Nobody can say with a straight face that pay in patient access has increased dramatically. However, demand for high-level skill sets certainly has.

“The focus has moved to patient access entering the demographic and payment data accurately,” says Karoline Pierson, director of patient financial care services and access at Minneapolis-based Hennepin County Medical Center. Pierson offers several examples of how important patient access is in the revenue cycle. For one, patient safety starts with correctly identifying patients at the time of scheduling. When insurance information is entered correctly, this leads to the creation of an accurate bill. Also, a referral to financial counseling happens quickly when self-pay patients are identified at the point of entry.

“The list goes on,” Pierson says. By appropriately compensating patient access, hospitals can receive a clear return on investment. Fewer denied claims and happier patients are two obvious examples. “We reap the benefits of an engaged workforce who knows what to do, and does it well, with a focus on both the patient’s experience and the organization’s financials,” Pierson notes.

Low pay is just one reason registrars decide to resign shortly after the hospital invests time and money in their training. Low morale is equally important. “The biggest reason people leave the job is they just get frustrated,” says Suzanne Mell, MSN, RN, system director of access at Cincinnati-based Mercy Health.

For schedulers, the struggle comes mainly from an inability to do their jobs. Patients are eager to see a provider as quickly as possible. “But it’s very difficult if there is no access. Everybody struggles with that,” Mell explains. The employee then faces the unenviable task of telling the patient the provider is fully booked. Worse yet, the patient has to wait weeks or even months to be seen.

It is not just patients who are upset with this; the provider’s offices often are unhappy, too. “There’s kind of an adversarial relationship,” Mell says. Not surprisingly, the call center gets blamed for everything that goes wrong with scheduling. In reality, says Mell, “most of the mistakes happen within the practices.”

A common scenario: A patient checks in after waiting weeks for an appointment, only to find out he was booked at the wrong location or on a day his doctor is not even in the office. For the provider’s office staff, it is all too easy to point a finger at an anonymous call center agent they have never met. Further investigation often reveals that the providers’ offices were to blame. However, this usually falls on deaf ears.

“You can pull the calls and prove it,” Mell offers. “But that message never makes it quite as far as the original message that blamed access.”

Part of the problem is that neither area really understands what the other does. Directing physicians to observe schedulers is one interesting solution, Mell suggests. “It’s a very high-pressure job. Most people don’t understand it.”

On the call center side, employees do not think of all the repercussions when a provider is terribly overbooked or a visit is booked at the wrong location.

“Call center agents need to go to the practices to see what happens when they make a mistake,” Mell says. “They need to have the why behind what they do.”

Nowhere to Go

Constantly talking on the phone with people who are sick and worried or annoyed they cannot see a physician takes a toll. Much of this dissatisfaction is out of the control of patient access. That is why giving staff a say in how the job gets done “is huge,” Mell says. “Quite frankly, every time I bring something to them, they think of something I’ve missed.”

Asking for input on process changes and acting on it can help day-to-day morale. Still, it is not enough to get staff to choose patient access for a career. The problem stems from offering no clear path to advancement.

“You are in an entry-level position. Where is there to go?” Mell asks.

To differentiate themselves from competitors, Mell’s department is working hard to develop career ladders.

“If we have the reputation as the place where you can get your foot in the door and work your way up, then we won’t have a problem retaining people,” Mell predicts.

This only becomes more important as higher-level skills sets are demanded. Scheduling high-dollar diagnostic tests requires complex financial conversations. These are not easy discussions. “Insurance companies like to change their rules often. Keeping up with that is a full-time job in itself,” Mell laments. Staff also are expected to bring excellent service skills to the table but without commensurate compensation. “It’s a really hard job, and we don’t reimburse well,” Mell notes.

While some call centers in urban areas pay in the $20 per hour range, “that’s not what the market supports here,” Mell says. Some employees conclude it is far less stressful to work at a fast food restaurant or grocery store. “We have the same entry-level pay as jobs that don’t have the complexity and the pressure that this job has,” Mell explains.

The challenge is to give good patient access employees a reason to stay. For some employees, flexible scheduling is that reason. “It’s not as hard to get nights and weekends covered as you think if you are smart about how you do the shifts,” Mell advises. One creative idea is to follow the nursing example of offering four 10-hour shifts for evenings and nights. “It takes some real maneuvering to make that type of scheduling work,” Mell acknowledges. The bottom line is patient access leaders must work harder than ever to keep their best registrars. “A leader can make the difference between [employees] staying or leaving,” Mell says. Celebrating “wins” becomes very important.

Buying staff lunch always is appreciated. However, by itself, that can appear like an empty gesture. “You need to stay and eat with staff,” Mell says. “Sit down with them, and ask about their challenges. Tell them, ‘You are doing an amazing job.’”