EXECUTIVE SUMMARY

Patient access departments struggle with obtaining pay increases for employees, despite a greatly expanded role. Some results of UW Health’s initiative:

  • Most patient access staff received pay increases.
  • Some billing positions decreased in pay grade.
  • Outpatient registration went a year without any turnover.

Patient access is asked to carry out more duties than ever, but many departments struggle with retention due to outdated entry-level pay.

“You need data to show why the positions are worth more,” says Rebecca Haymaker, director of registration and technical Services at UW Health in Madison, WI.

UW’s revenue cycle department recently tackled this problem in a comprehensive way.

“Certainly, patient access had the most to gain, but it wasn’t a patient access-driven initiative. It was a revenue cycle initiative,” Haymaker says.

The revenue cycle has changed dramatically in recent years.

“Patient access has a huge impact on the hospital’s bottom line,” Haymaker says.

Previously, the more complex, analytical work was performed by the business office, but automated payment postings and claims submissions have made the “back end” jobs easier. The front end, on the other hand, has morphed from largely clerical, data-entry duties into a complex role encompassing financial counseling and price estimation.

However, pay scales didn’t reflect these changes.

“Not only was there a disparity on the front end, but there had also been changes on the back end,” Haymaker notes. Many of UW Health’s traditional back end functions had moved to the front end, including collections, financial counseling, claim edits, and denials management.

The “patient experience,” encompassing the patient’s financial experience and overall satisfaction, is a top priority for the entire organization, and patient access staff play a major role.

“If this is really our number one priority, then we need to compensate like it’s our number one priority,” Haymaker adds. “We needed to ‘right size’ our revenue cycle to reflect the work that’s actually done today, not what’s been done historically.”

Not an Easy Process

UW’s project entailed looking at the responsibilities of all 19 roles, and more than 30 job titles, in the revenue cycle to determine what compensation is appropriate.

“This isn’t an easy process by any means. It took us about two years to complete,” Haymaker explains.

Patient access first convinced HR leadership to come on board. “We created a position review document,” Haymaker recalls. Using standard methodology, all compensable factors were weighted. These included required experience, decision-making, required knowledge, patient interaction, and customer service.

“We went through every single position, and gave it a [score of] 1 to 5 for each compensable factor,” Haymaker says. “We gave the highest weight to customer service.”

Registration roles didn’t necessarily require any experience, for instance, but transplant financial counselors did.

“We came up with a total score for each position,” Haymaker notes.

The next step was to conduct a market analysis. “This is where we hit a snag,” she says. Most organizations haven’t gone through the same process, so there wasn’t data to support the proposed pay scale.

“HR took our proposed titles and position descriptions, and queried other healthcare organizations,” Haymaker explains.

Other organizations were asked to submit confidential compensation information for comparable positions.

“Not every role is comparable with other organizations, so you need to pick your most common titles,” Haymaker says.

Even then, responsibilities vary greatly depending on the organization.

The compensation information that came back wasn’t helpful, since it aligned with the traditional way of grading the positions.

“Because there are not many organizations that have reviewed their revenue cycle positions as a whole, we felt as though we were not going to align with pay for our patient access and customer service positions,” Haymaker says.

Not Lowest Paid

Undeterred by the setback, UW Health’s patient access leaders argued strongly for more compensation.

“We made a case that certain roles should be compensated differently than the fair market value,” Haymaker says. “It was uncomfortable at times, but it was a good exercise to go through.”

Ultimately, the group succeeded in getting pay upgrades for most patient access positions.

“At the end of the day, registration isn’t at the top of our pay grade, but they are not the lowest anymore,” Haymaker says. “They are at least on par with their counterparts in the business office.”

Previously, patient access employees often left the department for better-paid positions with the business office.

“It was a pay increase, with more flexibility, and perks like wearing jeans,” Haymaker notes. “We were constantly losing people.”

Some back-end billing positions decreased in pay grade because of the initiative (current employees continued at their present rate, so no pay cut was given). For patient access, this meant improved retention.

“We went almost a full year without any turnover in outpatient registration, which was unheard of,” Haymaker recalls.

More candidates for patient access jobs have college degrees.

“We are also holding people accountable,” Haymaker says.

The department created stricter guidelines for staff to move to higher-level positions.

Recent integration of the health system has put patient access compensation in flux once again. The size of patient access increased because of multiple new locations, necessitating repeating the process.

Previously, the medical foundation and hospital and clinics operated as separate organizers and employers.

“We integrated under one UW Health umbrella in the summer of 2015,” Haymaker says.

Throughout the organization, all positions are under review to achieve equal compensation for equal roles.

“Today, the hospital registrars are paid differently than our medical foundation registrars,” Haymaker says.

To align staff into the same job titles, HR will conduct a current market compensation study again.

“We anticipate we’re going to hit that same challenge with the front-end staff again when we do those market comparisons,” Haymaker says.

Since cash collections previously were conducted on the “back end,” the most highly skilled and qualified people usually were placed in the business office — with commensurate compensation. However, this has changed dramatically, with patient access handling comprehensive pre-service financial clearance.

“In the new revenue cycle world, the goal is to push all the complexity to the front,” says Ketan Patel, a senior manager in the healthcare provider segment of strategy and operations for New York City-based Deloitte Consulting. “Get it right the first time” is the goal.

“This makes the business office simply an exception-based processing center,” Patel adds.

Conversely, in patient access, higher compensation is needed. Patel notes that patient access leaders must “justify appropriate pay increases to attract and retain the right talent to patient access.”

Susan Labow, vice president of Long Beach, CA-based Receivables Optimization Incorporated, and former interim executive director of revenue cycle at Bakersfield, CA-based Kern Medical Center, recently conducted a revenue cycle assessment at a mid-sized hospital. She asked hospital administration what kind of education was provided to patient access staff.

“I said, ‘I am willing to bet that the people managing the stock portfolio for your board members have more than a GED or high school degree. Yet, you have patient access staff making million-dollar decisions every day,’” Labow recalls.

If patient access staff select the wrong payer, significant amounts of revenue are at stake.

“These people are the first line of defense and are paid the least,” Labow says.

Patient access employees are the first people the public sees, and they interact constantly with clinicians and patients.

“Patient access must know all the rules for all the payers in all situations, all the time,” Labow adds. “The hospital’s most experienced collector doesn’t have this knowledge.”

SOURCES

  • Rebecca Haymaker, Director, Registration and Technical Services, UW Health, Madison, WI. Phone: (608) 829-5689. Email: Rebecca.haymaker@uwmf.wisc.edu.
  • Susan Labow, CRCR, Vice President, Receivables Optimization Incorporated, Long Beach, CA. Phone: (562) 843-1211. Email: slabow@roi-corp.com.
  • Ketan Patel, Senior Manager, Strategy and Operations, Health Care & Life Sciences, Deloitte Consulting, New York City. Phone: (832) 752-5385. Fax: (713) 427-0480. Email: ketanvpatel@deloitte.com.