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An ED patient can't pay? Don't leave them hanging
Have staff offer aid with finances
At Catholic Health Initiatives in Lincoln, NE, the patient access department is forming a workgroup to do a better job of helping patients with financial counseling at the time of their emergency department (ED) visit, says Lauree M. Miller, director of patient access.
"If it's an emergency situation, it's difficult to have that conversation with patients," she acknowledges. "They are concerned about their condition. They were not planning to come in, so they didn't have any time to think about how they will pay."
However, Miller says that ED patients are getting more comfortable discussing finances, and staff are getting more comfortable asking them for payment. "We incorporate it into our scripting and hardwire it into the work that we do," she says. "Even asking the question is a shift. Before, it was always just 'we'll just send you a bill.'" The department has seen some recent increases in its ED cash collections, says Miller, but "probably not where we want it to be."
The workgroup was formed due to the growing numbers of self-pay patients in the ED, says Miller. "We are looking at what we can do to help ED patients with financial assistance counseling," she says. "Are we just giving them a form, or do we have a good process in place to close the loop? This is an area we feel we really need to close the gap."
It's not enough to simply hand the patient an application for Medicaid or the hospital's financial assistance program, says Miller. "The paperwork may seem overwhelming and complicated to the patient," she says. "We don't want the bill to go to a collection agency down the pike, when the patient really didn't have the ability to pay in the first place."
Miller says that some ED patients have been "very grateful for our assistance. It's all in our scripting and how we reach out to them. We want to be sure they have an avenue to come back to the facility for assistance."
Offer a service
While scripting can help registrars to discuss finances initially, staff ultimately are most comfortable using their own words, says Miller.
"We did some role playing. This gave staff the chance to practice dealing with some of the more difficult customers," she says.
Staff are reminded to remember that being asked for payment is new for ED patients, says Miller. "People aren't used to paying upfront at a hospital. It's a change," she says.
Likewise, registrars are not accustomed to being financial counselors, says Miller. "That is a mindset change for them, as well," she says. "We are getting staff comfortable by doing role play after role play. Still, some have told us, 'I wasn't hired to call people and ask them for money.'"
Miller says that while registrars are given additional training and support in this role, some have remained resistant. "Staff have to meet us halfway. They have to want to do this," she says. "If it's not something they could ever get comfortable doing, we help them recognize that this isn't the position for them."
Patients are more likely to respond positively to collection attempts if staff present it to them as a service being offered, says Miller. For instance, staff may say to a patient, "We'd like to provide a service to you, to help you understand your coverage and your out-of-pocket responsibilities. Can we put a down payment on your visit today, to reduce your bill when you do get it in the mail?'" she says.
"If you start out that way, patients are much more willing to listen," says Miller.
For more information on ED collections, contact:
Lauree M. Miller, Director, Patient Access, Catholic Health Initiatives, Lincoln, NE. Phone: (402) 219-5488. Fax: (402) 219-8008. E-mail: firstname.lastname@example.org.