Top performer to train ED registrars

Collections increased 140%

Since copayments first were collected in Cambridge (MA) Health Alliance’s three emergency departments (EDs) in October 2008, collections have increased 140%, totaling $173,000 in fiscal year 2009 to an expected $416,000 in fiscal year 2012.

Richard Hollis, Cambridge Health Alliance’s director of admitting and registration, attributes this increase to ongoing training provided to registrars and setting monthly collection goals for each ED, based on volume. One of the EDs rarely meets its collection goal, but patient access leaders came up with a novel solution.

“We are going to have our highest collector at our highest collecting campus, who consistently does a wonderful job, do a training for the staff and talk about why she is so successful,” he says.

The top collector also will observe the other staff, evaluate them, and offer suggestions, as staff might be more likely to respond to suggestions from one of their peers who does the same job as them, says Hollis. The idea is to have registrars see that the ability to collect involves more than just following a script, he explains.

“From the moment this employee goes into the room, she makes the patient feel comfortable. Then she gets to the question of, ‘How would you like to pay your copay today?’” he says. “We have other people who use the same language, but if they haven’t set the patient at ease, the patient may be less forthcoming.” Here are other changes that have increased ED collections:

• Managers regularly observe interactions between patients and registration staff.

Although collections had increased significantly by 2011, totaling $306,000, the actual goal for that year was $400,000, notes Hollis. Staff had never collected ED copays before 2008, and many were doing so halfheartedly, he explains.

“We did more training, with more of a focus on manager observation of staff, to try to bring the numbers up,” Hollis says. “That was successful.”

Managers realized that many times, registrars weren’t following the script for collecting copays and instead were asking open-ended questions that gave patients the choice of whether to pay.

In response, says Hollis, “we made sure staff understood that it’s actually an advantage to the patient to take care of it right then, to avoid getting statements and future collections going forward.”

• Hollis makes a point of emphasizing the collection role when interviewing applicants for the department.

“We make it clear that it’s a primary function of their job. Right from the beginning, we are setting this expectation,” he says. “They know going in that it’s a top priority.”

• Spreadsheets show how individuals measure up against their peers.

Some registrars were surprised to learn that they were falling far behind their colleagues, “and we have had a number of staff who have made successful efforts to improve their collections,” says Hollis.