Collections soar to $2.9 million: Cash incentives are the reason

Staff is motivated as a group

At Hendrick Medical Center in Abilene, TX, offering incentives "has impacted our collections tremendously," reports Berdia Thompson, admissions supervisor.

Registrars collected about $800,000 in 2003, but this amount increased to $2.9 million by 2011 after additional training was given and an incentive program was started. "An incentive of 3% of total monthly collections is divided among the employees," she says.

Thompson says that an incentive for collections gives registrars "that extra push" to ask patients for money. "Some employees depend on that extra incentive to pay bills. It is more than just a bonus to them; it is their livelihood," she adds.

If patient access employees at Martin Health System in Stuart, FL, collect 5% more than the same month in the previous year, they receive a $50 payment.

"At first, we couldn't figure out what a reasonable increase was every year," says Carol Plato Nicosia, CHFP, CPAM, MBA, administrative director of corporate business services. "We chose 5% because that is about what our charges go up every year."

"In a bad economic time, time-of-service collections are even more important," says Nicosia. "The adage 'If you don't get it at the time of service, you probably won't get it,' is even more true."

Because bad debt collections are included toward the collection goal, this inclusion motivates staff to ask for previous balances. A registrar recently noticed that a patient receiving a discount for an elective cosmetic procedure had an uncollected balance from 2004, and the registrar ended up collecting 50% of this amount, says Nicosia.

"Previous balances are probably 5% of the money they collect, so it's not a huge amount. But if we didn't bring it up, it would not be collected," she says. "Staff tell the patient, 'Before we continue, we have to take care of this outstanding balance.' The patients pay up, then they talk about the current balance."

Employees received the bonus just seven months last year, but Nicosia says it's not intended for the employees to receive the extra payment every single month, because the incentive is for meeting a "stretch goal."

A running total of collections is posted, so staff members know exactly how far they are from meeting the goal. "This really fosters team spirit. Staff can see, 'We have only $2,000 more to go this month, and we'll get our bonuses,'" says Nicosia.

Each year, the hospital's COO asks Nicosia whether she thinks anything should be done differently to obtain even better results from the incentive program. "We have found that this approach takes the least amount of effort and time by the manager. In terms of dollars collected, it's a small amount to pay out," she says. "We get a lot of bang for our buck."

A 40% increase

In the first month after an incentive program was started at Ronald Reagan University of California — Los Angeles Medical Center, collections increased by 40%, reports Cris De Castro, CCS, manager of financial counseling for patient access services.

The new incentive program offers admission and registration staff up to $1,500 every quarter, says De Castro. These steps are taken:

• An individual goal is set, based on the specific job duties of staff in the main admission area, the emergency department, pre-registration, and patient financial services.

For example, admission staff and emergency department registration are given a goal of collecting from 20 patients each month.

"This mean they only need to do one to three collections per shift, depending on their work hours," she says. "When we reviewed this new goal with our staff, they agreed that it didn't seem too hard to do."

• Staff members are given a collection scripting tool.

"This helps them approach our patient in a comfortable and professional manner," says De Castro.

Highlighting top collectors

• Previous collections versus current collections are posted.

"We highlight our top collectors for everyone to see. This motivated our staff to do more," De Castro says. "The top collectors in the four areas will be given a gift card."

• Staff members receive training if their goal isn't met.

"We have a high number of staff who were close to meeting their individual goal," adds De Castro.