Majority at Level 2 on access career ladder

Annual recertification required

A three-rung access career ladder in place since 2004 at St. Joseph's Hospital Health Center in Syracuse, NY, has drawn a positive response from staff, who move to the next level by demonstrating accuracy and productivity, completing in-services, and scoring well on a mission-based evaluation tool, says Nicole Doshna, CHAM, training and quality improvement (TQI) supervisor.

Information on the career ladder is easily accessible on the department's patient access web link (see related article at the end), where an initial click takes users to the advancement program's philosophy and reason for being, she adds.

Every patient access employee is automatically at Level 1, once he or she has passed a six-month probationary period, Doshna says, and must meet the following requirements to reach Level 2.

• Attend at least one of several in-house programs that include "conflict resolution," "team building," and "attitude of a champion."
• Demonstrate their productivity level by maintaining 95% accuracy on face sheets and Medicare Secondary Payer (MSP) audits.
• Reach two to three "exceeds" ratings on the seven categories of the evaluation tool based on the hospital's mission statement.

The components of the mission are stewardship, excellence, reverence, vision, integrity, compassion, and enthusiasm, Doshna adds. "All employees are evaluated on these seven criteria during their annual review."

Stewardship, for example, is about "being accountable for responsible use of resources and assets, including time and talents," she explains.

To reach Level 3, Dosha continues, the employee must have three to four "exceeds" on the mission-based tool, must have worked with another staff member as a preceptor, and must have passed the Certified Healthcare Access Associate (CHAA) examination offered by the National Association of Healthcare Access Management (NAHAM).

The access career ladder "has been a very good opportunity, and a lot of people take advantage of it," she notes. "We have a good majority of staff in all areas that are at least at Level 2. We do tie in a monetary incentive — an additional 75 cents an hour for each level attained."

Participants must recertify each year according to a point system, Doshna says. "For Level 2, you have to achieve 50 points. If you attend different in-services, that counts. If you train people, that counts."

Accruing points has to do with going "above and beyond" the normal job requirements, she adds. That might include volunteering outside the hospital — participating in a "Heart Walk," for example — or taking college courses, Doshna says.

The access department director recently implemented a management career ladder, she notes, which basically consists of receiving an increase in pay for passing NAHAM's Certified Healthcare Access Manager (CHAM) examination.

"That was rolled out [in April 2007] and has received a strong response."

(Editor's note: Nicole Doshna can be reached at Nicole.Doshna@sjhsyr.org.)

Report cards, on-line classes featured on access web site

'We make it fun for staff'

A patient access site linked to the main web site of St. Joseph's Hospital Health Center in Syracuse, NY, takes users to a wide variety of features, including employee "report cards," online classes, and information on the access career ladder (see related story above), says Nicole Doshna, CHAM, training and quality improvement (TQI) supervisor.

Doshna and a part-time TQI customer service representative maintain the patient access site, she says. "We keep it updated, change the colors, make it fun for staff.

"One of the links is for access supervisors," Doshna explains. "On that link we put information for each service area within patient access to allow them to view the report cards we keep on their employees."

The 431-bed hospital's access staff of just less than 80 employees covers central scheduling, preregistration, admitting and hospital registration, primary care clinics, and ED registration, she adds.

"All of the competencies for patient access are listed on the site, so staff can access and pull off the information for their service area beforehand, when they go for their annual review," Doshna says. "Most of the criteria are the same, but each area's requirements are a little different."

An education link includes schedules for all access classes, in-services, and audits, as well as some on-line classes, she says. "We put together Insurance 101 for new hires, and we let them do it at their own pace. They have to go through that before they go to the insurance training class."

Classes on the ADT (admitting/discharge/transfer) system, which is a product of Atlanta-based Eclipsys Corp., are held every other month, Doshna notes. Departmental trainers who she oversees conduct those classes, which include the following.

• A session on registration information, primarily demographics.
• A "visit class," focusing on the specific visit on the date of service.
• A Medicare Secondary Payer (MSP) overview class.
• The insurance class, which covers how to load insurance information into the system and what to look for on certain insurance cards.

The access site, in place since 2004, also contains information for those interested in taking the Certified Healthcare Access Associate (CHAA) examination, she says.

Included on the access site are direct links to the insurance company sites, Doshna adds. "We also have all of our orientation guidelines listed, and all of our policies and procedures, so employees don't have to go fishing through binders."

Doshna is particularly proud, she notes, of the Access Communique, a feature added to the site in June 2006. "It's a weekly communication tool that goes out via e-mail to access and non-access areas. There's a nice quote, and then information about what's going on, including insurance updates, anything that's new with Eclipsys, and any changes that affect the access work flow.

"I used to save that kind of information for the quarterly access newsletter, but it was too cumbersome," Doshna explains. "Now we use the newsletter for personal, fun things, like a new baby or a graduation."

Putting together the access site "was very easy," she says. "I contacted the information services department, got our own link, and now I create everything through Microsoft Front Page. I can do whatever I want. I just save it and it's on the web site."