Access turnover still most challenging issue

There's hope, veteran director says

Staff turnover in the access field takes a heavy financial toll on health care organizations, notes Keith Weatherman, CAM, MHA, associate director of patient financial services at Wake Forest University Baptist Medical Center in Winston-Salem, NC.

"It takes time for human resources and management to review applications, interview, test, check references, hire, and train new staff," says Weatherman, who is in the process of writing a white paper on the subject. "It takes time for the new registrar to get up to speed to do the work at the accuracy level that is needed."

The cost of mistakes in registration resulting from that lack of experience and full understanding of the job is significant, he adds, in an environment in which denial management is an ongoing challenge.

It is not uncommon for access jobs to remain open for three or four months before being filled, Weatherman says, and it takes at least another three months before a registrar is working at the desired competency level.

During that six-month period the work has not stopped, Weatherman points out, so someone has to fill the vacancy — registering patients in the admissions area or the ED and doing it within the required timeframe to ensure proper patient care.

That usually requires overtime, he says, which is not only expensive but often results in burnout on the part of the registrars who have to work harder and more staff turnover down the road.

"Before we can determine fixes for staff turnover," Weatherman says, "we must understand the reasons behind it." Among those, he lists:

1. Registrar is usually considered an entry-level position, which means it is low on the payroll scale compared to other jobs in patient finance.

2. The hours are not conducive to "normal" family life. Only a choice few have the luxury of working a first shift, Monday through Friday position. Twenty-four hour coverage often means pulling staff from one shift to another and using part-time employees who get few, if any, benefits.

3. Opportunities for promotion within patient access are rare. When employees are seasoned and want more money or better hours, they transfer out.

4. Most patient finance jobs, including accounting, collecting, billing, and verification, are Monday through Friday positions, so access staff often leave the "front end" for these "back end" positions. They no longer have to work holidays, either, and there is usually a pay increase involved.

5. Patient access employees are considered "critical staff," meaning they must find a way to and from work when there is inclement weather. Yet because they are not clinical staff, the organizational "Snow Plan" for offering transportation often does not include them.

While many studies have indicated that the No. 1 reason employees leave their jobs is because of problems with supervisors or co-workers, Weatherman notes, his almost 30 years of experience in the industry tells him that is not the case with patient access staff.

"It has been my observation that most access managers understand the importance of keeping well-trained staff and are constantly rewarding them and showing appreciation," he adds.

So, is solving the problem of patient access turnover a lost cause? Not so, says Weatherman, who offers the following list of remedies:

1. Stay in touch. Visit the staff, know the staff, and understand their jobs and their barriers. Do what it takes to eliminate those barriers. Make sure your "off shifts" have access to required information. Even better, have a leader available to them for consult.

2. Make the human resources staff aware of the importance of the job roles in patient access.

3. Be creative in developing different schedules or time tracks.

4. Develop a career ladder for patient access staff. Give employees an opportunity for promotion, so they don't have to leave the department.

5. Consider bonus pay for off-shift, weekend, and holiday work. Provide extra compensation for working during inclement weather.

6. Provide flexible training — training that fits the employees' schedules, not the trainer's.

7. Have flexible and frequent staff meetings that don't require staff to come in on their days off.

8. Stay abreast of and utilize newer technology that helps staff work smarter, not harder.

9. Constantly supply employees with feedback to let them know if they are performing up to expectations. Don't wait for the annual review.

10. Pay employees for their worth. Understand that their job is one of the most important in health care, and that it is cheaper to pay them well and keep them on the job than to constantly fill vacancies and have inexperienced staff on duty.

The front-line access position has changed dramatically since he entered the field in 1977, Weatherman notes. He recalls that the most frequently requested capital item in the '70s was a typewriter, and three decades later it's a personal computer, printer, or software.

"There are new challenges, such as obtaining information before a patient arrives so upstream and downstream processes can happen," he adds. "Insurance contracts require precertification, patients are responsible for higher deductibles and co-pays, yet as a satisfier we want to have patients report directly to a ready bed or service area and bypass the registration process."

Technological advancements, such as real-time address and insurance verification, have helped obtain patient information, Weatherman notes, but are signs of just how complex the registration role has become.

"Technology has enabled our registrars to work smarter, but the pressure of working in a highly emotional, fast-paced environment has not changed," he says. "The job remains stressful, the willingness to work off shifts is still not there."

What also remains true in this decade, Weatherman adds, as was the case in the '70s, '80s, and '90s, is that the chief concern for access management is staff turnover.