Can Hospitals Achieve the “Collections Hat Trick”?
Patient Satisfaction, Strong NPS, and Higher Self-Pay Collections
Let me begin with an example from outside the revenue cycle.
I recently read about a healthcare organization implementing a “Discharge Lounge.” The idea was simple: provide patients with a comfortable place to relax during the often-frantic discharge process while allowing hospitals to turn over beds more efficiently and improve throughput.
Initially, patients resisted being moved to the lounge. When the hospital spoke with patients, the feedback was clear: staff couldn’t explain why the change existed or how it benefited patients.
Once staff began explaining the purpose earlier in the patient journey — starting during admission and reinforced by clinical staff — acceptance improved significantly.
What does this have to do with revenue cycle performance?
Quite a lot.
Hospitals today are often trying to achieve what I like to call a “collections hat trick.”
Strong Net Promoter Scores (NPS) and patient satisfaction
Positive Patient Financial Services (PFS) interactions
Improving patient responsibility collections
Many organizations assume these goals conflict with one another. My experience suggests they do not.
Patient Satisfaction and Financial Conversations
Net Promoter Score has become a widely used metric for understanding patient perceptions and whether patients would recommend a healthcare organization to others.
For those of us leading Patient Financial Services departments, however, the experience has sometimes been frustrating. When I reviewed our Press Ganey scores, I often felt they did not fully reflect the quality of the interactions my team had with patients and guarantors.
Still, I understood the broader point: financial interactions are part of the patient experience.
To better understand our performance, I developed internal measures that compared operational outcomes with patient impressions of how we performed.
Our goal was simple: strong financial outcomes with minimal complaints. To ensure that I was doing my part to create a positive perception, I developed my own internal measurement metrics.
Access Performance
Total encounters
Less negative encounters (complaints, errors, delays)
Payment Plan Collections
Collection percentages
Less accounts referred to collections
Less number of complaints
Bad debt referrals were viewed as failures to identify positive financial solutions for patients. Complaints were viewed as communication failures.
Looking Beyond Point-of-Service Collections
There is often an oversized emphasis on point-of-service collections as a measure of patient/guarantor collection performance. A more appropriate measurement is total patient responsibility collections across all points within the revenue cycle
Moreover, organizations should be asking:
Are bad debt levels declining?
Have we positively impacted bad debt reserve levels?
This broader view better reflects how effectively a hospital is supporting patients while protecting financial performance.
How Hospitals Can Achieve the Hat Trick
Over time, healthcare has moved from isolated departments — admitting, billing, medical records — to a more integrated revenue cycle mindset.
Access, Health Information Management, Information Technology, care coordination, physician advisors, regulatory compliance, and financial services all play roles.
Achieving the collections hat trick requires an integrated revenue cycle team and a shared understanding that everyone contributes to both the patient experience and financial performance.
Based on my experience, here are several practical strategies.
1. Begin Financial Conversations Early
The financial conversation needs to begin before the patient ever arrives at the hospital – often in a physician’s office.
Pre-registration forms or online access should be available for patients scheduled for future services. This allows the hospital to begin conversations about insurance information, potential out-of-pocket costs, and payment options before the date of service.
This approach improves transparency and makes the day-of-service experience smoother.
At one organization, we focused heavily on pre-registration within our obstetrics program and achieved 90%+ pre-registration rate across more than 5,200 annual deliveries via a joint effort of OB physician practices and our Access Department.
2. Make It Easy for Patients to Speak with a Real Person
Few things frustrate patients more than navigating endless phone menus.
While automated systems may reduce costs, they often create dissatisfaction and delay financial resolution.
Patients who need help understanding their bills should be able to speak with someone quickly.
A simple tip many patients already know: try pressing “0.”
3. Be Careful With “Propensity to Pay” Models
Some organizations rely heavily on propensity-to-pay scoring to determine which patients to pursue for collections.
While the analytics may be interesting, my experience suggests that focusing on broad, inclusive financial strategies works better.
Patients want to resolve their balances if the options are reasonable and clearly explained.
Investing staff energy into identifying solutions — rather than filtering patients — tends to produce stronger results.
4. Carefully Evaluate Recourse vs. Non-Recourse Vendors
Many hospitals select non-recourse vendors because balances are permanently removed from accounts receivable and the perceived risk disappears.
However, this often comes at the cost of deep discounts and lower net returns.
In my experience, recourse-based programs can produce significantly stronger financial outcomes while maintaining strong patient satisfaction.
In one program we implemented, payment plan balances achieved a 94% collection rate with patient complaint levels below 1%, producing an NPS of 93.
This is a topic worthy of its own discussion, and I will explore it in a future article.
5. Reduce Financially Driven Procedure Cancellations
Patient satisfaction inevitably suffers when procedures are delayed or canceled for financial reasons.
Revenue cycle leadership should track elective procedure cancellation rates, particularly those related to financial barriers.
At one organization, we partnered with a payment plan vendor to develop a pre-service funding option for patients who might otherwise postpone care.
The results were extremely positive — both financially and from a patient experience perspective.
Patients appreciated having a path forward, and clinical leadership supported the program.
The Bottom Line
Hospitals do not have to choose between patient satisfaction and strong patient collections.
With the right strategies, communication, and financial options, organizations can improve the patient financial experience while strengthening revenue cycle performance.
In other words, the Collections Hat Trick is achievable.
Improving patient financial experience and financial performance doesn’t have to be a trade-off.
If you’re exploring how to better manage patient balances, we’re always happy to share what we’re seeing across hospitals.
Author Bio
About the Author
Michael Berger is a former senior level Revenue Cycle Officer and healthcare finance consultant with more than 35 years of experience in hospital operations and revenue cycle leadership. During his tenure at St. Peter’s Healthcare System, Berger led initiatives focused on improving patient financial engagement while strengthening collection performance and financial stability for the organization. Having worked directly with patient financing programs as both an operator and a client, he now shares insights on revenue cycle strategy, patient financial services, and the financial challenges facing rural hospitals.