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Be creative to maintain staff training even in the face of drastic budget cuts
A chance to 'grow your staff' under bad circumstances
Many patient access departments are facing two opposing pressures right now: They are being asked to improve collections and help the hospital's bottom line, while at the same time, resources are being cut. Staff education programs are often the first thing to go when budgets are cut, but this may be a "penny wise and pound foolish" move when it comes to patient access departments. After all, if staff are poorly trained, the hospital's bottom line likely will suffer, as claims denials increase and upfront collections decrease.
"Are formal staff education programs a luxury ripe for cutting when times get tough? I'm afraid so," says Peter Kraus, CHAM, CPAR, a business analyst with patient financial services at Emory University Hospital in Atlanta. "Changing, reducing, or eliminating a well run, productive program is bound to have a negative impact. You have to weigh your choices and go with the least of evils."
An additional negative is the effect that downsizing can have on meeting the standards for compliance with government entities and accrediting bodies. "Even the best processes can fall apart when we skimp on quality and rush though our work. When you think about what this could cost an organization, it is a big eye-opener," says Katherine Murphy, CHAM, director of access services for Nebo Systems, a subsidiary of Passport Health Communications in Oakbrook Terrace, IL. Murphy also is a delegate to the National Associate of Healthcare Access Management and the president of the Illinois Access Association.
Potential problems with downsizing include failure to obtain the Advanced Beneficiary Notice (ABN), incorrect or missing information on the ABN, violations of the Emergency Medical Treatment and Labor Act, violations of patient privacy regulations, missed opportunities with 1011 filing, and failure to obtain consent forms, warns Murphy.
So how are patient access leaders maintaining education of staff during the recession?
"Our hospital system has certainly not been immune to the current financial crisis," reports Jessica Murphy, CPAM, corporate director for patient access services at Methodist Le Bonheur Healthcare in Memphis, TN. "Ensuring the patient access salary expense budget falls in line with the 'leaner look' of 2009 has been accomplished, to a great extent, by eliminating unfilled positions."
The hospital's access directors have restructured existing jobs to accommodate a balancing of duties, days, and hours of coverage. Every task is carefully monitored, says Murphy, with a renewed interest in answering these two questions: "What is the added value in performing this task?" and "What does it cost in resources?"
"The only areas exempt from this intense scrutiny are those with a direct impact on quality and customer service," says Murphy.
Cross training is one answer
"Cross-training has always been a desirable work philosophy, but this year it will escalate to a necessary technique to manage the 'more with less' commitment," says Murphy.
Murphy says that her hospital is experiencing the nationally recognized impact of layoffs and loss of insurance. She reports that the number of ED patients is growing significantly, and that more patients are opting out of elective procedures and tests.
"Sending staff home due to 'lack of work' seems incongruous to the structure of a busy admission and registration department. Patient access is an area where there is always work to be done," says Murphy. "In reality, however, that is another way we are being asked to monitor and evaluate on a daily basis for optimal FTE ratios."
On a regular basis, the hospital's CEO is providing personal video updates, made available through the Methodist Le Bonheur Healthcare Intranet, to make sure all staff know how the organization is doing, from both a quality and fiscal perspective.
"This has had a very positive impact on morale and has kept rumors to a bare minimum. Staff attitudes are strong and supportive," says Murphy. "We are hearing on a regular basis, 'I am grateful to have a job and will do what is asked of me.' This often leads to creative thinking and process re-engineering that might not have happened in a more complacent environment."
The health care system operates with a centralized business office, headed by a corporate patient financial services director, health information management departments at each facility with dual reporting to a corporate health information management director, and patient access divisions at each facility with dual reporting to Murphy, the corporate patient access services director.
"All three of us report directly to the corporate CFO," says Murphy. "His expectation is that we pool resources and design a task around 'Where can it be efficiently provided?' not 'Where does it report?' on the organizational chart. In keeping with that philosophy, we are designing a new approach to training and education this year."
The patient access department has had a dedicated trainer/educator for the past three years. This year, patient financial services was planning to post a position and hire its own dedicated trainer/educator.
"Our CFO asked if my trainer and I couldn't look at the possibility of taking that on instead of hiring for this new position," says Murphy. "It so happens that we have both been patient accounting directors in the past, as well as having many years of access knowledge and experience."
The two women met with the corporate director of patient financial services and have now begun designing a training agenda and calendar for the department's associates.
"This meant that we had to carefully assess our own calendar commitments, and reduce or eliminate those that do not absolutely require one or both of us to be part of that team," says Murphy.
As a result of this change, the training schedule for patient access was cut. While three-day classes previously were held each month, these now will be provided every other month. On the alternate month, three-day classes will be given to patient financial services instead.
"We are looking for training opportunities where access and patient financial services can attend the same class," adds Murphy.
Murphy says that this expansion of duties and knowledge has given her a better perspective for where access needs to concentrate its efforts from a quality perspective.
It also gives her the chance to explain to patient financial services account reps and collectors how registrars work and what challenges they face each day. "We think this is a win-win concept, with the added advantage of saving the company the cost of an educator position," says Murphy.
Although the advantage of a full-time trainer in patient access is lost, Murphy says that the change is a positive improvement, because it cultivates the "buddy system." "The two departments will now work even more closely as a team and will develop an increased respect for the challenges of each area," says Murphy.
Staff ready to learn something new
At Bon Secours Hampton Roads Health System in Portsmouth, VA, patient access recently lost four schedulers, which has made ensuring staff education and training more challenging, says Dee Sutton, manager of central scheduling and concierge services.
"In the past, there may have been a bit of a cushion - now you really have to be very creative," she says. "We have to constantly ask ourselves, 'What can we do to get this done efficiently and timely - and do it with a reduction in staff?'"
The situation has forced patient access staff to be very creative in finding ways to improve efficiencies. For example, preregistration and scheduling previously each made a separate phone call to the patient, but these calls are now combined into one.
"We knew it was something that we could do, but we weren't doing it. Basically, our mission was to get that customer off the phone as quickly as possible so we could schedule our next appointment," says Sutton. "Scheduling was focused on scheduling, and registration was focused on registration. But we are finding now that we need to cut that extra call down."
Staff were cross-trained, so that when they learn how to complete the scheduling form, they also learn how to do the pre-registration and identify whether that patient's insurance needs any follow up.
The recession and budget cuts that many patient access departments are struggling with, says Sutton, are "actually, an opportunity to grow your staff under maybe a negative set of circumstances, but you can turn that to a positive. We are building our staff so they have more knowledge underneath their belts. When you are not being forced to do that, you get comfortable."
The fact is that most patient access staff are "ready to grow and learn something new," says Sutton. "Even though they are feeling the pressure of having less staff, they are also willing to jump in."
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