Address these concerns before offering incentives
Expect a 'tremendous difference'
Access departments struggling with dwindling cash collections may find that some simple incentives can work wonders. On the other hand, there are some potential pitfalls to consider.
"The downside to using incentives is establishing employee expectations of ongoing rewards," says Diane Manuel, director of patient access for admissions and the emergency department at Wake Forest University Baptist Medical Center in Winston-Salem, NC.
The problem is that employee efforts can become overly dependent on incentives, instead of collections being considered just another part of the job.
"Collections monitoring can become labor intensive," says Manuel. "Once a program has been in effect for an extended period of time, employees' satisfaction may diminish."
Manuel says that when she worked as an ED cashier at another hospital, a daily contest was held among cashiers. "The numbers were posted in the cashier area," she says. "After several years, this was discontinued. It was viewed as an unfair display of work performance."
The department experimented with an incentive plan for ED collections in early 2010, which was in effect for three months. The high collector for each month was awarded a $50 gift certificate, and the top collector for the first three months received a $100 gift certificate.
"We had experienced a 12% drop from the first 2010 fiscal year quarter to the second quarter," says Manuel. "The incentive was in place during the third fiscal year quarter. For this quarter, we saw a 22% increase between the second and third quarters, and 7 1/2% above the first quarter." Collections increased $25,952 over the three-month period.
Cook Children's Medical Center in Fort Worth, TX, offers a cash incentive to employees for increased collections. This is based on a monthly departmental cash collection goal. "We have had an incentive-based collection policy and process for several years now," says James Nicholson, manager of patient registration. "It has made a tremendous difference in our point-of-service collections."
All employees are eligible for the incentive, based on particular benchmarks being met or surpassed. These vary according to their job description.
As for the particular type of incentive offered, Nicholson says that a cash-based program has proved to be the most successful. "We have designed our incentive program in a particular way," he explains. "It is not only to enhance point-of-service collections, but to ensure a high degree of accuracy at the same time."
In order to qualify for the incentive, an individual must meet a 95% accuracy standard. This is determined by constant auditing of the employee's work, by the quality assurance (QA) team.
The QA team looks at every field and every screen, to make sure the employee is capturing and updating all the required information at every visit. A full-time employee who meets the accuracy standards receives a $250 incentive every month.
Nicholson says that his major concern with offering a cash-based incentive program is that employees will forget the mission and focus only on collections. "We coach our employees extremely well when it comes to the collections process," says Nicholson. "The staff understand that a point-of-service collection is great, but that we can assist the family in other ways if they are unable to pay at the time of service."
The "Coaching with Compassion" method is used. "Our employees do an outstanding job of not only collecting, but also helping families with payment arrangements, applying for government programs, and assisting them with hospital charity," says Nicholson.
Employees are told to imagine themselves as the customer. "We want our employees to treat our customers just like they would want to be treated when they bring their children here," says Nicholson. "We want our employees to consistently ask each family for their known cost share, but we want them to do it in a way that promotes our compassion for their child, not in a bill-collector style."
Top collectors appreciate the financial incentives, but they're also recognized at staff meetings and in departmental newsletters. "Our employees still like to be personally recognized in front of their peers," says Nicholson. "Everyone likes to be told they are doing a good job. It validates all the hard work the employee is doing."
Patient access managers at Cook Children's are very diligent about sending staff e-mails to give them immediate kudos for their efforts.
"In our system, we have access to all collections made throughout the day," Nicholson explains. "We know it is hard, under the circumstances we deal with daily, for staff to ask families for large amounts of money at the point of service."
The majority of the department's point-of-service collections are driven by scheduled procedures. "We have made great strides in this area by instituting a pre-registration team. We have built a team work module between our insurance staff, financial counselors, and registration staff," says Nicholson. "It takes all three areas working together to create a smooth and seamless registration process for the family."
The pre-registration team calls scheduled patients in advance, and completes the entire registration process over the phone. Since the insurance team has already verified the patient's benefits, the pre-registration team is able to speak to the family about the amount due at the time of service.
This is all taken care of before the family arrives. This way, the registration staff can focus on giving good customer service during the visit, and getting the family in and out of registration as quickly as possible.
"We have the ability to focus on escorting patients to their destination," says Nicholson. "Wait times have diminished greatly in our scheduled procedure registration areas. All but the signing of consents and collecting money has been taken care of before the family arrives." Families now typically wait less than three minutes.
Registration staff also have a better chance of success with collections. The department's point-of-service collections have increased by more than 25% since 2008. "Collections have continued to grow, even with the problems in the economy over the last few years," says Nicholson.
[For more information, contact:
Diane Manuel, Director of Patient Access, Admissions and Emergency Department, Wake Forest University Baptist Medical Center, Winston Salem, NC 27157. Phone: (336) 716-3312. Fax: (336) 716-0623. E-mail: [email protected].
James Nicholson, Manager, Patient Registration, Cook Children's Medical Center, 801 7th Ave, Fort Worth, TX 76104. Phone: (682) 885-7116. Fax: (682) 885-6060. E-mail: [email protected].]
Access departments struggling with dwindling cash collections may find that some simple incentives can work wonders. On the other hand, there are some potential pitfalls to consider.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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