Scripting popular with ED and customer service

Could it be said better?

Are you as aware as you could be of how your access employees speak to the customers? Hospitals are increasingly taking note of not only what is said, but the dramatic impact it can have on patients’ perception of the care they receive, as well as on the organization’s bottom line. With that in mind, the practice of "scripting" suggested remarks — whether to fine-tune a registrar’s cash collection technique or to gather information in the emergency department (ED) more quickly and efficiently — appears to grow.

While much of the attention is on helping employees gain the confidence and assertiveness they need to ask patients for point-of-service payment, there are many occasions where a well-turned phrase can diffuse a volatile situation or streamline operations, suggests Beth Fries, education and training specialist for the patient access department at The Ohio State University (OSU) Medical Center in Columbus.

Even the most well-meaning registrar — faced with a patient who is complaining about wait time — might be prone to say something like, "Don’t feel bad — yesterday, somebody had to wait six hours."

And despite the usual focus on accuracy, when a patient proclaims that he’s been waiting two hours, it’s probably not the best idea for the registrar to respond, "Oh, no, it was only one hour."

At OSU Medical Center, scripting was added to the training repertoire about1½ years ago, says Fries, at the behest of access managers. Their complaint, she says, was that while employees were well schooled in processes and filling in fields, "nobody talks about how to actually talk to patients."

When the time allocated for training was expanded, Fries adds, she put scripting, role playing and dealing with real patients on the schedule. "As part of our training with all new registrars, there are at least two sessions of role playing," she explains. "The trainers are always the patient, and the trainee is in front of the group, asking the questions, so [the class] can review at the end [and ask], Could we have said it better?’

While the new registrars access most of their training materials on-line, Fries notes, a copy of the suggested scripts is given to the employees to take with them. (See excerpt from script.) In some cases, she says, the emphasis is on what one doesn’t say. "When they give out the notice of privacy practices, we teach them to say, Here’s your notice of privacy practices. Would you sign here that you received it?’"

The registrars are told not to get into a long discussion about the notice unless they’re asked, Fries adds. If they are asked, she says, they are to respond, "It’s how medical records are used here at OSU."

Fries says she learned long ago — and shares her experience with the new hires — not to begin a conversation with ED patients with, "How are you?" If you do, she points out, "you hear more than you want." Instead, Fries notes, the ED registrar would do better to begin with, "Hello, I’m Mary. I need to get some information from you. Have you ever been a patient at OSU?"

During her own time in the ED, she adds, "all of that was out of my mouth before the person made it to the chair." Insurance cards should be requested immediately, as well, Fries points out. "Sometimes, it takes forever for them to get it out."

In some exchanges with patients, it’s particularly important to think about what you’re actually saying, she explains. "When you ask, May we release your religious information?’ be sure to add, . . . to a member of your faith’ or to our pastoral care department?’"

Overhearing registrars ask the Medicare Secondary Payer (MSP) questions, Fries says, she notices a tendency some have to put an unnatural separation in the flow of conversation. "I tell them, Don’t even give an introduction [to the MPS topic]. You already know [from previous questions] if the person is employed, so [go directly to], "Is your wife working?"

Word the questions "so it won’t sound like you’re reading them," Fries advises registrars. One thing she always emphasizes, Fries says, is the importance of asking patients before the registration is completed whether Medicare — or whatever — is their only insurance. Experience has taught her, she notes, that patients often don’t mention such pertinent facts as that they also are covered under a spouse’s insurance, or that there might be two insurance plans for outpatient care and only one for inpatient care.

At Swedish Covenant Hospital in Chicago, employees throughout the facility are encouraged to use "key phrases at key times" as part of the organization’s service recovery process, says Gillian Cappiello, CHAM, senior director for access services and chief privacy officer. "There are key components to a greeting," she adds. "You always say Good morning’ or Good afternoon’ and How may I help you?’" Closing phrases, Cappiello notes, include "Thank you" and "Is there anything else I can do for you?"

"If someone has a concern, you always start out by saying, I’m sorry you had a problem with that," she adds. "There are certain phrases that evoke the kind of interaction you want to have."

Such scripting helps reduce instances of employees not knowing what to say in a given situation, Cappiello explains. Having a key phrase ready also "allows a little time to think about what you want to say next."

"The purpose is not to tell people exactly what they should be saying, but the idea is that the message should be consistent," she says. "There is always intended to be flexibility, and always circumstances that will [call for] unique responses, too."

Carolinas HealthCare System in Charlotte, NC, is among a growing number of providers that prepares scripts for staff involved in upfront collections, says Katie Davis, CAM, assistant vice president of patient registration. Employees making pre-service calls are given the following script, she notes, to help avoid the potential awkwardness that comes with asking patients for payment:

"I have verified your insurance benefits and the estimated cost of the procedure, and your coinsurance/ deductible for this visit will be $____. I can take care of that for you today so you don’t have to be concerned about handling it the day of your procedure. We accept cash, checks, MasterCard, and Visa."

If the patient does not pay in advance, Davis notes, the hospital sets the expectation for payment on the date of service by having the employee use this script:

"You may pay your copay/deductible on the date of service. The registrar at (name of the area) will be happy to assist you with your payment on (specific date of service). We accept cash, checks, MasterCard, and Visa."

However, Davis points out, "At no time do we push the patient for payment or in any manner indicate that payment has to be received before services are rendered."

In teaching registrars at OSU Medical Center about asking for money, Fries notes, she always tells them to wait for several moments for the patient to answer. "The inclination is to fill in that silence by adding something like, ". . . or we can bill you.’"

(Editor’s note: Beth Fries can be reached at Gillian Cappiello can be reached at Katie Davis can be reached at