Co-payments represent just a small portion of the revenue healthcare facilities collect for services rendered, however the small up-front payment has a big impact. That’s why two departments at Brigham and Women’s Faulkner Hospital—Rehabilitation Services and Admitting and Registration—are focusing on improving their co-pay collection process with incentives from a friendly competition with their counterparts at Brigham and Women’s Hospital.
When co-payments are collected on the day of a patient’s appointment, it eliminates the cost to generate a billing statement later. It also provides cash flow for financial viability. But more importantly, it’s been shown that educating patients of their financial obligation improves patient satisfaction and it helps reduce patient confusion about their bills.
While it might seem like just a simple step in the check-in process, there are barriers to collecting co-pays. On busy days, it can be easier for staff to simply skip the collection process and bill the patient later in order to keep patients on time for their appointments. Another contributing factor is that patients may not know for sure how much their co-pay is. And sometimes, patients just prefer to be billed later. “Particularly in Rehabilitation Services where patients come for multiple visits, it really is best for the patient to pay their co-pay as they go rather than be faced with an unexpected bill later on,” says Director of Rehabilitation Services Jean Flanagan Jay, PT, DPT, CLT. “Plus, it’s revenue the hospital can begin using right away for important improvement projects.”
Last year, Brigham Health Revenue Operations, led by Director David Doherty, set out to increase co-pay collections. “We decided to focus on Rehabilitation Services departments across the system due to their nature of scheduling recurring visits with single patients,” he explains. “Our thought was the department personnel would have multiple opportunities to collect the co-pay amounts due, and the repetition would help them learn to make this step a part of the normal check-in process.”
Doherty explains that within the Epic Benefits Engine there is data related to a patient’s co-pay amount due. “This data is displayed to the front desk user to assist them with knowing when to collect a co-pay. Epic contains a monthly report that accumulates visit data by department and compares patient payment dollars collected on visits against the total possible co-pay amount eligible for collection. The department leads were very engaged in the process improvement, and wanted to know how well they were doing. As the team experimented with ways to distribute and display information, there was a lot of conversation related to seeing percentage improvements as compared to each other… and thus our spirit of friendly competition began,” he says. “We initially distributed outcomes in a narrative format, which later included spreadsheet tables and now goes out as an interactive dashboard to the department leadership. It’s all about the feeling of having accomplished something that benefits the bottom line.”
At BWFH, Emergency Department Admitting and Registration is also participating. Director Stephanie Johnson says her staff has been encouraged by the data tracking and the competition. “We’ve encouraged Champions to lead the cause. I am thankful to Norbely Bustillo for doing such an amazing job in this role. And we’ve tried to give the staff the tools they need to assist the patients,” she says. “We provide the staff with a script outlining the best way to ask for a co-pay. That way, the message is the same throughout the ED. And we try to be flexible with our patients. We offer patients who have large co-pays the chance to pay less with us and be billed for the rest later. We also provide a handout with information about financial assistance should the patient need it. We can even send one of our in-house counselors up to the floor to meet with them if they are admitted.”
Back in Rehabilitation Services, Jay is also giving her staff the tools they need to improve their process. “We’ve changed the way we word things when we ask patients about their co-pays. We say, “Would you like to pay your co-pay today?’ or ‘How much is your co-pay today?’ And we are trying to collect co-pays the first time a patient comes to us so that they know to expect it each time they visit,” she says. “During some months we are great at it. In fact, we’ve achieved up to 79 percent which translates to almost $6,000 in some months for the hospital. That’s approximately $70,000 over the course of the year. But during other times we’ve only hit about 39 percent. It’s something we have to keep our eye on. Our goal now is to achieve 80 percent.”
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