Are collections less than they could be? Training is probably the answer
Staff unaware hospital was ‘writing off millions’
When upfront collections first became a focus several years ago at Portland, OR-based Legacy Health’s six hospitals, “we started with the basics,” says Lindsay Hayward, director of patient access and health information management.
Staff members were given scripting to use when asking for copays, along with a list of standard deposits to collect for each type of service. “All of that was working pretty well. But last year, we decided to take things to the next level,” says Hayward. “We’re 80% above our baseline from when we first started tracking upfront collections.”
Hayward attributes the department’s dramatic increase in collections to training, setting goals, and implementing price estimator software. Here are changes that were made involving training, as part of Legacy Health’s new focus on collections:
• Staff members were told the dollar amount being written off in patient balances for their service area.
“We told staff that the hospitals are losing money we could be collecting,” says Hayward. “We were writing off millions, and staff were shocked by the numbers.” In addition, Hayward learned that staff assumed that it didn’t make any difference if the balances were collected on the back end, so she made them aware of the costs involved.
• Staff members were instructed to ask patients “How would you like to pay?” instead of “Would you like to pay this now?”
“Some of our staff had been here for so long that they were used to telling patients, ‘You can pay this today, or we can just bill you,’” says Hayward. “They eventually were able to get comfortable asking questions in a different way. We did see our numbers start to jump up after that.”
• Amounts collected are posted.
All patient access staff can keep track of the totals collected each month by individuals, service lines, and the overall hospital.
“They can see how much their peers are collecting,” says Hayward. “I was hesitant about doing this at first, but it has made staff competitive. They are motivated to be one of the top collectors.”
Aggressive goal
Outside of physician office and ED settings, most patient access staff at Edward Hospital and Health Services in Naperville, IL, weren’t accustomed to asking patients for payment at the point of service, says Orlando Melendez, director of central scheduling and patient access.
“Therefore, the focus of our training was on communicating the payment message to the patient,” he says. “We have a very aggressive goal to increase our point-of-service collections.”
The patient access management team trained groups of two to four registrars at a time. “This was done in order to stress the importance of the initiative, as well as to get a sense of any staff anxiety related to asking for payment,” says Melendez.
Registrars are required to indicate whether payments collected are part of the point-of-service payment initiative, so a report can be run showing the total dollars collected as part of the initiative.
“This initiative is fairly new for us, so it is too early to tell to what degree the training will increase point-of-service collections,” says Melendez. “However, we are off to a good start. More staff are actively asking for payment now.”
Incentives not enough
Currently, Bronson Methodist Hospital in Kalamazoo, MI is meeting only about 50% of its collection goals, reports Patti Burchett, CHAM, director of patient access.
“Goals were established based on 2 to 3% of net patient revenues for each area,” says Burchett. “Our expectation is that our education plan will allow us to fully achieve our targets.”
The patient access department trainer provides additional systems training to identify collection information and does role-playing with various patient interactions involving collections. This ongoing training already is helping staff feel more comfortable with requesting payment while maintaining positive patient experiences, says Burchett.
“Similar training will be provided to pre-registration staff. It will ultimately serve to better educate patients,” she says. “We will follow our model for improvement of ‘Plan, Do, Check, Act,’ and re-measure for success.”
Bronson offers incentives via an employee benefit called GainShare, notes Burchett, “so we know monetary incentives are not enough alone to meet our goals.”
Results for this payout are tracked by area on a monthly scorecard that is posted on the patient access department web page. “This current system provides an easy way for us to determine the educational impact before and after training,” says Burchett. (See related stories on setting minimum collection standards, below, and using a top collector to train ED registrars, below right.)
Sources
For more information on using training to increase collections, contact:
• Patti Burchett, CHAM, Director, Patient Access, Bronson Methodist Hospital, Kalamazoo, MI. Phone: (269) 341-6370. Fax: (269) 341-6648. E-mail: [email protected].
• Lindsay Hayward, Director of Patient Access and Health Information Management, Legacy Health, Portland, OR. Phone: (503) 413-2885. Fax: (503) 954-3393. Email: [email protected].
• Richard Hollis, Director of Admitting and Registration, Cambridge (MA) Health Alliance. Phone: (617) 665-2071. Fax: (617) 665-1042. Email: [email protected].
• Orlando Melendez, Director, Central Scheduling and Patient Access, Edward Hospital and Health Services, Naperville, IL. Phone: (630) 527-7472. Fax: (630) 548-7712. Email: [email protected].
When upfront collections first became a focus several years ago at Portland, OR-based Legacy Health’s six hospitals, “we started with the basics,” says Lindsay Hayward, director of patient access and health information management.
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