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When Ron Malcolm, PA-C, first considered the idea of having the medical staff ask patients for money in the treatment room, he initially rejected it as "a sacrilege." But as Malcolm, a physician assistant at East Albany (GA) Medical Center, and Bernard Scoggins, MD, the clinic medical director, discussed ways to improve efficiency at the clinic by "thinking outside the box," they decided to bite the bullet and test the idea.
To their surprise, the process proved to be very successful. Not only did patients not object; it had a positive impact on the clinic’s bottom line. "It blew us away. Our cash receivables went up and up and have continued to go up," Malcolm says.
During its project to improve efficiency at the clinic, the redesign team decided to install computers in each examination room and have the nurse check out the patients and refill any prescriptions before the patient left the room. Malcolm proposed that the nurses check the patient accounts. If the patient has a balance due, the nurse asks them to pay, if they’d like to pay on it that day, and how much. She enters the amount into the computer. If they have a co-pay, she does the same.
"The accounts are discussed with the patient in privacy at the point of service, when patients feel they got something for their buck," Malcolm says.
When they initiated the program, the clinic staff did satisfaction surveys for all patients. Only one person said they didn’t like to be asked for cash in the examination room. The practice has many indigent patients who often do not have enough to pay their bill or their co-pay and are embarrassed when the cashier asks them about their account in front of a full waiting room. "We asked about the accounts in private so that patients were not embarrassed when they didn’t have enough to pay," Malcolm says.
Even if the patients can’t pay their entire bill when they get to the cashier, they won’t be embarrassed. For instance, if they owe $20 but tell the nurse they have only $12, the nurse sends the cashier a note about how much the patient can pay, and the cashier only asks for $12. "It looks very professional," Malcolm says.
The clinic’s financial counselor visits with patients who are in arrears while they are in the treatment rooms. She gets a list of the scheduled appointments each day, notifies the nurses of whom she needs to talk to, and is alerted when the patient is in the room and the providers are gone. "In the past, the cashier would have flagged the account and asked the patients to wait to see the financial counselor. Now, it’s built into the waiting time," Malcolm says.