New co-pay procedure sparks education blitz’

After Providence Health System set up new co-payment collection procedures in the emergency department (ED) of its three Portland-area hospitals, the first move was to roll out the program educationally, says Patricia Weygandt, on-site access services manager at Providence Milwaukee Hospital.

ED registrars and clinical staff were informed — through e-mail, face-to-face encounters, and staff meetings — about the new method of collecting co-pays after the patient’s medical examination, Weygandt says.

The continuous quality improvement (CQI) team charged with designing the new process distributed flowcharts (see charts, pp. 5-6) so staff would understand how it works, and the procedure was piloted for two weeks, she adds. Staff were given questionnaires to fill in regarding the new procedure’s effectiveness and any impact it had on patient satisfaction, Weygandt says. There was a "problem log" where staff could record where and when problems occurred, providing as much explanation as needed.

Responses to a "yes or no" survey indicated that 81% of the employees at the three hospitals believed the new procedure was workable and that it did not interfere with the clinical care of patients, Weygandt notes. Data from the pilot were presented to the regional access services director and the regional ED nursing director.

After the pilot, the team determined more staff education was needed, Weygandt adds, "to make sure everybody was in the loop and understood the process." That included physicians, on-call staff, unit secretaries, nurse practitioners, registered nurses, medical technicians and registrars. The extra effort was needed, she explains, "because we felt the two-week pilot was not enough time to completely roll out the process to all staff." Responses to the problem log indicated that some staff were having to explain the procedure to colleagues who were not fully aware of the new system.

A desire for precise data

With that in mind, the team conducted an education "blitz" throughout the month of November, using storyboards and handouts, Weygandt says. A second employee survey, which was to be distributed throughout December, January, and February, was modified to allow responses scaled from one to five. "We wanted more precise data." (See questionnaire, p. 7.)

During this follow-up period, the CQI team will continue gathering data, Weygandt says, taking "snapshots" of certain days to measure the co-pay collection rate. "We will run a report from Logicare showing how many times the physician chooses the option discharge with co-pay.’"

In addition, she says, the team will measure and compare the attempts to collect a co-pay vs. successful collections. "Then we will determine if we’ll actually adopt this process and make it a policy and procedure."