Cross-training exposes registrars to many areas of patient access, which opens up the possibility of promotions and offers a better understanding of the revenue cycle. Jackson Memorial Hospital uses these processes:
- Registrars work on their own after being placed with a team lead for two days.
- Registrars are rotated to different areas on a regular basis.
- Shifts are adjusted to allow registrars to work in the new area for a few hours.
Carlos Diaz says that even after 18 years in the field, he still sees employees viewing patient access as a “transient stepping stone to a career path.”
This view is especially true of younger staff.
“Most of those come in to pursue careers in nursing or other allied health fields, such as radiology or respiratory therapists,” says Diaz, director of patient access management at Jackson Memorial Hospital in Miami.
Unfortunately, these staff members often are Diaz’s star registrars. “They are energetic and career-minded. They are typically my top collectors,” he says. “It’s difficult when they come in and give notice.”
When Diaz started in his current position in 2013, there was no shortage of grumbling in patient access. Many registrars felt that there was no way to get ahead.
“Individuals felt stuck in a particular position or area. There was really no movement,” says Diaz. To move up, registrars had to wait until someone left the organization or retired.
For Diaz, cross-training is one way to encourage registrars to make a career in patient access.
“I try to cross-train every single registrar, so they are exposed to different patient access areas,” he says. Though it isn’t mandatory, the vast majority of the department’s 136 registrars volunteer to be cross-trained.
“This helps keep our staff within the organization,” says Diaz. “If there are openings within other areas, registrars that are cross-trained have an advantage.”
Skills Kept Sharp
Cross-training helps with sudden volume surges, whether due to disasters or due to it being a busy day.
“We have a group that’s fully trained to move into different areas,” says Diaz. “We make sure that whatever skill set they learn, they fully master it.”
The registrar is placed with a team lead in the new area for the first two days and then is allowed to work on his or her own.
“If they don’t feel comfortable, they can come back with any questions or concerns,” says Diaz. For example, ED registrars aren’t familiar with Advance Beneficiary Notices, so they often need some help explaining it to the patient. Similarly, an outpatient registrar might need extra assistance in working with trauma patients.
To keep skills sharp, registrars are rotated to different areas on a regular basis. Sometimes schedules are adjusted so an outpatient registrar can work a few additional hours in the ED, or vice versa.
If staff members need more time in the new area, Diaz gets creative with scheduling.
“Rather than have them work 11 p.m. to 7 a.m., we cut the shift in half and ask them to come in at 3 a.m. or even 4 a.m.,” he says. With this system, the registrar will be in the area when volume spikes between 8 a.m. and 10 a.m.
Staff “Save the Day”
All newly hired patient access employees at CHI St. Luke’s Health – Lakeside and Springwoods Village Hospitals, Houston, spend time in three areas: scheduling, registration, and the welcome center. They do so regardless of the role for which they were hired.
“Learning multiple areas of the department better equips the employee to understand how their role impacts the other areas,” says Mike Potter, director of patient access services.
It also gives Potter a ready pool of trained registrars to fill in anytime it’s needed. “I truly feel blessed to have so many cross-trained employees in my departments,” he says. “They ‘save the day’ almost every day.”
No patient access manager wants to get a 5 a.m. phone call from a registrar who will be out due to illness. When Potter receives such a call, he tells him or her not to worry, but to get well, and “we will take care of it.”
“I say this because it is true,” says Potter. “Our team pulls together and can switch areas with ease.”
Moving a registrar to scheduling, or a scheduler to the welcome center, is done fairly often. “This is so the hospital and our patients do not feel the impact of a shortage in our department,” explains Potter.
Potter sometimes finds himself covering for staff as well. “There is no meeting on my calendar that can’t be rescheduled, so I can get in the trenches and do what is best for our team and patients,” says Potter.
Registration process times, call handling metrics, and collection rates continue to stay strong, regardless of volume surges or unexpected call-ins. “I believe the national average, or benchmark, is around 2% of net patient revenue collected at the time of service,” says Potter. “Historically, we perform closer to 6%.”
Registration time — from the patients’ greeting at the Welcome Center, to the time they are cleared by registration and ready for their appointment — averages about 15 minutes total. “But the results we see are not easily measured on paper or by standard metrics,” says Potter.
The biggest benefit he sees is with the department’s morale.
“Historically, we celebrate employee engagement scores in the high 90th percentile. For retention, I have had zero turnover this year,” says Potter.
Registrars, when unable to come to work due to illness, appreciate getting calls from coworkers assuring that all is going well in their absence. “Normally, when an employee leaves my team, it’s to grow within the organization, which I am always thrilled to support,” says Potter. (See related story in this issue on how the department handles unscheduled “walk- in” patients.)