‘Healthy competition’ comes from incentives

Set minimum standard

While some patient access representatives in the emergency department (ED) at Greater Baltimore (MD) Medical Center collected co-pays consistently, others collected almost nothing, reports Sherry Jones, ED patient access supervisor. To address this problem, a minimum standard was set of a monthly average of three co-pays collected per shift of four hours or more.

“I do have some people that struggle. Out of all the ED patient access representatives, I generally need to consult with a few each month,” Jones says. “It’s almost like sales: Some people are just naturally good at collecting, and others struggle.”

Currently, more than 80% of staff members are meeting or exceeding the minimum collection standard, compared to only 30% when it was first established. “Weekly, I compile the previous week’s co-pay collections. Individual collection amounts and percentages are emailed to staff and publically posted,” says Jones.

Cash incentives given

If patient access representatives collect a certain amount over a specified number of shifts, they receive a cash incentive or bonus in their paycheck, says Jones. Depending on what they collect, they can receive an incentive of $20, $40, $60, $80, or $100 each pay period.

Some patient access representatives find it more difficult than others to meet collection goals because they register a larger portion of Medicare and/or Maryland Medical Assistance patients not owing a co-pay at the time of service, Jones notes.

“Occasionally, we run into situations where an employee may be intentionally avoiding Medicare and/or Medical Assistance patient registrations in order to capture a larger number of co-pays per shift,” she says. “It can be challenging to definitively prove, although when it comes up. I address it with the individual employee.”

The ED patient access supervisor surveyed patient access representatives via email to identify group-based versus individual-based incentives, and 77% preferred an individual-based incentive.

If an employee doesn’t reach the minimum after one month, he or she is counseled, encouraged to review and practice “scripting,” and offered additional training as needed. “If the same employee continues to struggle meeting the minimum collection standard for the second month, we consider formal corrective action,” says Jones.

The department collects about 74% of the potentially collectable copays, compared to 32% before cash incentives and minimum standards were implemented.

“Staff is learning that a great majority of patients will pay,” says Jones. “It’s just a matter of asking in an appropriate manner.”