Healthcare executives say patients are more likely to pay before or during a hospital visit rather than after.
At Holy Name Hospital, emergency room registration employees now collect cash once patients have been triaged and stabilized by doctors and nurses.
The effort to boost on-the-spot collections from patients at Holy Name has targeted easily identifiable copayments in the emergency room and out-of-pocket payments for elective and same-day surgeries, Aaron says.
Changes have been “really, really very successful,” Aaron says, and Holy Name expects to gradually expand the effort. Cash payments from emergency room patients surged to $53,000 in the final five months of 2007 as employees began collecting bills before patients left the hospital, compared with $1,895 for the prior seven months.
For all of 2008, cash payments from emergency room patients added $186,900 to the hospital's bottom line. This past June, employees converted to registration and billing software from handwritten receipts in a bid to improve efficiency, Aaron says.
Meanwhile, cash from elective admissions increased to $205,000 for 2008 compared with $59,000 for the prior year.
While such amounts might appear small when compared with Holy Name's 2008 operating revenue of $260.3 million, they are more significant in light of the hospital's razor-thin operating margin of $1.8 million.
Aaron says that Holy Name will begin collecting from patients who visit the radiology department, particularly for more expensive diagnostic imaging such as CT scans. She is also considering strategies that will predict a patient's entire bill and score how likely that person is to pay. Such information will help the hospital collect deposits for medical care, she says. In some cases, Holy Name already delays some elective procedures or nonurgent care when patients don't make deposits, but only after consulting with physicians, she says. “We try to avoid that.”
For urgent or emergency care, hospital employees talk to patients after treatment but can do nothing should they refuse to pay. “We send them a bill and pray for payment,” Aaron says.
At Riverside, meanwhile, the system is now considering screening credit scores, income and available credit as patients schedule care to secure deposits from patients who are unlikely, but able, to pay, Fleischer says.
It is insured patients with available resources who Fleischer says she hopes to target with earlier credit screening. Emergency room services and medical care deemed urgent by physicians would be exempt from deposits, but required for other procedures, she says. “If it's clinically urgent, they pass go,” Fleischer says. “It's on the not-clinically-urgent that I'm going to ask questions.”
Without a down payment, “you're choosing not to have your healthcare today because you're choosing not to pay your financial obligation,” Fleischer says. She says she expects to lose some patients to nearby competitors. “I think we will get people walking out,” Fleischer says. “We'll have to stand firm.”