Enabling and Leveraging Mobile Payments in Emerging Market Hospital Emergency Departments

Working largely on site, teams from the University of Michigan independently collaborated with clinicians and administrators at two large, public teaching hospitals in Kumasi and Accra, Ghana in 2018 and 2019 to propose mobile payments options for emergency department (ED) patients and their families. (Status quo, all out-of-pocket payments must be made “cash and carry,” meaning solely in hard currency.) Simple, structured tools were created in advance to: evaluate ED paper record-keeping; chart existing ED clinical and revenue cycle workflows; interview frontline clinicians and other key stakeholders; track basic ED clinical and operational metrics (e.g., average length of stay); measure direct margins on high-volume and high-cost ED goods and services; identify specific bottlenecks and critical pathways; uncover revenue “leakages” and more generally take expedited clinical, financial and operational inventories of the two hospitals’ EDs. Our primary hypothesis was that “cash and carry” is a root cause of devastating ED and hospital dysfunction along multiple dimensions. A related secondary hypothesis was that offering ED patients new options to pay with mobile money could catalyze a cascade of improvements. This session reviews these two studies, the mobile payments proposals and the expected impact from implementation. It opens with a literature review of the pervasiveness of “cash and carry” in emerging market hospitals and the dysfunction surrounding the practice. Next, the study design and methods, specific tools and final results are explained. The presentation closes with an outline of a four-step mobile payments implementation plan, along with various improvements that can be expected (and measured) after each step. The steps include: i) baseline emergency department evaluation; ii) implementation of a mobile payments option; iii) itemized codes, rigorous revenue cycle, and clinical workflow redesign; and iv) functional ancillary ED service lines (radiology, pathology, pharmacy, and specialty consults).