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A Better Emergency Department Patient Access Strategy
March 15, 2017

A Better Emergency Department Patient Access Strategy

Kristen Coletto is the vice president of Financial Counseling at Change Healthcare, where she is responsible for developing and expanding financial counseling solutions for provider organizations. Before Change Healthcare, she led concept incubation at Healthagen, a subsidiary of Aetna, and developed new start-up businesses focused on population health information technology and services. She also served as the Head of Operations for NeoCare Solutions. Prior to joining Healthagen, Coletto was a member of Aetna's Corporate Strategy team and managed strategy and planning for Aetna International to identify global growth opportunities. Before joining Aetna, she worked for the Advisory Board Company and PA Consulting Group.
3. Refine workflows appropriate for fast-paced, regulated ED environments
While other inpatient and outpatient hospital intake areas afford front-end staff the luxury of pulling financial information ahead of time, ED admission staff must gather information in real-time. Furthermore, financial counselors in the ED must ensure that processes stay within the parameters of the Emergency Medical Treatment and Labor Act, which ensures public access to emergency services regardless of ability to pay.
Even with these crucial nuances, there are opportunities to speak with patients about their obligations and collect at the point of service. The key is to be sure financial counselors collaboratively work with registration staff and clinical staff to understand where patients are in the care process. The financial conversation in the ED should only occur after a patient is triaged, seen by a provider and deemed stable, but before he or she is discharged from the ED, for optimal results. 
Access to tools, such as electronic patient bed boards or real-time census information, can help ensure all clinical and administrative staff understand where patients are in the process. Professionals can then work with care teams to identify an appropriate time to discuss payment obligations prior to discharge.
4. Provide information access to financial counselors
Effective financial conversations that engage patients and motivate response hinge on the availability of accurate and complete information. Financial counselors need access to an accurate tool that verifies insurance benefits and helps estimate both cost-of-service and patient-responsible balances. In addition, patient access systems must support strong payment capture that empowers both patients and admissions staff with easily understood financial payment records.
When this framework exists, counselors are intelligently equipped with the information they need to have financial conversations with patients, as well as help patients make informed choices and payment decisions.
5. Improve communication skills
Critical to any ED point-of-service payment strategy are staff members skilled at having financial conversations. Collections traditionally have been a back-end task conducted behind the scenes and after services have been provided. However, a front-end workflow that encourages well-trained staff to speak empathetically with patients about their financial obligations—and to ask for payments upfront—can have a dramatic impact on the bottom line. For example, the same Advisory Board data reveals that patients are almost 2.7 times more likely to pay their full balance owed when 61% to 70% of their estimated obligation is collected at the point of service, than if they are billed after service is rendered.1
So, healthcare organizations would be wise to train staff specific to ED workflows, as well as provide scripts that address the nuances of counseling patients in emergent situations. When patients have the chance to ask questions and understand their upfront obligations—like co-pays—point-of-service payments can only improve.
Taking Hold of ED Patient Access
High-deductible health plans will continue to shift payment obligations to patients for the foreseeable future, and the chance to collect will continue to remain low when patients leave the hospital without proper financial engagement. Most patients want to take ownership of their monetary obligations, but are unfamiliar with upfront collection processes. That is why it’s so important for administrative staff to guide them empathetically to the best solutions.
To start reducing bad debt and realize optimal payments, hospitals must focus on enhancing front-end financial counseling, point-of-service collections and the overall patient experience. High-volume patient areas, such as the ED, present notable opportunities for patient access process improvement. With the right infrastructures and workflows, EDs can effectively motivate patient payments, increase clinical and administrative staff collaboration and ultimately increase collections. 
1. Financial Leadership Council Brief: Are you Asking for Enough at Point of Service? Advisory Board. 2016.

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