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Registrars at the University of Texas Medical Branch (UTMB) in Galveston have a built-in incentive for patients to stop and pay the bill on their way out of the emergency department (ED): If they don’t, they’ll likely get stuck with a $15 parking fee. In place about a year and a half, the parking policy is one part of an initiative that began about five years ago, says patient access supervisor Betty L. Avery, CHAM, when UTMB put out the word that it would no longer be the facility where everyone comes for free care.
The way the process works, Avery explains, is that after patients receive treatment from ED clinicians and get their discharge instructions, a nurse escorts them to the registration area. "They see the registration staff, who verify demographic information and collect any copays or deductibles that are due." If appropriate, she adds, staff can screen the patients at that time to see if they qualify for financial assistance.
Although patients don’t have to park in the ED garage, it’s by far the easiest and most accessible option, Avery says. Otherwise, they can park some distance away in another hospital lot, or park on the street, where they risk getting a ticket, she notes. Formerly an open area, the ED garage now is gated, Avery explains. There is a large sign at the entrance stating that it costs $15 to park there, and that a token allowing free parking can be obtained from an ED registrar, she says. "To get out, they have to pay or put in the token."
In addition to boosting the hospital’s bottom line, the policy also helps ensure that patients’ follow-up appointments are made, Avery points out. Before, she says, patients might have been told to arrange a clinic visit in two weeks, but instead of scheduling the appointment, would simply show up at the clinic. Now the appointment is made at the registration desk when they check out, Avery says.
Several years ago, UTMB Galveston "was almost at the point where it might have to close its doors," she notes. To change the public’s mindset that it was a charity hospital, UTMB "did a lot of advertising in the newspaper, and put the word on the street that we were in the red," Avery adds. "The community knew that there had been layoffs at the university and that measures would be taken [to improve the hospital’s financial health]."
At that time, the hospital instituted the Demand Access Management Program (DAMP) for its indigent patients, she says. Calls from patients who don’t have insurance or some other form of third-party assistance are routed to DAMP, Avery explains. Employees ask the callers about their income, number of dependents, and other factors, and let them know if they might qualify for financial assistance or a discount from the hospital, she adds.
Patients are told to bring documents supporting that information to their appointment, Avery says. When they arrive, they meet with a financial counselor, who does a screening to see if they meet the criteria to receive Medicaid, or to participate in the hospital’s sliding-scale fee system, she adds. "The patients have the mindset before they get here that they can get assistance."
If a discount is arranged, it is good for six months, Avery says. That means that if the patient makes a visit to the ED during that period, registrars can access the information in the computer, simplifying the registration process. At the end of the six months, participants whose status hasn’t changed can bring in the same documentation to renew their discount, she notes. If the person’s situation has changed — due to the birth of a child, for example — he or she may qualify for a further discount.
The minimum contribution required from any patient is $12, Avery says. "It’s like their copay."