Copay collections rose 30% — with help

Make nursing staff your allies

At Monroe Carell Jr. Children’s Hospital at Vanderbilt in Nashville, TN, a discharge office is the last stop before families exit the emergency department (ED), but many don’t stop there at all.

"The office is marked, but we knew we were not catching all families as they exited," says Diana Bittle, manager of admitting in the ED.

In June 2012, a process was piloted by patient access, with full support from the ED nurse manager. The nursing team now walks each family to the discharge office. "The nurse hands all discharge paperwork to our staff. We collect co-pays and give the family another opportunity to ask any questions," says Bittle. Patient access designed a special envelope for the patient’s paperwork, so everything easily could be kept together.

"We anticipated a small increase in co-pay collections. We were surprised when we saw a 30% increase in collections over the previous year with a flat increase in visits," says Bittle. "We were very excited!"

In July 2012, patient access leaders were disappointed to see that collections decreased by 7% compared to the previous year’s collections, with only a slight decrease in visits. "We talked with our discharge staff to see what insight they could offer," says Bittle. "We communicated the month’s results to the nurse manager, so she could query her staff about obstacles they were encountering with this new process."

After it was determined that nurses weren’t bringing patients to the discharge office consistently, the nurse manager educated her staff on the importance of copay collections to the hospital. For the next two months, the department once again saw significant increases in collections. "While this may seem to be the end of our story, something happened the following month that highlighted why it takes a collaborative effort to make our new process work," says Bittle. The ED nurse manager, who was very supportive of the copay collection efforts, took another position, and her position stayed open for several months.

"Without her support and continuing education with her staff, we quickly saw our collections falter," says Bittle. "We were seeing a 13% decrease in collections, even with an 8% increase in visits compared to last year."

With a new ED nurse manager now supporting the initiative, collections once again increased by 30%. The moral of this story? "Collaborative projects take time and can be slow-moving," says Bittle. One year after the department’s initial pilot, patient access is only now beginning to see a consistent increase in collections.

"You have to be willing to step back when necessary, check in with staff often, and keep the drive fresh with visible data," Bittle says.

SOURCES

• Diana Bittle, Manager, Admitting, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN. Phone: (615) 936-4336. Fax: (615) 936-8230. Email: diana.bittle@Vanderbilt.edu.