Joyce Sauvager has it easy when it comes to dealing with patients. “If I have a difficult patient, I just put them under. No more difficulty,” says the veteran nurse anesthetist. “People can be nasty. They get violent with me, I step away. But then the drugs go in, the patient goes out. End of trouble.”
OK, that’s an unfair advantage. And certainly, Sauvager has had her share of presedation scuffles. Still, positively interacting with patients, along with getting them to honor your practice policies, challenges all who work in the medical field. What can you do to foster a mutually beneficial relationship with those your serve?
Let’s look at each of the major types of difficult patients for answers.
The bill shirker
Insurance contracts require you to collect a copayment for every patient visit. So why is it so hard to collect them? “Part of the time the person just doesn’t want to pay, even if they have insurance,” says JoAnn Johnston, director of operations for the 170-employee Heart Center Medical Group in Fort Wayne, Ind.
To be sure, some people really do struggle to produce a $25 copay, and insurance companies are piling more and more out-of-pocket expenses onto the consumer. “There’s no more $10 copays,” says registered nurse Denise Kleber, who is the team leader for the Heart Center’s gastroenterologist. But with overhead costs absorbing half of your gross receipts and reimbursements shrinking like the polar ice caps, you need to be on top of collecting every dime you’re due from reluctant patients.
Luckily, there are some specific strategies to help you ramp up your collections at the time of service:
- Offer varied payment methods. Nearly four out of five physician practices accept credit cards, reports the 2005 Medical Practice Monitor by American Express’s OPEN division, which focuses solely on small-business development. If you’re one of the 20 percent that still doesn’t, then get on board. Increasingly, people pay with plastic. Yes, there are fees associated with processing credit cards, but you can find good deals through credit unions or bulk warehouse businesses such as Costco. You’ll get paid in just a couple of days, and without worrying whether the check will clear. Put your Web site to work, too, by getting set up for online payments. The easiest way is through PayPal, a popular and safe method of Internet payment. Anyone with an e-mail address can send you money electronically, using either a credit card or a bank account.
- Set and publicize a “same-day payment” office policy for copayments. Post it everywhere. Also, send a letter to your entire patient panel, announcing the policy. Explain how this same-day payment strategy will help to keep administrative costs down because you won’t have to spend hundreds of dollars and hours of time sending out paper reminder statements (which often go ignored). Emphasize that insurance contracts legally bind your practice to collecting copays from patients. Be nice, but also firm in your statements.
- Engage your staff. Make phrases like “Will you be making a payment today?” verboten in your office; instead, teach your staff to ask, “How will you be paying today?” Do not allow your team to offer a choice of paying or not. Also, personalize the issue of collecting payment by pointing out that the money in staff paychecks is connected to the money they collect. Set collection goals, and when they’re met, reward them with some sort of incentive, such as a catered lunch.
- Be flexible if the situation truly warrants it. Work with those who are truly struggling to pay you. Set up a payment plan. Consider offering a slight discount for paying the bill by an agreed-on deadline; some is better than none.
Your schedulers do their best to fill the appointment book in a way that keeps the patients flowing. Perhaps the schedulers also make reminder phone calls a day or two before patients are supposed to come in, and maybe your practice even levies a fee for those who never materialize at the appointed time. Still, certain patients just don’t show up.
Frustrating? Yes. Can you improve your stats? Depends. “You really have to look at each case individually,” says Kleber. When you have a patient who is chronically late or in absentia, start by probing for details. Can they drive themselves? Are they handicapped in any way? “We’ll be a lot more tolerant in those cases,” she says.
Johnston concurs, adding, “If it’s someone who’s institutionalized, it’s never their fault.” She also takes into account the fact that 60 percent of their patient population is on Medicare, which seems directly related to appointment time befuddlement. “They’re either 15 minutes late or a half-hour early.”
Regardless of where the fault lies, you still have a right to decide whether you want to continue a relationship with a patient who’s habitually AWOL. Decide on a policy that works for you: First-offense forgiveness, then $25 a pop?
If a patient contracts a case of terminal tardiness you may choose to discharge him, but make sure you’ve noted — literally — a pattern you can prove. “Grievously late” is fairly subjective; decide what’s right for your practice. If you use open access scheduling, you’ll have a varying ability on any given day to retrofit Johnnie-come-latelies into the daily docket. Those with traditional scheduling will have less wiggle room.
