2010 Salary Survey Results

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What's in store for access? Higher skill set, constant changes

Top three challenges: regulations, market, technologies

Things are changing faster than ever before in the patient access world, and leaders must stay one step ahead. John Woerly, RHIA, CHAM, a senior manager at Accenture in Indianapolis, IN, says that the top three challenges faced by patient access are keeping up with changing health care regulations, a changing employment market, and changing technologies.

According to the 2010 Hospital Access Management Salary Survey, 16% of respondents received salaries in the range of the $40,000 to $49,000 range, with 8% earning less than that amount. Another 11% earned between $50,000 and $59,000, and 26% make more than $100,000. Notably, about a third (32%) of respondents reported no change in salary in the last year, while 47% reported a 1% to 3% increase, and 11% received a 4% to 6% increase.

The survey, which was administered in July and tallied, analyzed, and reported by AHC Media, publisher of Hospital Access Management, identifies some of the factors impacting salaries and benefits in patient access.

Other key findings of the survey:

• Twenty-nine percent of respondents worked between 41 and 45 hours, and 29% worked between 46 and 50 hours. About a third (37%) put in more than 50 hours.

• Eleven percent of respondents have worked in patient access for only one to three years, and 8% between four and six years. Thirty-two percent have worked in patient access for 25 or more years.

• Forty-two percent of respondents were over age 50.

Higher skill set

A higher skill set is expected for today's access staff. Registrars will be having complex financial discussions and complying with more regulatory requirements at the time of registration. "It will be incumbent on the leadership team to ensure that initial training and ongoing skill enhancement programs are focused on these changing needs," says Catherine M. Pallozzi, CHAM, CCS, director of patient access at Albany (NY) Medical Center.

Charlene B. Cathcart, CHAM, director of admissions and registration at Palmetto Health Richland in Columbia, SC, foresees a movement into a patient care-centered model.

"This model would include the patient access reps in the clinical work — taking the patient's weight or reminding them of their last physical," she says.

Although patient access professionals have traditionally worked in the hospital and ambulatory settings, other employment venues have opened in the past few years. These include management and operational consulting and technology design/deployment within the revenue cycle.

Woerly says, "Knowledge of front-end operations, together with the know-how to fully engage and optimize people, process, and technology," makes the patient access professional a great candidate to move to non-traditional roles.

"Although such a change may be seen as a role stretch, for the right person it can be exhilarating, both from a professional and a personal level," says Woerly.

Within the hospital setting, multi-hospital entities are beginning to embrace the concept of shared services operations, notes Woerly, which has been successfully implemented within other industries.

Antionette Anderson, CHAA, CHAM, director of patient access and centralized scheduling at Skaggs Regional Medical Center in Branson, MO, notes that patient access is now responsible for medical necessity screening. Preventing identity theft also is playing a growing role in their responsibilities. "We are now taking pictures of all our patients at point of entry and asking for a picture ID," says Anderson.

Anderson's staff also collect previous balances when the patient comes in for testing. "Our preadmission staff preregister 98% of the scheduled procedures," she notes. "They call the patient prior to their appointment and advise them of their out-of-pocket responsibility."

Staff either collect this amount over the phone, or prepare an estimation sheet for the registrars to let them know that the patient will pay at the time of service. "Our collections have increased considerably," reports Anderson. "For a 165-bed hospital, we are able to collect over $1 million a year upfront."

Reform on horizon

Vicki Lyons, patient access manager at Baptist Hospital East in Louisville, KY, says that her department struggles to comply with all of the various government requirements. "The newest thing is making sure the patients are made aware that we do provide charity," she says.

As for health reform, patient access leaders are still unsure what this will mean for their departments. "I don't think anyone really knows at this time what changes the health reform is going to mean for patient access," Lyons says. "Registration is an ever-changing area, so we will be ready for any change we need to make."

Clearly, though, there is a growing need to help patients understand changes in their benefits. "We need to make certain that we have the programs in place to screen uninsured patients and help link them to the correct programs," says Cathcart.

Patient access will have to be knowledgeable on all of the coming changes that impact a patient's coverage, and when they become effective. "They will have to dig deeper and ask more questions," says Anderson.

For instance, if an adult under age 26 presents, he or she may be insured under his parents even if he is married. "More people will qualify for Medicaid under different levels, so there will be more screening by the front-end staff for self-pay patients," says Anderson.

Salaries are obstacle

At Albany Medical Center, the salary of the front-line staff member has not changed, as it is aligned with the billing staff. "That said, there is a growing need for the front-line staff to know and understand payer contractual obligations, with the ability to interpret and impact this information to our patients," says Pallozzi. "This may necessitate the need to evaluate the front-line patient access staff salary structure."

Lyons reports that "even though it seems more job requirements are being placed on registration to keep expenses down, the pay increases are being reduced.

Since registration has only so many management positions, there is not a lot of room for advancement. "But with the ever-changing job duties of registration and more expectations, we may see a change in this," says Lyons.

Woerly has a similar expectation. "Although last year's economic situation may have negatively impacted many, I believe that we'll see increased salaries as patient access professionals move to non-traditional roles," he predicts. "In addition, they are moving to a more corporate level within their organizations."

For better or worse, front-end operations clearly influence back-end operations. "If the right thing was done at the right time in the right way in patient access, other health care personnel would see an enormous improvement in their output," says Woerly.

Health information management, patient financial services, case management, utilization review staff, and others would see a marked reduction of "rework." "Health care leaders are beginning to understand this, and so will properly invest in the right professionals to improve their operations," predicts Woerly.

How do you position yourself as the "right professional?" Woerly says, "Advancement comes with doing the right thing for the right reason." In order to demonstrate your leadership skills, show that you are someone who is truly enthusiastic in your work. Collaborate with diverse personalities to successfully design and implement new solutions.

"This will aid the individual in advancing," says Woerly. "Who better to work with but someone who creates a positive, energized environment? Being seen as the 'go- to person' and the authority, will be rewarded by your leadership. If not today, then perhaps tomorrow."

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