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What follows are some common issues that upset patients and ideas for how registrars can rescue these difficult situations:
Recently, a patient was registering in the ED at Kadlec Regional Medical Center in Richland, WA. His father was shocked to hear someone mention a $3,500 copay.
“He was stunned and angry,” recalls Patient Access Lead Laurie Lawson, CHAA. The father stated that there was no reason to buy insurance when it does not cover anything. He vented about how much hospitals charge and how ridiculous it was. Lawson listened without interrupting. When the father ended his tirade, Lawson kindly responded, “I understand you can’t pay the copay in full, and that’s all right. How much can you pay today?” The man was surprised to find out the entire amount was not required. He decided to pay $250. Lawson offered a financial assistance application. “He still wasn’t happy, but was much calmer,” Lawson says. “He thanked me for being kind.”
One patient at CoxHealth was very upset to have to register each time they arrived for testing, along with wearing ID bracelets and providing insurance cards. Patient Access Team Lead Angelina Anderson explained it this way: “We have measures in place to protect our patients. It is our job to ensure a good experience. That includes billing as well as protecting people from identity theft.”
“That patient went from irritated to grateful before they left my office,” Anderson recalls.
Sometimes, patients just cannot be calmed. “Registrars need to recognize when to report the issue,” Anderson advises.
One such case started because an estimate was handled incorrectly. Registrars were not aware that some changes were made to the Affordable Care Act that affected sterilization in men. The incorrect estimate showed that service was not covered.
“The patient was outraged,” Anderson says. Registrars quickly called the insurance plan and verified the service was covered, then contacted the patient and apologized for the upsetting misinformation. “However, the patient still verbally threatened the registrar and insisted on knowing where they were located,” Anderson says. “In this case, we allowed security to follow up on the matter.”
(Editor’s Note: For more information about how to prevent and de-escalate patient-on-employee violence, check out the May issue of ED Management.)
One registrar could not help but notice a child’s tantrum and the fact that the registration was taking much longer than usual. After learning the child was hungry, the registrar went straight to the cafeteria and bought a banana for the child. This allowed the mother to quickly register and then enjoy a more peaceful time in the waiting area.
Sometimes, radiology registrars at Cox Medical Center Branson encounter patients who arrive at the incorrect time for a CT or MRI. Some of these patients have traveled a long distance for the appointment. Before registrars even tell these patients that they have arrived at the wrong time, registrars first check to see if radiology can squeeze the patient in. Most of the time, the answer is yes.
Other times, patients arrive at the wrong location. They may have been told to visit an outpatient location when a test is actually scheduled onsite at the hospital, or vice versa. Cox Branson staff use the same process: Someone calls radiology to see if they can take the patient at the site he or she visited. “This can be done without the patient even knowing that they were in the wrong location,” says Karla Dennis, patient access team lead.
Walk-in patients for labs or X-rays often waited a long time. Now, preregistration is offered for any outpatient procedure. By making a phone call, patients can skip the lines. “These changes have really made for happier patients,” Dennis reports.
Recently, a patient came to pay a bill at the registration desk at CoxHealth Branson Cancer Center. The registrar could have just told the patient to go to billing, which was located in a different building. Instead, she took the time to look at the bill and realized it was from the outpatient lab area. She walked the patient next door to the outpatient registration area to pay the bill.
“The patient didn’t have to go to another building and got personal care being walked to the right place,” Dennis says.