2007 Salary Survey Results

Revenue cycle leadership a trend with staying power

Viable candidates must have experience on both ends of the operation

High-level positions with "revenue cycle" in the title are generating buzz in the health care access management field, and that trend won't be slowing down any time soon, industry sources tell Hospital Access Management.

Whether at the hospital director, corporate, or vice president level, the initiative of creating revenue cycle leaders, "while gaining strength, is in its early stages," says Scott Sette, CPC, owner and president of the Kensington Group, a Houston-based executive placement firm specializing in financial leadership positions in the health care industry. "We will see a lot more in the upcoming few years."

The current focus on revenue cycle leadership follows a consolidation trend in the '90s, Sette notes, in which patient accounting and patient admitting functions were consolidated under patient financial services.

"The same logic has taken the next step forward to revenue cycle [directors]," he adds, with more functions added to the mix. "Some of the areas we're seeing now, in addition to admitting and registration and billing and collections, are chargemaster and medical records. We even have done a few searches for revenue cycle directors that encompass case management."

There also are instances in which some facets of the managed care operation will report to the revenue cycle director, Sette says, as well as an increasing focus around centralized scheduling. "What the whole creation of [the revenue cycle position] has been about is having one person to effect positive change in all areas that impact patient revenue."

At many facilities a centralized scheduling department is already under the access services umbrella, he points out, but when that is not the case, it is often one of the areas a new revenue cycle director is expected to tackle.

"One of the things we're seeing is that the revenue cycle director will be charged with establishing uniform policies and procedures for all points of access and training staff on proper protocols for registration, scheduling, and other access functions," Sette says. "The idea is that if everybody is doing things the same way, there is clean information going in, which results in clean and timely collection."

At multi-facility systems that have individual patient accounting and patient access directors for each hospital, he notes, those positions won't go away when a system vice president of revenue cycle is hired, but will work in concert with an increased initiative from the corporate level.

In such cases, Sette adds, the revenue cycle leader will make rounds to individual facilities, keeping tabs on progress, analyzing data, and making any needed adjustments. While individual facility directors may retain dotted-line reporting to the hospital CFO, he says, the trend is to have them report to a corporate vice president or director of revenue cycle.

The specific process that is put in place, of course, varies by organization, Sette emphasizes.

What Carolyn Milburn, president of the Dallas-based executive search firm Milburn Partners Inc., which specializes in revenue cycle positions, has observed in regard to the revenue cycle — a term that was virtually unknown a few years ago — is that its components are becoming more defined.

"What I'm seeing across the board is specialization," Milburn says, with work focused, for example, on the chargemaster or the front end or medical records. Similarly, Milburn says, if one used the term "access" just a couple of years ago, the listener — even someone in a health care field — might or might not know the intended meaning.

"We're now looking at points within the revenue cycle," she adds. "[Consultants] are saying, Let me come in and do an access project, as opposed to just doing a general revenue cycle analysis.'"

Like Sette, Milburn notes an increased interest in centralized scheduling expertise, along with more focus on customer service.

Patient access professionals interested in moving up to revenue cycle director or vice president, Sette says, should have leadership experience in both the front and back end and "have been in patient financial services for a reasonable amount of time. It's difficult to promote someone who is just [experienced] in one area."

Health care consultants, he adds, are increasingly being targeted for revenue cycle jobs because of the scope of their experience. "They might have an engagement at a community hospital and then, the next month, at a multi-hospital health system."

Sette encourages patient access directors interested in moving up the career ladder to get as wide a variety of experience as possible at their current facilities.

"Approach the CEO about more involvement in medical records or chargemaster," he says, recommending reading trade publications as much as possible and attending seminars on revenue cycle initiatives. At the corporate and vice president level, he notes, there is more emphasis on education of all kinds, as well as advanced degrees.

The compensation that can be expected with such positions varies according to the size and type of organization, he notes. "For positions at individual facilities — revenue cycle director at a single, medium-size (200-400 beds) hospital, for example — [the salary] could be in the low $100,000s up to $125,000 or $130,000. There is bonus potential that is based on initiative in their area and the overall profitability of the organization.

"As you move into larger, multi-hospital systems — say, regional systems with four, five or six hospitals — total compensation could be $150,000 to $175,000," Sette adds. With two or three hospitals in the system, the figure might be closer to $140,000, he says. "There could be a bonus on top of that."

As for directors of patient access and patient accounting at the facility level, Sette says, there is less emphasis on education and more on experience. "Out of any of the financial leadership positions, the vast majority of the people we see who lack a four-year degree are in patient access and patient accounting. A lot of the individuals with this experience have learned through moving up the ranks and through years of service."

That said, he adds, "I certainly don't encourage [not getting academic degrees]." Moving into the future, Sette notes, "more and more [professionals in that category] will be getting degrees."

Directors of patient access and patient accounting at a medium-size hospital, he says, can expect to be paid between $85,000 and $110,000. If those individuals are over patient financial services, with a manager or assistant director of patient access or accounting reporting to them, he adds, the figure will be a little higher.

Data compiled by Milburn's firm, based on 148 professionals with director-level experience in access services at hospital systems across the country, show about a 5% increase in compensation compared to last year's figures, she notes.

That analysis is broken down according to whether the facility is non-profit or for-profit, and by region. In the southeastern states, in which she includes Georgia, North Carolina, Florida, Tennessee, and Kentucky, the average salary for a director with more than four years' experience at a for-profit facility is $89,145, compared to $81,375 at a non-profit facility.

In the northeast (Virginia, New Jersey, Ohio, Illinois, New York), according to her firm's data, that figure is $108,150 at a for-profit facility, and $95, 200 at a non-profit facility. In the west (California, Arizona, Colorado), the figures for that level of experience are $91,350 at a for-profit hospital, and $84,000 for a non-profit facility.

In the south, for her purposes defined as Texas, Louisiana, Mississippi, and Arkansas, comparable figures are $79,275 at a for-profit facility and $75,600 at a non-profit hospital.

Looking at the gross compensation of access professionals responding to our 2007 Salary Survey in $10,000 increments, the highest percentage (19.6%) fell into the salary range of $60,000-$69,000, followed closely by the $50,000-$59,000 (16.9%) and $40,000-$49,000 (14.3%) categories. The next most frequently selected salary range was $100,000-$129,000 (12.5%).

Overall, salaries ranged from $30,000 to $130,000, with just a few respondents reporting incomes outside either end of that range.

The figures varied only slightly from those in last year's survey, with, for example, 7% reporting income of between $90,000 and $99,000 in the 2007 survey, compared to 8% in 2006.

Again this year, the great majority (88%) of respondents reported getting a raise within the past year, with most of those divided evenly between increases of 1%-3% and increases of 4%-6%. A little more than 5% of those surveyed said they got a raise in the 7%-10% category, compared to about 9% who reported that kind of increase in the 2006 survey.

Slightly more respondents than in 2006 (10.7% compared to 8%) had no change in income during that period.

The most commonly selected job title — of five choices — was director, access management (34%), followed closely by access manager (31%). The next highest number (17.8%) chose the "other" category, and listed a variety of similar access-related titles. Those included titles that were virtually the same as the stated categories, such as director of patient access services, admitting manager, and patient registration manager.

Also listed in that group were finance-related titles such as director of revenue cycle, director of patient financial services, and business office manager, as well as those reflecting other areas of access expertise, including manager of central scheduling and central registration.

After "other," the next most frequently chosen title category was "supervisor" (14.3%), followed by "manager, patient accounts" (2.7%).

Asked to give their highest academic degree, 10.5% chose "diploma, 3-year," 9.5% selected MSA, 3.8% selected BSN, and 2.8% chose ADN.

More than 70%, however, chose "other" and mentioned a variety of degrees. By far the most often named was the BA degree, which accounted for more than three-quarters of the category. Several other types of bachelor's degrees also were included.

A significant number of respondents listed other master's degrees, with the MBA the most frequently named.

As usual, the vast majority work for hospitals (96.2%) and "non-profit" (91%) best describes the ownership of their employer. They are, for the most part, an experienced group, with 88% having worked in health care at least 10 years, and more than half having worked that long in their present field.

As in the 2006 survey, more respondents said they work in facilities in rural areas (36.5%) than in medium-sized cities (30.7%), suburban areas (19.2%) or urban areas (13.5%).

Most of those participating in the survey (77%) were between 41-60 years of age, with the heaviest concentration (28%) between ages 51-55.

As usual, women make up the vast majority (84%) of access professionals responding to the survey.