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Patient satisfaction scores of at least 90 out of 100 have been maintained at Sarasota (FL) Memorial Healthcare’s two EDs for several years. “The few hits we have taken on surveys are related to asking for insurance or payment,” reports Vanessa Gordon Lewis, MBA, CHAM, patient registration manager.
Upfront collections totaled more than $1.3 million in 2017 at the two EDs. One reason is the emphasis on collections for all new hires.
“We maintain our collection goals and customer satisfaction scores because we provide adequate training,” Lewis says. Sarasota Memorial Healthcare achieves high satisfaction in the challenging ED setting, even while continuing to emphasize collections, for a few reasons:
“We take time with our new hires on how to read the eligibility response,” Lewis says. Staff can determine what the patient’s financial responsibility is, and give accurate information on out-of-pocket costs.
Newly hired ED registrars are thoroughly trained on the Emergency Medical Treatment and Labor Act. Registrars do not ask for any payment until a provider sees the patient.
“If the patient is unable, you do not want to push the topic to where they feel pressured or as though they will not be treated for inability to pay,” Lewis adds.
Once new hires are working in the ED, they’re continually reminded of expectations to collect.
“We also have a registration bonus as an incentive,” Lewis notes. Meeting collecting goals is one way the registrar achieves the bonus.
“We provide scripting on how to have this conversation with the patient while still providing excellent customer service,” Lewis explains.
Staff members use this script: “In reviewing your benefit information, you have an ED responsibility of a $200 copay. How would you like to take care of this today?”
If the patient is unable to pay the full amount, staff ask for a portion of the amount. If the patient is unable to pay anything, staff provide a payment slip with their visit information and a self-addressed envelope to mail the payment. Staff members ask the patient to mail the payment within four business days.
“Ultimately, to be successful with collections, you just have to ask the patient,” says Tabatha Terhune, patient registration assistant manager at Sarasota Memorial Healthcare. Staff are efficient, but they’re also compassionate.
“If I had to name a specific pain point, there are those patients who, no matter how many times they present, aren’t very happy when we get to asking for their responsibility,” Lewis says. Registrars are trained to always ask for payment, but they stop short of pressuring the patient to pay.
It is important to approach the conversation at the most appropriate time for the patient. “If they are in excruciating pain, you would want to wait until they are more stabilized to approach the topic,” Terhune offers.
The department doesn’t receive many complaints about its collection practices. Those who complain have objected to staff collecting in the ED at all. Some recent survey comments reflecting this mindset include: “The priority should be the patient, not their insurance,” and “The clerk could see I was in severe pain, but insisted on asking me questions and getting a payment.”
These negative comments reflect the difficulty of engaging in a financial conversation in the ED. “But if you take extra steps to make them feel as though you are helping them, they are likely to have a positive experience,” Terhune says.
Some patients share their appreciation for the help they’ve received from ED registrars. One self-pay patient explained that her son was uninsured due to custody issues, with neither parent obtaining insurance. “Rather than make the patient feel as though all that is cared about is payment, we provided resources from the patient assistance team to help them get assistance,” Terhune reports.
Another happy patient reported that the registrar went out of her way to help by calling the insurance plan to get information faxed. “Going the extra mile for the patients really helps in increasing satisfaction scores,” Terhune adds.