Say and do this if patients say they just can't pay

These days, access is seeing many patients who simply cannot pay what they're told they owe. In light of this reality, staff will need to be ready for some uncomfortable moments. "With the current economic situation, the public in general is extremely concerned about expenses," says Hollis Scott, a patient access supervisor at the Children's Medical Center of Dayton.

The Dayton area was hit particularly hard due to the loss of a major GM plant and the city's only remaining Fortune 500 company. "As a pediatric hospital, the tremendous loss of jobs has resulted in an unprecedented shift from commercial insurance to Medicaid coverage for many patients," says Scott. "People are scared and angry."

Many have never had to apply for assistance previously and may feel embarrassed about not being able to provide for their family. "It has become imperative that we communicate the opportunities available for public aid," says Scott.

In addition to offering this concrete type of help, conveying sympathy and understanding has become a critical skill for access. "We need to put ourselves in their shoes and try to understand why they may be dissatisfied," says Scott. "If the parent cannot be placated, staff should politely inform them that they would be happy to connect them with a supervisor."

At Texas Health Resources in Arlington, access staff go through a online upfront collection module that helps explain the purpose of collecting, how to ask the questions appropriately, and the various scenarios that could occur. "It is an online module specific to collections and is mandatory for all patient access staff," says Patricia Consolver, CHAM, the organization's corporate director. (See examples of scripting used by staff.)

Offer more options

"There are more folks wanting to set up long-term payment plans to meet their high deductibles, but they are not interested in bank loan programs," says Consolver. "We have had to expand our options for patients."

If a patient has no outstanding balances, payment arrangements have been expanded from six months to 18 months, with no interest. "We have had quite a few take advantage of this option," says Consolver.

[For more information, contact:

  • Patricia Consolver, CHAM, Corporate Director, Texas Health Resources, Arlington, TX. Phone: (817) 462-6426. E-mail:
  • Hollis Scott, Supervisor, Patient Access, The Children's Medical Center of Dayton, One Childrens Plaza, Dayton, OH 45404. Phone: (937) 641-4323. E-mail:]