Flex access staffing based on volume — Fixed model approach is no longer effective
Executive Summary
Patient access managers need productivity data to staff registration areas appropriately based on volume, particularly for areas such as the emergency department.
- Quality and quantity measures are needed.
- Manual sampling methods often are outdated or inaccurate.
- Systems can integrate several key tasks performed by registrars.
One of the biggest challenges in staffing patient access areas is incorporating volume flexing into the staffing model, says Jen Nichols, senior director of revenue cycle operations at Kaleida Health in Buffalo, NY. "At many organizations historically, patient access was staffed in a fixed model," she explains.
Previously, a department might have scheduled three registrars on the first shift, Monday to Friday, for a particular area. "Staffing to a fixed schedule prevents us from responding flexing down or up to changing business priorities and volumes," says Diane Pazderski, RN, Kaleida Health’s director of patient access services.
For example, ED volumes dictate a staffing model in which there are fewer staff members early in the day and additional registrars on the evening shift, while ambulatory surgery departments need earlier staff assignments. "With the dynamic financial environment in healthcare, the challenge is to now look to reflect volume in our staffing structures," says Nichols. "We flex to volume both in budget planning as well in daily operations." Here are some approaches to do this flexing successfully:
• Assess volume patterns.
"Different departments experience different patient flow patterns and arrival times," says Pazderski. "Registration services need to be fluid and reflect the individual needs of those departments."
There are some areas of patient access, such as the emergency department, that have unique challenges in staffing to volume. "But done carefully, volume can be a key staffing indicator in those areas as well," says Nichols.
• Design staffing to support "staggering" start and end times to reflect business needs, and vary shift length to ensure optimal coverage.
A registration area might need four separate starts of 5:30 a.m., 7 a.m., 8 a.m. and 9 a.m., for example. "All cover the first shift, but at staggered intervals, to provide peak coverage aligning with peak volume," says Pazderski.
• Evaluating replacement of FTEs against volume trends.
"FTEs may be shifted to other areas," says Nichols. "In some cases, volume changes may warrant reduction or addition of FTEs."
• Site managers and supervisors may adjust staffing throughout the day if needed.
"Routine staffing adjustments must be incorporated in daily, and even hourly, operations assessment," says Pazderski.
Workload boosted 30%
To ensure patients are registered timely and accurately, patient access managers have to staff according to anticipated volume, warns Mark Sammartano, interim director of revenue cycle and managed care at Waterbury (CT) Hospital.
"In order to establish these schedules, patient access managers have to work from a baseline, using productivity to determine capacity," says Sammartano. "This facilitates a quantitative approach to allocating FTEs."
Stacy Calvaruso, CHAM, assistant vice president of patient access services at Ochsner Health System in New Orleans, says her biggest staffing challenge is that as the medical industry continues to change, the scope of responsibility for patient access areas continue to expand. "In most hospital registration areas, there are over 140 decision points in any given patient registration," says Calvaruso. The push to capture more information real-time from the patient has increased the workload for front-end staff members an average of 30% over the last five years, she reports.
"Meaningful use, HITECH [Health Information Technology for Economic and Clinical Health Act], balanced billing notifications, accountable care organizations, and increased financial counseling responsibilities related to the exchange plans and high-deductible plans are all common responsibilities for patient access representatives," says Calvaruso. Here are approaches used by Ochsner’s patient access leaders:
• They are proactive in evaluating staffing models.
"As we do with our productivity metrics, we look at our history information as well as our future visit information," says Calvaruso.
• They look at schedules by location, provider, day, hour, week, and months.
"We use this to determine if we can or should flex our staff members," says Calvaruso.
• Supplemental staff personnel are used to help offset overtime, call-ins, Family and Medical Leave Act (FMLA), vacations, and holidays.
"This enables us to control expenses as well as allow staff members to take the time off that they work hard for whenever possible," says Calvaruso.
• The department cross-trains in many areas, including hospital admitting to ED admitting, clinic to hospital registration, and facility to facility.
"Having consistency in one master training program and one operational philosophy, we are able to utilize our team members in other locations to help with staff shortages, go-live events, and weather events," says Calvaruso. (See related stories on additional work done by patient access, below, and tools to staff appropriately, p. 116.)
SOURCES
- Stacy Calvaruso, CHAM, Assistant Vice President, Patient Access Services, Ochsner Health System, New Orleans. Phone: (504) 842-6092. Fax: (504) 842-0516. E-mail: [email protected].
- Jen Nichols, Senior Director Revenue Cycle Operations, Kaleida Health, Buffalo, NY. Phone: (716) 859-8382. Fax: (716) 859-8664. Email: [email protected].
- Diane Pazderski, RN, Director, Patient Access Services, Kaleida Health, Buffalo, NY. Phone: (716) 859-8399. Fax: (716) 859-8664. Email: [email protected].
