Executive Summary
Observing registrars allows patient access managers to help struggling employees, assess how well staff work as a team, and identify employees’ different learning styles. Patient access leaders learned the following during rounding:
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A registrar didn’t know how to explain insurance benefits.
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Staff members needed help responding to changes in the state’s Medicaid program.
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An employee wasn’t using the new insurance eligibility system properly.
An experienced registrar at UCLA Medical Center, Santa Monica (CA) did her job very well, but had consistently low collection rates. While rounding one day, patient access services manager Maria Gordillo found out why.
“As I watched her one afternoon, I noticed she told a patient they could be billed,” she recalls. Shortly afterward, Gordillo asked the employee why she didn’t try to collect.
“She told me she didn’t know how to explain the patient’s benefits, so she just told patients we would send them the bill,” Gordillo says.
She gave the employee scripting and spent some time instructing her about how to explain insurance benefits. “We saw an increase in her collections almost immediately. She took a little time to gain her confidence, but she came around,” says Gordillo.
Jump in to assist
Zander Davis-Washington, director of ambulatory support at Ann & Robert H. Lurie Children’s Hospital of Chicago, likes to see how her staff are operationalizing patient access processes.
“It’s one thing to put processes on paper. Looking with a deeper eye, you see the reality of how it actually works,” Davis-Washington says. (See story on how the department responded to a switch to Medicaid managed care plans and its effect on front-end staff, in this issue.)
Davis-Washington and other patient access leaders round first thing in the morning and periodically throughout the day. On high-volume days, they do additional rounding. If they see patients or families waiting, “leaders jump in to assist,” says Davis-Washington. “If you have to get on the phone and answer calls or make appointments, that is what you have to do.”
By pitching in with such day-to-day tasks, patient access employees “see that you are not just sitting somewhere and giving orders, but are part of the team,” says Davis-Washington.
Recently, some employees admitted they felt very uncomfortable requesting copayments from families. Davis-Washington motivated them to collect by sharing collection totals. “Utilizing productivity reports has had a tremendous impact on our collections,” she says. (For more information on this topic, see “Here are best role-playing scenarios to increase your department’s collections,” Hospital Access Management, August 2015.)
When rounding, Gordillo is often surprised at what she learns about her staff. “I don’t always look for something in particular when I observe them,” she says. “I may miss something that I wasn’t looking for that can benefit the employee or the department.”
Here are some things Gordillo has learned while rounding:
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Members of her staff work very well together.
“To see how much they help each other out was one of my biggest surprises,” says Gordillo. “It’s something I would have never noticed, had I not been observing them.”
She watched her staff members work as a team to get through a recent short-staffed shift and when one employee was having a difficult day personally. “I was able to see their customer service skills, not just for the patient and other departments, but with each other,” she says.
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Staff members didn’t realize how they affected the next shift.
The evening shift sometimes didn’t prepare the appropriate paperwork, which caused the morning shift to scramble.
“If the schedule changed, they didn’t print a packet, which consists of a face sheet and a page of labels with the patient’s information, for add-ons or direct admits,” says Gordillo.
She explained that both shifts benefit by leaving a clean, organized area for the next shift. “They are able to finish faster, which then gives them an opportunity to leave the next shift a cleaner slate,” Gordillo says. “It continues to roll from one shift to another.”
Employees restart computers for the next shift. “Our system uses a lot of memory. If the computers are not restarted, they run slow,” explains Gordillo.
Each shift avoids leaving extra work for the next shift. “Staff stay on top of daily tasks that can turn into time-consuming projects, like organizing charts, instead of leaving them for the next shift,” she says.
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Staff members were using a new insurance verification system incorrectly.
An employee casually mentioned to Gordillo that she used an outside insurance verification tool, “because the system never works.” “When I watched her run for eligibility in our new system, I noticed she missed one simple but key field: subscriber relationship,” says Gordillo.
Gordillo instructed the employee to add the field before running eligibility. “It worked, and she was then able to verify with the new system,” she says. She then asked other staff how the new insurance verification system was working out. “We found that others were in fact struggling with some of the functionality — something we didn’t know until we observed our employees,” she says.
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Staff members each learn differently.
By observing employees, Gordillo usually can tell whether they’re visual, auditory, or hands-on learners. “Knowing how they learn is one of the most important parts of my job. It teaches me how to present a new process,” she says.
Here are some things she looks for:
— Employees who like to explain processes verbally are probably auditory learners.
Gordillo recently explained the differences in consent forms used for various types of patients to a new employee. “She was able to connect it to a previous lesson on outpatient versus inpatient and explain how the consent form applies to each,” she says.
— Visual employees often ask managers to “show me.”
“That’s their key phrase,” says Gordillo. “I have several employees that need to see the screen shot of a function to understand what needs to be done.”
— A hands-on learner won’t feel comfortable even after being shown a process or hearing about it.
Instead, the employee asks, “Can you watch me do one?” “Once I identify these employees, I take the extra time to teach them separately, or I ask them to be the example of the group,” says Gordillo. (For more information on how to teach different types of learners, see “Are access employees struggling with new skill sets? Don’t let them fail,” Hospital Access Management, July 2012.)
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Zander Davis-Washington, Director, Ambulatory Support, Ann & Robert H. Lurie Children’s Hospital of Chicago. Phone: (312) 227-3145. Email: [email protected].
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Maria Gordillo, Manager, Patient Access Services, UCLA Medical Center, Santa Monica (CA). Phone: (424) 259-8001. Email: [email protected].
