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A Better Emergency Department Patient Access Strategy


Improving patient collections in fast-paced, high-volume clinical environments.

Although traditionally reliant on reimbursement from insurance carriers, today’s hospitals are now looking to patients for a much higher percentage of revenue for healthcare services. One recent Kaiser Family Foundation survey found that out-of-pocket healthcare costs rose by nearly 230% from 2006 to 2015.

This revenue shift represents a big change for hospitals and consumers alike. Consequently, many patients need help understanding how greater financial responsibility fits within the broader scope of their care delivery options. Without this help, some patients may find it difficult to navigate their care costs.

Hospitals, in turn, must contend with the fact that the probability of collecting patient balances drops significantly after services are rendered. Research conducted by the Advisory Board suggests that providers who fail to make point-of-service collections on a $150 patient-responsible balance only have a 36% chance of collecting fully.1

In response to this new reality, some providers are prioritizing front-end financial counseling strategies to elevate both the revenue cycle and the patient experience at the same time. Workflows supported by a solid infrastructure of automation and analytics can improve upfront payments, while also enhancing the overall patient financial experience.

Many hospitals have deployed financial counseling in patient access processes associated with scheduled inpatient and outpatient services. However, forward-looking organizations also recognize that these tactics are especially important in the emergency department (ED), where complex patient situations and workflows can increase the challenges associated with point-of-service collections.

Five Steps to Building the ED Patient Access Strategy

Improving the ED revenue cycle and the patient financial experience starts with developing processes to address patient needs, patient access efficiency and clinical team collaboration. Hospitals and health systems should consider these 5 elements:

1. Recognize the point-of-service opportunity

The first step to better patient collections is identifying and acting on point-of-service opportunities specific to the ED. Examining patient volumes and patient mix can help healthcare providers ascertain opportunities specific to their organizations. While the basic premise for expanding point-of-service collections is the same in the ED as elsewhere, the clinical intricacies of this highly acute, fast-paced environment are unique. Therefore, patients in the ED require a more collaborative approach to financial conversations. Patient conditions need to be considered in determining whether financial counseling should take place in the ED, or in a different hospital care setting.

2. Determine appropriate resource allocation

Hospitals must also consider resource allocation needs, both from the staffing and training standpoints. As patient volumes increase, many EDs are grappling with fluctuating administrative staff-to-patient ratios, which has a direct effect on front-end registration responsibilities. As a result, hospitals have a good reason to dedicate resources to financial counseling and ensure all patients can be reached to have their financial questions and concerns addressed.

Importantly, a balance of proactive engagement and compassion must exist to ensure collections occur for a positive patient experience. Healthcare organizations are wise to train financial counselors on specific workflows and scripting that address the nuances of counseling patients in emergent situations.

Although some hospitals are bolstering the ED patient access experience by adding staff, those facing lean budgets may have difficulty getting approval for this approach. When added internal resources are not an option, healthcare organizations increasingly find a viable and effective alternative in partnering with a third party to outsource the ED financial counseling function.

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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