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As she begins point-of-service collection classes, Beverly Varshovi sometimes shows her staff a magic wand — the kind in fairy tales — and says if they don’t ask patients for the cash they owe the hospital, they’re going to need the wand to get it.
Making the job fun is just one of the ways Varshovi, associate director for admissions at Shands Hospital at the University of Florida in Gainesville, motivates her employees toward ever more successful upfront collection of copays and deductibles.
In one session, she told employees that with some facilities in the seven-hospital Shands HealthCare system clearing only $100,000 or so annually, their upfront collection of $1 million could actually save a hospital — and the jobs of their peers that work there. Two years ago, Varshovi says, she told her staff that without their collection efforts, their hospital’s margin would have been more than 50% less than it was.
At the core of her efforts — which also include assigning individual and team collection goals and making the outcomes part of job evaluations — is a steadfast belief that upfront collections equal good customer service, she says.
"I knew my staff [initially] would be reluctant and would see this as a conflict with customer service, but I do not," Varshovi says. "I think just the opposite. It’s worse customer service to ambush the patient [with a bill] three or four or six weeks past treatment. Patients are under stress because of the clinical component of their visit, but they’re also worrying about, How will I pay?’ and What is my responsibility?’
"My belief is that we really are providing superior customer service if we notify the patients [of their financial obligation] in advance if possible, but certainly before treatment is performed," she adds.
Under Varshovi’s leadership, registration staff at Shands at the University of Florida exceeded its fiscal year 2001 target of $4.1 million in upfront collections, taking in $4.477 million for the year that ended July 31, 2001, notes Tim Carney, CPAT, assistant manager of outpatient financial arrangements.
In 2000, staff collected $3.249 million, and $2.789 million in 1999, Carney adds, both times also exceeding the goal. What makes the success particularly sweet, he points out, is that these are the accounts that patient financial services personnel often write off because individually they represent small amounts. "This is money you [otherwise] probably won’t collect."
As the departmentwide collections goal increased each year, so have the individual goals, he notes, going from $1,000 in fiscal year 2000 to $1,500 in FY 2001. "Now we’ve got them up to $2,000. It’s something to shoot for."
Asking patients for cash opens the door to uncovering a potential problem, Varshovi notes. "If patients let us know they can’t pay, then we have a branch to take. Either they can’t pay or they won’t; and if they truly can’t, then financial counseling efforts really begin in terms of sponsorship or of asking the hospital to extend credit.
"From my perspective," she adds, "it’s truly customer service when we get somebody qualified for Medicaid that either didn’t know they were eligible or were embarrassed to ask."
Her final thought on the subject, however, "is that it’s Shands’ money and our role is to try to secure it," Varshovi says. With that in mind, her department has these practices in place:
Contests are held for the highest percentage of goal met — monetary amounts differ according to the potential for a particular area — and staff are rewarded with small gifts, drawings and food celebrations. (See "It doesn't cost a lot to reward staff effort," in this issue.)
"Managers report on why they’re ahead, or why not," Varshovi notes.
When people interview for registration jobs they’re told that if they don’t meet their cash collection goal, they probably won’t pass probation, she says. New hires who knew from the beginning this was part of their job have outperformed a lot of existing staff, Varshovi points out. "Then [existing staff] didn’t have any argument left to make."
"We told them, If you encounter situations where patients are distraught, call us,’" she says. "I must have gotten paged 50 times, but the resolutions were all positive. We did have to deal with complaints — in some cases employees were more aggressive than they needed to be, but in others, patients were just angry about being asked for cash."
The last time she was paged to handle a collections complaint, Varshovi adds, was more than a year ago.
However, if patients say they can’t pay 80% of what they owe on the inpatient side, or 60% on the outpatient side, the employee handling the account must page a supervisor to get the OK to move ahead, she notes. If a person is judged to be a financial risk, Varshovi says, "we go back to the ordering physician and see if [the procedure] can be rescheduled."
"The employee can say, I have a flag here that indicates there is something about your account that is not resolved,’" Varshovi explains. "They’re able to resolve it then and there and prevent future bad-debt issues."
These staff, she says, sit in radiology or the electrocardiogram area. The accounts of scheduled patients who owe a copay or deductible are flagged so that the clinician knows the financial specialist needs to see that person, Varshovi adds. Meanwhile, that person has been called in advance and told to bring such-and-such amount of money to the appointment, she says. "That’s where the real [collections] focus will be this year."
Access managers instituting an upfront collections program, Varshovi advises, should start slow, with a realistic goal, and hold training classes for their staff. "My job is to hold that class," she says. "They need to see me, not their supervisor, telling why it’s important."
Be upfront with hospital administrators, Varshovi adds, and tell them that initially there might be complaints. "There were people saying they’d been coming here for 20 years and were never asked for money. Somebody reached in a pocket and threw change in an employee’s face. There were ancillary staff who helped people escape us.
"If I could have done anything differently," she continues, "I would have spent more time educating."
[Editor’s note: Beverly Varshovi and Tim Carney can be reached at (352) 265-0322. Look for articles in future issues of Hospital Access Management on how Shands at the University of Florida got a handle on pre-cert denial management, and steps the admissions department is taking to prepare for the Health Insurance Portability and Accountability Act of 1996 implementation.]