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4 Pillars of the Compassionate Framework for Healthcare Collections

Updated: Jun 29, 2021

Since the beginning of the COVID-19 pandemic, “empathy” and “compassion” have been buzzwords in almost every industry. People are craving the human connection and understanding that comes with empathy, which is why now more than ever, understanding empathy and compassion is extremely important.

Luckily, I’ve got you covered. For the past 15 years, I’ve studied neuroscience and conducted communication experiments in my debt collection agency to understand how empathy works and how to use it effectively in business situations. As a result, I’ve discovered empathetic communication techniques that work, even in the most challenging circumstances, including collecting money.

Since then, I’ve trained patient account representatives to use my communication principles while collecting balances from patients. That experience, coupled with the lessons I learned from the COVID-19 pandemic, has led me to create the Compassionate Framework for Healthcare Collections, which is a step-by-step guide for training patient account representatives to collect medical debts empathetically and effectively.

The framework has 4 key pillars:

  1. Understanding the patient experience

  2. Investing in top skill sets

  3. Creating connection

  4. Establishing credibility in the new normal

I wholeheartedly believe that we’re entering a paradigm shift brought on by the pandemic, and healthcare providers across the country will need to find new ways to collect—ways that involve the empathy component that individuals are asking for and expecting. All of that starts with the compassionate framework, so let’s dive into the first pillar—Understanding the patient experience.

Pillar 1: Understand the Patient Experience

Patient account representatives have a unique role because they’re having conversations with patients who are experiencing a great deal of stress due to their medical needs, and likely because of their finances.

In fact, according to a 2014 report published by the Commonwealth Fund, 75 million Americans reported problems paying their medical bills or are working on paying off medical debt. And that number is on the rise every year.

Patient account representatives need to be mindful of the potential challenges patients are facing when they speak with them about their medical expenses. If patients don’t feel like their unique circumstances are being considered, they will be less likely to reach a solution with the patient account representatives.

When representatives understand the patient experience, it’s easier for them to show empathy when speaking with patients, which will in turn allow them to collect balances easier.

Once representatives have a greater understanding of the emotional and psychological toll patients in medical debt experience, the next step is to boost their emotional intelligence so they know how to navigate these difficult conversations with patients.


If we don’t focus on emotional intelligence, our patient account representatives could become overwhelmed with sympathy, which could cause their collection practices to be too passive, landing them in the “friend zone” with the patient. When representatives are in the friend zone, it’s unlikely that they’ll collect the account balances because they’ll be too afraid to ask for payment.

When we focus more on the representatives’ emotional intelligence, we’re able to teach them how to collect balances without being too aggressive or too passive. They’re able to utilize empathy to handle conversations from start to finish without triggering the patient while still collecting money. It’s truly a win-win situation. Let me explain how this works. Something important to know is that all humans have a universal need: To feel heard and understood.

When a representative is emotionally intelligent, they can meet a patient’s need to feel heard and understood, and the patient will feel more comfortable moving on in the conversation to reach a solution.

The truth is, emotional intelligence is only one part of the equation. Representatives need additional training to handle other roadblocks that may come up during their conversations with patients. And that’s where the second pillar, investing in top skill sets, comes into play.

Pillar 2: Invest in Top Skill Sets

In addition to emotional intelligence and a grasp on the patient experience, patient account representatives need training in 3 key areas to keep conversations with patients flowing smoothly.


Effective communication training is one of the most important skills a patient account representative can have. After all, the conversations with patients can be extremely challenging, and being able to communicate and build trust will make or break the outcome.

Additionally, when representatives are trained to communicate, you’ll notice more consistency across the board. When representatives are consistent, it gives the patient more confidence in your office’s ability to help them reach a solution.

Combined with the other skills outlined in this section, empathetic communication training will really put representatives on the next level and will equip them with the confidence they need to have those challenging conversations with patients.


Sometimes, representatives might notice that conversations go in a direction they weren’t expecting, and they aren’t sure what to do next.

For example, maybe the patient is refusing to pay, and the representative isn’t sure what to say next to move the conversation forward. A representative without critical thinking skills may end the conversation immediately; a representative with critical thinking skills will be able to problem-solve and reverse-engineer the roadblock until they reach a solution.

One way to promote critical thinking is to pre-script solutions to any common roadblocks that come up during conversations with patients. That way, the representative already has the tools they need to move the conversation forward, and even if the first solution they present doesn’t work, they’ll feel more confident and equipped to continue navigating the conversation and offer alternative solutions.


Many patient account representatives run the risk of leaving a lot of money on the table because they don’t know how to negotiate.

Most healthcare facilities have payment guidelines already created for their patients, which is great because these guidelines can help patient account representatives negotiate more effectively. For example, the representative can negotiate from the top-down of the recommended guidelines until they negotiate to the “sweet spot” that will help the patient pay off their bill as quickly as possible with their current financial situation.

Pro Tip: A great mantra to improve negotiations is “The higher you start, the higher you’ll end,” which means the representative can remind themselves to start their payment plan negotiations high so they can end at a higher payment plan than they would have landed on if they started their negotiations from the bottom-up.

These 3 skill sets, along with emotional intelligence, all boil down to one main goal: Creating connection with the patients.

Pillar 3: Creating Connection

In the new normal, I believe patients will expect connection from the patient account representatives, and they won’t want to move on in conversations until they gain the trust that comes along with a deep human connection.

Connection is currency, and luckily it’s easy to get into the connection zone with patients. At the same time, it’s just as easy to get into the conflict zone as well, so representatives need to understand what drives connection and what causes disconnection.

The conflict zone is characterized by high tensions. Usually, if the conversation is going nowhere, the representative is likely in the conflict zone.

Remember how every human needs to feel heard and understood?

We need to check that box in the mind of every patient so they can move on in the conversation. If we don’t, the conversation will likely end up in the conflict zone.

On the other hand, if representatives are using their skills (emotional intelligence, negotiation, critical thinking, and communication) to navigate the conversation strategically, they’ll be able to stay in the connection zone with the patient from start to finish.

Once they’re in the connection zone, the patient will feel a sense of trust and will view the representative as an ally, which will ultimately open them up to receive a solution.

The first three pillars all center on guiding the patient through a conversation until a solution is reached. Now, it’s time to talk about the fourth pillar, which is all about how a healthcare facility can create and maintain a positive reputation, which will ultimately allow patients to feel more comfortable paying their balances, and it will allow the practice to use the skills their representatives have learned to market their services.

Pillar 4: Establishing Credibility in the New Normal

In the new normal brought on by COVID-19, there are 3 ways healthcare facilities can establish credibility.


Medical providers are always considering the safety and security of their patients. What if we looked beyond physical safety and promoted safety and security when it comes to communicating? Patients truly need to feel comfortable when they’re talking to patient account representatives. If you make the other three pillars a priority, this will naturally fall into place.


Highlight your organization’s unique qualities, and market those promises to your patients. For example, you may use your mission statement to let patients know you’re an empathetic provider whose representatives truly care about the patients’ experiences.

Note: If you market yourself a certain way, make sure to follow through on the promises you make. Otherwise, your credibility will be greatly impacted.


In other words, they need to find ways to make patients truly satisfied with their services. A great way to do this is to invest in customer service training. Ultimately, providers want to make sure their patients want to return after interacting with their representatives.

The Complete Framework for Empathetic Communications

We have the power to use empathy and compassion to make patients feel supported and understood by patient account representatives.

This power lies in the representatives’ voices.

I challenge you to commit to investing in your representatives today, and make sure your company’s mission and values operate effectively in the new normal.

The time for an empathetic communication revolution is now, and I know you can make a difference in the healthcare industry one conversation with patients at a time.

Do you want to learn more about training representatives, identifying valuable skill sets in agents, reducing conflict with patients, and more? You'll definitely want to learn more about my communication online training programs, which take this framework to the next level.


To see this post as it was originally written and to see the accompanying webinar, visit

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