Free’ hospital needs help sending payment message

Patients risk health with careless ID use

Nancy Stringer, director of patient access at Truman Medical Center in Kansas City, MO, would like to know how other nonprofit hospitals deal with the impact of nearby for-profit providers that have much stricter patient payment policies.

A large for-profit chain recently bought a group of hospitals in the Kansas City area, Stringer says, and she’s concerned about what that will do to the balance of uncompensated care in the community.

Truman already is known as "the free hospital," she notes. "We always joke that the best marketing strategy our CEO could have would be to run a big ad saying that Truman isn’t free. People think that just because we’re a public hospital, they should be able to come and receive all the care they need without paying for it."

Exacerbating the situation has been a change at another Kansas City hospital, Stringer says. "It used to be primarily state-funded, but while it’s still not-for-profit, it has changed its philosophy. [That hospital] is asking for cash up front; and when people are not able to do that, they come to Truman."

Her registrars constantly are dealing with people who can’t afford to pay, who are anxious about getting help, but who, in many cases, don’t qualify for Medicaid or other forms of aid, she says. "We have discounted care, but a lot of patients we see don’t fall into our catchment area and aren’t eligible for that."

Staff must tell these patients that while the hospital will continue to treat them, it also will continue to bill them, and to go through the collection process if necessary, Stringer explains.

"My big issue with all this is that I’m trying to make the workplace as pleasant as possible, and that’s difficult to do when every other patient is anxious about how they’re going to pay for care," she adds. "What I’d like to do is help my employees understand how to communicate with patients about these things."

Identifying patients

Another issue on which Stringer would like feedback from her access peers has to do with the proper identification of patients. While she’s looking at technology options provided by health care vendors, one of the main problems is that many patients don’t understand how not correctly identifying themselves can impact their health, Stringer points out.

"We still have cousins who use each other’s IDs and [foreign] patients who share their visas," she notes. "One registrar asked for identification and the male patient showed the ID of a female friend. When the registrar said she needed his ID, the patient responded, Well, she told me I could use it.’"

In many cases, Stringer says, the problem is that patients don’t have a good grasp of English or of how the health care system works.

"It’s really a patient safety issue," she says. "We’re not going to deny care if a person coming into the emergency department doesn’t have a picture ID, but we need to have the correct health history and blood type. We want to make sure we’ve got the correct person."

Stringer also is hearing from her staff that people of certain nationalities either don’t know their birth dates or use them in a different way. "They’re all Jan. 1."

"Also, since [foreign] names aren’t familiar to employees, if they’re similar they sometimes don’t recognize the difference," she adds. "It’s enough of a problem that it poses a daily challenge."

The hospital has put together a multidisciplinary team, with representation from the legal department, to brainstorm solutions, Stringer says, but she would welcome suggestions from other access professionals.

Deliberate misidentification

Dee Alugbin, collections coordinator in patient access services at St. Joseph’s Hospital of Atlanta, seeks help on a related issue — how to address the problem of deliberate misidentification.

St. Joseph’s has many self-pay patients who deliberately give emergency department (ED) registrars the wrong information, she says. "When we try to call later in reference to their admission and to work out a payment plan, we find out the telephone number is wrong, the address is wrong, and sometimes a number or two is off in the Social Security number."

"Is there a way we can cut down on that?" wonders Alugbin. She adds that she was unable to find solutions for this particular problem at the recent National Association for Healthcare Access Management conference, where other access professionals reported having similar experiences.

Tweaking collections

Although ED operations remain a major challenge, she has had some success in improving collections efforts in other patient access areas, as well as in the hospital’s ancillary departments, says Alugbin, who was hired as collections coordinator in November 2002 and began working full time at the position in May 2003.

"I’ve been working all the different departments, just seeing what they do every day," she notes.

Alugbin says she recently observed registration activity in the Breast Health Center, where employees did not ask patients for copayments, even though in most cases the copay information is right on the insurance card.

"I just got a little sign saying, Copay is required at the time of service,’" she adds, and collections improved.

One of her initiatives has been to make copies of the insurance cards the hospital deals with most frequently, blocking out the patient’s name and highlighting with a yellow marker the area where copay instructions are given, Alugbin says. "If the card doesn’t give the copay information, I have them look up [that payer]."

If patients become argumentative when asked to pay, she notes, staff are instructed to explain that it is a new procedure, that they can be billed, but that it is better if they pay at the time of service.

At the hospital’s Center for Wellness and Rehabilitation, the only ancillary area that is located several miles from the hospital complex, staff were reluctant to accept cash payments for security reasons, she says. They didn’t want to keep large amounts of money on hand between visits to the main campus.

Noting that the bank the hospital uses has a branch right behind the center, Alugbin made arrangements to have employees make a deposit there every day. They simply keep the deposit receipts, she adds, and take them to the hospital cashier twice a month.

[Editor’s note: If you have feedback on any of these issues or comments or information to share regarding any access topic, please contact editor Lila Moore at (520) 299-8730 or by e-mail at]