Staff, training improvement part of access makeover

New uniforms are part of the package

The patient access department at Centegra Health System in McHenry, IL, has undergone what can best be described as a total makeover, with expanded staffing, a revamped training program, and a new focus on registration accuracy and regulatory compliance.

Registrars even have begun wearing uniforms as part of the departmental overhaul, says Liz Kehrer, CHAM, system administrator for patient access.

The changes began around April 2001, when Kehrer — formerly patient access manager — assumed her new position (see related story, p. 78) and Deb Fanning was hired to be the new access manager. After years in which she held all the responsibility for the daily departmental operations, staff training, quality assurance (QA), and regulatory compliance at the system’s two hospitals, Kehrer explains, Centegra’s administration made the decision to distribute the access workload.

Several factors got the attention of administration, she says, including turnover among registrars, new staff’s frustration with inadequate training, and quality assurance problems. "We were spending so much time fixing [bills] later," Kehrer notes.

"There was a steering committee at the time looking for opportunities for improvement," she adds. "We made recommendations to that committee and got the green light to move forward. We had a lot of support from the CEO."

Several new access positions were created to take over some of the hats formerly worn solely by Kehrer, she says. They include a patient access supervisor at each of the system’s two hospital campuses, a departmental trainer, and the new system administrator position that she now holds.

Super registrars’ can’t do it all

Previously, Kehrer adds, she relied on a lead registrar at each hospital to serve as a resource for staff when she wasn’t available. Although these "super registrars" could answer staff questions, they weren’t able to help with such supervisory functions as discipline or hiring and firing, she says. "They didn’t have time for that. They were working registrars who had patients lined up at their desks, too."

The results have been dramatic, notes Fanning. Improvements include a drop in accounts receivable (AR) days, which have gone from 59 to 49, and an increase in customer satisfaction, as measured by the patient satisfaction surveys by Press, Ganey Associates of South Bend, IN.

Fanning says she gives much of the credit for improvement in AR days to the new QA process. "We selected two of our top people as far as quality of work and put one at each facility," she says. "They go through all the registrations for the day — today, they do yesterday’s — and make sure everything is correct."

The QA specialists give feedback to registrars who have made mistakes, and if the problems are consistent, those people may be sent back for more training, Fanning adds. At present, she says, the QA staff are auditing 66% of the hospital’s registrations, with plans to increase that to 100% within the next couple of months.

To facilitate that goal, Fanning says, two more QA specialists are being added to perform the same functions on the evening shift.

Although her position and those of the two supervisors and the first two QA employees represent an increase in staff, many of the other changes have been made through "creative staffing," she notes. For example, to form a new centralized pre-registration team, Fanning adds, she took four registrars from each hospital. 

The improvement in customer satisfaction, she suggests, is related to the attention that now is being given to the registrars, which in turn encourages them to take more care with patients. With supervisors in place at the two hospitals, "they now have someone they can go to" with questions and concerns, Fanning says. Those who meet monthly goals for collections and for the inpatient and outpatient Press, Ganey surveys receive a $25 gift certificate, she adds.

The health system has been recognized for its achievements with two certificates for best practices in access management from the consulting firm Zimmerman & Associates, including one for revenue management, Fanning notes. In August 2001, she says, Centegra hired her boss, who has the new title of director of revenue.

Interdepartmental conflict nonexistent

The conflict that often exists in hospitals between admitting and business office staff is virtually nonexistent at Centegra, adds Fanning, who gives a large amount of credit to the QA initiative. "[The business office staff] see us training and retraining and trying to make it right up front," she says. "We now get e-mails from them about our performance and about the money that is rolling in. We’re on the same team."

Access staff began wearing their new uniforms — black slacks or skirt with a wine-colored blazer bearing the health system logo — in May, Fanning says. The uniforms are aimed at enhancing the professionalism of the department, she adds, and the reaction from patients has been gratifying. "We’ve had nothing but compliments."

Along with the new look, Fanning explains, comes an increased emphasis on improving employee skills, with an eye on eventually getting access employees the compensation they deserve.

"They all know how to verify, and they all know how to pre-cert," she notes, adding that the goal is to train all employees in the financial counseling function and ultimately upgrade the position across the board.

Centegra already has a system in place whereby registrars can be promoted to level 2 and then level 3 through certain achievements, Fanning says. Of the 92 access employees, she adds, "there are about eight registrars that have moved up."

Because of the skills required of the pre-registration team, she adds, it is made up entirely of level 3 employees.

[Editor’s note: Liz Kehrer can be reached at (815) 344-4061 or Deb Fanning can be reached at (815) 338-2500, ext. 5305.]