Give best registrars chances to advance

Reward excellent work

Every patient access department has registrars who can be counted on to rise to every occasion, but better pay may lure these valuable employees to other hospital departments or industries. Instead, why not give these employees "an offer they can't refuse"— that is, a clear path to career advancement.

"We have created a career ladder for our patient access staff," says Antionette Anderson, CHAA, CHAM, director of patient access and centralized scheduling at Skaggs Regional Medical Center in Branson, MO. The career ladder has five rungs, enabling staff to increase their wages by $1.75 per hour, says Anderson, and the last rung requires that staff pass the Certified Healthcare Access Associate (CHAA) examination.

"Each rung has several line items of criteria, such as 98% accuracy, or training new employees," says Anderson. "Each rung [involves] a different level of competency exams that they must pass. After they have achieved them, competency testing is done on a yearly basis."

Jessica Murphy, CPAM, corporate director for patient access services at Methodist Le Bonheur Healthcare in Memphis, TN, says there is a four-tier management team at each facility's access department, consisting of lead, supervisor, manager, and director.

"We work with staff to encourage their acceptance of cross-training in other departmental positions," says Murphy. Staff also are encouraged to attend locally offered training classes and exhibit leadership skills by working with new associates and becoming the "go-to" resource in their area, she adds.

"These traits are noted and rewarded through the annual performance evaluation, and by encouraging these associates to apply for management jobs when available," says Murphy. Here are some other approaches to retain patient access staff:

• Improve the way you communicate with staff.

"Updating standard work processes, and reviewing these with each staff member one-on-one, really helps ensure we are all on the same page," says Angela Cabarteja, admitting supervisor in the patient financial services department at Virginia Mason Medical Center in Seattle.

Cabarteja also provides monthly reviews to identify any necessary training staff may need and eliminate any barriers that might be keeping them from doing their best work.

• Thank staff members for all they do.

"This isn't just with the big things. It is also recognizing the little things they do when they think no one is looking," says Cabarteja. "We purchased a fleece jacket with our logo and gave it to them 'just because.'"

An internal recognition system gives staff members "applause" points with specific details about something they did very well, says Cabarteja. "We also bought the team bubble tea and pizza when they collected $1 more in copays than the previous month," she reports. "We randomly send them cards at home to say what we appreciate about them."

• Provide staff development.

Carol Triggs, MS, director of patient access at St. Joseph's Hospital Health Center in Syracuse, NY, says that staff development is critical to retain competent and dedicated staff.

"Much of the former back-end processes have now shifted upfront," says Triggs. "In addition to accurate registrations, access staff must be well-educated in payer requirements, medical necessity, and estimating patient copays, deductibles, and balances. Staff must be trained in multiple software applications to perform many of these functions."

Equally important, says Triggs, is that staff understand the importance of their own role in the revenue cycle. "They are the 'key' in preventing costly rework and reduced reimbursement," says Triggs. "Customer service training is an equally important component of education. Every patient's first encounter begins with patient access, which sets the tone for the patient's stay."

The department has tried to ensure that staff in multiple service locations are familiar with the roles and functions of their patient access colleagues throughout the network, says Triggs. To accomplish this, managers developed a "Walk in My Shoes" program last year, she says.

"This has been well-received by staff," reports Triggs, adding that a career ladder has been vital in helping the access team become multi-functional and obtain their CHAA certification.

"We have a formal orientation and training program for all access new hires," says Triggs. "A weekly communication of important updates occurs through our 'Access Communique,' which is e-mailed to all access staff throughout the network."

In 2011, the department will be looking at ways to formalize open communication and share ideas and knowledge through unit-based councils. "We will model this after our clinical unit-based councils," says Triggs.

• Pick top performers to act as preceptors.

Charlene B. Cathcart, CHAM, director of admissions and registration at Palmetto Health Richland in Columbia, SC, says that her department has implemented a successful preceptor program. "We started out by identifying our top performers in each of our entry points including the ED, the Children's Hospital, and the Heart Hospital," says Cathcart.

Each employee's supervisor wrote a short letter of recommendation, and each candidate was interviewed by Cathcart to make certain that they were interested in and committed to the program.

The preceptor team went through a series of educational sessions, says Cathcart. Managers expected each competency test to be passed with a score of no less than 95%, she adds. Upon completion of the 12-hour training sessions, each participant received a small pay adjustment.

Now, every new employee is assigned to a preceptor. "This program has helped quickly establish a relationship between the new employee and the department," says Cathcart. "It also allows the preceptor to be recognized and rewarded for their efforts."

[For more information, contact:

Antionette Anderson, CHAA, CHAM, Director of Patient Access & Centralized Scheduling, Skaggs Regional Medical Center, Branson, MO. Phone: (417) 335-7701. E-mail:;

Carol Triggs, MS, Director of Patient Access, St. Joseph's Hospital Health Center, Syracuse, NY. Phone: (315) 448-5379. E-mail:]