Keep current requirements front and center for staff

Make your expectations clear

At Methodist Le Bonheur Healthcare in Memphis, TN, a variety of tools are used to keep current requirements "front and center" for scheduling, registration, and verification staff.

"At the heart of most of these methods is a strong communication link," says Jessica Murphy, corporate director of patient access services. "As much as possible, we tie competency, quality, and compliance expectations to a clearly defined key performance indicator goal for patient access."

These key performance indicator numbers are reported monthly and year-to-date to senior leadership, access management, and CFOs at each Methodist facility. "This has proved to be an excellent accountability incentive," says Murphy.

At Methodist LeBonheur, patient access is structured within a very small corporate office that sets policy and procedure for the system. This allows one area or person to funnel information to the access management team at each facility or free-standing center. Here are some of the tools used for that purpose:

• Monthly two-hour conference calls are held over a brown-bag lunch. "As the corporate director, I facilitate those calls," says Murphy. "Participation is excellent, and feedback is very positive."

• Once every four months, Murphy facilitates a full-day, off-site retreat. Included in the agenda are all-new or future policies, procedural updates, and key performance indicators report reviews. Each facility team is asked to cover issues, concerns, and best practices for their area.

"This facilitates almost instant benchmarking and networking," says Murphy. "Often, I will ask another department to send a representative to talk to us about how we can be an effective partner to them. I ask them to tell us, in general, what their department does and what they depend on from us." Some examples would be patient financial services, health information management, case management, credit, and collections.

"We have an access director who volunteers her home to us for the day," says Murphy. "From my corporate budget, I furnish a main entrée for lunch, and all the participants bring a side-dish for pot luck. This keeps costs to a minimum."

• A patient access services web page is maintained with policies, procedures, definitions, forms, contact lists, and links to other departmental web pages that would be helpful to patient access.

• E-mail is "used as effectively and judiciously as possible," says Murphy. "Address groups allow for wide distribution or can be directed to management only. Often if we see a pattern developing from a denial perspective, we attach an 'alert' notice describing the problem and delineating the correct process," says Murphy. "We ask that it be distributed to all patient access services workstations and staff."

• Important documents or notices are mailed to the homes of supplemental PRN staff or anyone on extended leave.

• A full-time trainer and analyst works on the team. "This is a significant advantage for teaching registration and verification in a consistent manner with accountability factors built in," says Murphy.

Retention is big challenge

At Mary Rutan Hospital in Bellefontaine, OH, inservices are held periodically for the patient access team. Recent topics covered have been cash up-front incentives, real-time eligibility patient dashboard, the staff member being "the first impression of our hospital," handing out charity/financial assistance information to patients, bad addresses, reviewing hospital corporate goals, and reviewing the compliance software.

"Staff have an opportunity to ask various questions on these topics or other issues they have encountered at their job," says John Kivimaki, director of patient accounts. Here are some actual questions staff have asked, with answers in italics:

• Can we collect on other accounts the patient has? (Yes.)

• What if the patient says his or her address is the address that is coming up "Mail Return?" (If you cannot get an address, ask for a phone number where the patient can be reached or place of employment if not on the account.)

• What if the patient says he or she already has a charity application when you offer one? (If we have one on file or pending, the system will show that in a pop-up-window. Please tell the patient to call the business office to make sure an application is on file.)

To keep staff current on changes in insurance requirements, updates are e-mailed to all patient access staff immediately. "In addition, staff are encouraged to bring new insurance information presented at the time of registration to the supervisor's attention, so that this can be updated in the HIS system," Kivimaki adds.

Kivimaki says that he struggles with retention of quality staff members. "We lose a lot of staff to other areas in the hospital that do registration functions in a medical area, such as cardiology," he says.

Initially, patient access staff go through a well-developed training program. Through the initial training program for new employees, all patient access staff members are cross-trained in inpatient, outpatient, and ER registration procedures. "Since we are also responsible for the switchboard, training is also required in that area. When an opening comes up, a patient access employee trained in our program is of great value, with very little training needed," says Kivimaki. "These areas pay more because of their medical environment, and we end up losing some very good employees."

Patient access staff also receive hands-on training. The new person actually does the job duties while the experienced person observes and assists when needed.

"Any of our patient access team can fill in or replace staff when needed. We also have a number of part-time staff who are trained the same way as our full-time staff," says Kivimaki. "Many of these are always wanting more hours and fill in, especially during vacations. This is very cost-effective when covering an area 24/7."

[For more information, contact:

• John Kivimaki, Director of Patient Accounts, Mary Rutan Hospital, 205 Palmer Ave., Bellefontaine, OH 43311. Phone: (937) 592-4015. E-mail:

• Jessica Murphy, CPAM, Corporate Director for Patient Access Services, Methodist Le Bonheur Healthcare, Memphis, TN. Phone: (901) 516-8162. E-mail:]