Access has dramatically expanded role, but salaries aren't keeping up

Higher skill level is required

If you find yourself struggling to hold on to your best employees, compensation is probably an issue. "Employees tend to transfer to other positions in the facility for more money, such as the business office," says Antionette Anderson, CHAA, CHAM, director of patient access and centralized scheduling at Skaggs Regional Medical Center in Branson, MO.

In fact, Charlene B. Cathcart, CHAM, director of admissions and registration at Palmetto Health Richland in Columbia, SC, names "finding creative ways to staff without increase staffing levels" as the No. 1 current challenge for her patient access department.

"In many areas of patient access, such as the emergency department, the patient volumes are growing much quicker than expected," she explains.

Pay impacts turnover

Many still consider patient access an entry-level position, with entry-level pay, despite the fact that responsibilities have grown sharply, says Anderson. "In fact, patient access is the front-end business office," she says. "Patient access has to input all information correctly, ensure the medical necessity, ensure the pre-certification is done, and ensure that all out-of-pocket expenses are paid at the time of service."

Still, Anderson points out that good employees can advance in patient access, moving from registrar positions to roles in pre-registration, centralized scheduling, and financial counseling.

As more back-end revenue processes migrate to the front end, the skill sets are "evolving to a higher level," says Carol Triggs, MS, director of patient access at St. Joseph's Hospital Health Center in Syracuse, NY. "We are recruiting more experienced and qualified candidates."

Over the past 10 years, many processes have shifted from the back end to the front end, notes Triggs. These include verifying insurance, interpreting benefits, ensuring and validating medical necessity, providing pre-service estimates, and communicating with physician offices and insurers to ensure authorizations are obtained, she says.

"Much of the success of the revenue cycle depends upon patient access," says Triggs. "Many of us have implemented career ladders to create a higher level of compensation based on functions and skill sets. This in turn reduces staff turnover."

Patient access is contending with the impact of health care reform and numerous other requirements, says Jessica Murphy, CPAM, corporate director for patient access services at Methodist Le Bonheur Healthcare in Memphis, TN. "There are constant regulatory and other changes at the front doors," she adds. "It takes the ability to multi-task and embrace change to be successful in this field."

In order to meet the requirements of health care reform, Murphy says that access "will certainly have to be ready and tuned in to changes in coverage for our patients. We will need to perform at optimal productivity and quality, in order to operate in new budgetary territory."

Angela Cabarteja, admitting supervisor in the patient financial services department at Virginia Mason Medical Center in Seattle, says that the responsibilities of her staff have expanded a great deal recently.

"We empower and coach our staff members to come up with and test ideas that eliminate waste and improve quality and consistency in our work flows and processes," says Cabarteja. When patients can't afford to pay for medical care, staff members screen and complete charity applications with them, using on-line screening tools or paper applications, she adds.

Cross-training and flexible scheduling help spread the work of obtaining authorizations more evenly across the team, says Cabarteja. "This gives staff members more visibility for the correct copay amounts we should be collecting," she explains. "It enables them to better answer patients' questions."

When patients know authorization for the surgery they are about to undergo has been approved, it helps put them at ease, says Cabarteja.

During a pre-admission process, staff verify insurance eligibility and obtain benefits information including deductibles, co-insurances, and out-of-pocket responsibilities, says Carbarteja. When there is no secondary insurance, staff submit the authorization and call the patient at home to complete the "admission" process, she explains.

"This helps identify patients who may qualify for financial assistance upfront. It reduces the time they spend in admitting on the date of service," says Carbarteja. "It also allows us to provide needed 'concierge' services, such as providing driving directions and information on area hotels."

Some increases

Murphy says that the biggest current challenge for patient access, and all areas of health care, is "doing more with less." "The trend for reimbursement reductions and pay-for-performance measures has squeezed budgets everywhere," she says.

Patient access plays a critical role in ensuring that information is complete and accurate for every patient encounter, says Murphy, so that claims are filed in a timely and "clean" manner. "This allows for maximum reimbursement, with short turnaround from the payer," she says.

Murphy says that patient access salaries have remained stable at her facility. "These are compared each year to similar jobs throughout our community, to ensure they stay competitive," she reports. "Last year, I was able to secure a one-grade increase and raise for our ED staff. That has had a very positive effect on our turnover in the ED."

Cabarteja says that patient access salaries have risen commensurately with the increased responsibilities in her department. A program called "tiering" is used for new employees who have passed their probationary period and are competent in their primary area of responsibility, she says.

Staff can be cross-trained in another patient financial services area for a 5% increase in pay for each tier, explains Cabarteja. "This is staff-driven," she says. "We have found that while staff members like the pay increases, they find the process of learning new skills most rewarding," she says. "It helps them understand the work flow better, prevents defects, and improves processes."

[For more information, contact:

Angela Cabarteja, Patient Financial Services, Virginia Mason Medical Center, Seattle, WA. Phone: (206) 583-6461. Fax: (206) 583-6523. E-mail:

Charlene B. Cathcart, CHAM, Director, Admissions and Registration, Palmetto Health Richland, Columbia, SC. Phone: (803) 434-6990. E-mail:

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