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When Ron Malcolm, PA-C, first considered the idea of having medical staff ask patients for money in the treatment room, he rejected it as "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, they decided to 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 their 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 patients leave 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 there is a co-pay, she does the same. "The accounts are discussed with patients in privacy at the point of service, when they feel they got something for their buck," Malcolm says.
When clinic staff initiated the program, they administered satisfaction surveys to 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 copayment 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. For instance, if a patient owes $20 but can only pay $12, the nurse writes a note to that effect and sends it up front so the cashier knows how much to ask for.
The clinic’s financial counselor also visits with patients who are in arrears while they are in the treatment rooms. She gets a list of the scheduled appointments each day, tells the nurses 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.