Is another hospital, or another department, offering an experienced registrar more money? If so, patient access leaders face an uphill battle.
“The money saved by not having to recruit, interview, onboard, and train far exceeds the cost of improving what forces an existing employee to leave,” says Tara Tinsley Smith, CHAM, MBA, director of patient access systems at Birmingham-based Children’s of Alabama.
In the past few months, five experienced registrars left for better pay, including one who had been in the department for a decade. “In April, our company made some major salary adjustments,” reports Tinsley Smith. “These adjustments have helped. But for some employees, it still isn’t enough.”
Opportunity for advancement and financial incentives are always a top concern identified in employee satisfaction surveys at Hennepin County Medical Center in Minneapolis, MN, says Karoline Pierson, director of patient access. “The literature says pay isn’t important, but quite frankly, I don’t buy that,” says Pierson. “For staff to be able to go home and say, ‘I got a raise’ is so important, even if it’s a small raise.”
Counteroffers backfire?
Obtaining across-the-board pay increases is a daunting challenge for patient access leaders. However, it’s a better approach than to offer registrars more money only if they threaten to leave, cautions Lauren Delpino, manager of the Patient Service Center at Chester, PA-based Crozer–Keystone Health System.
“We have all heard employees say, ‘If they are offering me an increase when I am leaving, why didn’t they offer me this before? I would not have looked,’” says Delpino.
At Hennepin County Medical Center, new employees in admitting or registration sometimes leave for easier schedules. Pierson says, “They quickly learn they don’t have to work weekends or holidays if they switch to a clinic.”
Delpino warns that making counteroffers if registrars say they’re leaving for more money is “a slippery slope. It does not take long for staff to realize this is the only way to earn an increase.” Some registrars leave regardless of a manager’s offer to match the increase. They won’t be shy about sharing this information with former coworkers.
“Staff who leave always call their friends and share their increase amount,” says Delpino. This information quickly causes hard feelings. “Staff who cannot make a move will feel they are appreciated less” than the registrar who was offered extra money to stay, she says.
Put value on access role
Traditionally, patient access was paid less than the “back end” because a lesser skill set was required. “But the days of access merely collecting demographics are long gone,” says Pete Kraus, CHAM, CPAR, FHAM, business analyst for revenue cycle operations at Atlanta-based Emory Hospitals. “Pay parity between front-end and back-end staff should be a given.”
If specific insurance and clinical prerequisites are not met prior to service, the facility and physician won’t get paid. Kraus says, “For patient access departments still struggling with an inferiority complex linked to poor pay, the first step is to ensure staff understand their role in the revenue cycle and work to high standards.”
Patient access’ greatly expanded role is acknowledged by Emory’s administrators. “For many years, we have paid revenue management operations staff on the same scale for comparable jobs, wherever they work in the cycle,” says Kraus.
Kraus says it would be logical to speculate that all the emphasis on the front end has left back-end collections less critical. “The goal is to get it right up front, bill it correctly, and the money will flow more or less on its own,” he says. “Unfortunately, that isn’t quite the case.”
Payers still find reasons to delay or deny payment on clean claims. “Even the best access departments produce accounts that require back-end clean-up,” says Kraus. “Some collectors have migrated into revenue management.” These employees analyze and appeal denials and underpaid claims.
“But they haven’t a prayer without a clean claim,” says Kraus. “Clean claims are a direct result of getting it right in access.” To obtain parity with the business office, Kraus says patient access leaders should take these steps:
• Make data on clean claims and denials based on front-end lapses readily available.
This step helps put a monetary value on the work patient access staff accomplish. “If the data is not available, access should be pushing hard with administration and IS [Information Services] to make it available,” says Kraus.
• Spotlight customer service-related expectations in job descriptions.
“In terms of persuasion, this helps sweeten the pot,” says Kraus.
• Ask human resources (HR) staff members to survey salaries at comparable hospitals in the area.
This step helps you make a business case to match salaries offered by competitors. “I don’t think anyone will challenge the cost of high turnover,” says Kraus.
• Do a thorough review of job descriptions.
“These may be hopelessly out of date,” says Kraus. Updated expectations, standards, qualifications, and job functions are needed. “This should be conducted in collaboration with HR, whose job it is to recruit qualified applicants,” says Kraus.
Justify pay increases
Delpino was successful in getting a market adjustment approved for patient access salaries. She says patient access leaders can justify pay increases with these approaches:
• Check job descriptions to ensure these include all of the responsibilities that have moved to the front end.
• Include specific metrics in job descriptions, so it’s clear what you expect from employees.
“This is helpful when discussing rate changes with HR,” says Delpino. “It demonstrates that staff are being held accountable for their work product.”
• Create a career ladder based on performance metrics.
“Include other accountabilities that demonstrate different levels of staff engagement,” says Delpino. Staff members might be required to cross-train in multiple areas of patient access or be willing to work at multiple locations, for example.
“Being able to pull staff who can work in multiple departments and locations saves the organization money in overtime and results in fewer errors,” says Delpino. This can justify paying a Level 2 access representative a higher rate than a Level 1 access representative.
• List the systems that staff members use on a daily basis.
“Most patient access staff use 4-9 systems,” says Delpino. Include payer websites and systems for scheduling, eligibility, document imaging, medical necessity, ICD-10 codes, bed tracking, order entry, and point-of-service collection.
“This demonstrates the knowledge and organization that is needed to work an account or register a patient with accuracy and efficiency,” says Delpino. (See related stories in this issue on pay increases and incentives and a story on giving employees more time with managers.)
SOURCES
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Lauren Delpino, Manager, Patient Service Center, Crozer-Keystone Health System, Chester, PA. Phone: (610) 619-7382. Email: [email protected].
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Pete Kraus, CHAM, CPAR, FHAM, Business Analyst, Revenue Cycle Operations, Emory Hospitals, Atlanta. Phone: (404) 712-4399. Fax: (404) 712-1316. Email: [email protected].
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Karoline Pierson, Director, Patient Access, Hennepin County Medical Center, Minneapolis, MN. Phone: (612) 873-5494. Email: [email protected].
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Tara Tinsley Smith, CHAM, MBA, Director, Patient Access Systems, Children’s of Alabama, Birmingham. Phone: (205) 638-7045. Email: [email protected].
