards to point-of-service collections, is that patients know they can be seen without paying at time of service,” adds Stone.

Emergency Medical Treatment and Labor Act (EMTALA) requirements must be met. Registrars simply cannot turn a patient away because of failure to pay in the ED setting, unlike a patient with a scheduled elective service.

“Our registration teams in the ED work very closely with the clinical team to assure we are following EMTALA rules together,” says Cox. Patient access and clinical leaders have worked hard to be sure their teams fully understand this very important concept.

Registrars at CoxHealth’s EDs rely on indicators in the electronic medical record that appear once the physician has done the initial medical screening.

“This lets our staff know they are good to go in the room,” says Stone.

Registrars then do their full verification of the patients’ demographic information. They also have a financial discussion, if one is needed.

The process to let registrars know the medical screening exam is complete is important. “Our current clinical system has visual indicators that let us know that the physician has seen the patient,” says Sandra N. Rivera, RN, BSN, CHAM, director of patient access at St. Joseph’s Health Care in Paterson, NJ.

Once the physician has seen the patient, registration staff go to the bedside. “We verify insurance. If the patient has no insurance, the financial screening is completed,” says Rivera.

Projecting Confidence

If an ED registrar asks for a copay in a robotic tone with an unfriendly demeanor without making eye contact, the reaction is likely to be negative.

“It’s all about how staff approach the patients when having financial discussions,” says Stone. He instructs his staff to do these things:

• Always try to be as personable as possible when having these discussions with patients.
• Never let patients feel like all that is important is to collect their money.
• Emphasize to patients that the number one goal is to get them better as quickly as possible.

Registrars need to have their facts ironclad before discussing the patient’s financial responsibility. Knowing the correct copay amount is essential.

“This then allows our staff to be very confident when a patient asks, ‘Why do I have to pay that today?’” says Stone.

If a patient asks this question, registrars state, “The agreement is between you and your insurance carrier. Paying today allows you to fulfill that agreement and assures that the hospital is paid for the services they are providing.”

Registrars need reminders of the “why” behind point-of-service collection themselves.

“We want our patients, and our staff, to understand it is important that we collect this money,” says Stone. “It allows our hospital to continue to provide innovative and excellent care.”

Better Clinical Outcomes

The goal is to start the financial conversation early, while the patient is still in the ED, says Rivera. It’s not always about collecting. Sometimes, registrars make the appropriate referrals to different programs for which the patient might qualify.

“This is key to getting a good outcome,” says Rivera. “It’s also important to ensure you are consistent across the health system in addressing the patient’s financial needs.”

Getting clinicians and registrars on the same page is not always easy, but it’s essential for success. “It is important to have support and understanding from the clinical staff, regarding the registration role,” says Rivera.

A good, early financial discussion even can facilitate the patient obtaining follow-up care post-discharge. “We can give the best clinical care. But to treat the patient holistically, we need to be able to also address the patient’s financial status,” says Rivera.

Although nurses and doctors are experts in healthcare, registration assists patients with financial needs. “They are the experts in referring the patient for Medicaid or charity care,” says Rivera. First, patients are screened for Medicaid eligibility, charity care, and the hospital’s self-pay financial assistance program. No-interest payment plans also are offered. “This greatly impacts the patient’s ability to follow up — and not end up in the ED again,” says Rivera.

SOURCES

• Sandra N. Rivera, RN, BSN, CHAM, Director, Patient Access, St. Joseph’s Health Care, Paterson, NJ. Phone: (973) 754-2206. Email: riveras@sjhmc.org.
• Roger Stone, System Manager, Admission Services/Patient Registration/Central Access, CoxHealth, Springfield, MO. Email: roger.stone@coxhealth.com.