OSF Healthcare Revenue Cycle Manager Mark Logan is cross-training several scheduling and registration employees at two of the organization’s facilities: OSF Holy Family Medical Center, a 23-bed critical access hospital in Monmouth, IL, and OSF Saint Luke Medical Center, a 25-bed critical access hospital in Kewanee, IL.

“My hope is to have staff want to learn more and grow within the revenue cycle, allowing us to retain and promote them,” Logan says.

At one facility, a financial counselor is cross-training in rehab and outpatient registration. This helped with staffing shortages as well as the patient experience.

“She can also help patients who need assistance with public aid applications or who have billing questions,” Logan adds.

At small critical access hospitals like the OSF facilities, patient access employees cover rehabilitation, outpatient, scheduling, and the ED. “Because of our size and volume, patient access services gets spread pretty thin,” Logan laments.

Some areas work with only one patient access person on a given shift. Thus, the department is taking a new approach of rotating staff in all four areas. This gives these employees a working knowledge of different department functions.

“Night shift coverage in the ED is always a challenge,” Logan notes. “I rotate coverage between several staff to alleviate third shift burnout.” If staff cover a third shift, they work for 10 hours instead of eight. “This allows me to give them an extra day off during the week,” Logan adds. “It allows greater work-life balance for those who have to work when everyone else is asleep.”

The department’s biggest challenge: Few people are available to cover for their cross-training colleagues. Taking an employee from one area to train means someone else is pulled from another area to cover for that employee. “This can be a nightmare when making a staff schedule,” Logan explains.

Differences at all registration areas are another challenge. The same information is gathered, “but each area has its own unique workflow,” Logan notes. For instance, outpatient registration staff conduct a full registration on a patient each time a patient arrives for an appointment. Rehabilitation registration is different. “These patients are considered series patients with a set of multiple appointments,” Logan explains. Thus, these patients do not require full registration each time they present.

Adding to the confusion, the EMR does not indicate when a patient was last fully registered. “The process involves manually checking to see when a patient had a full registration last,” Logan says. “That can sometimes get missed.”

Employees are not the only ones frustrated by this. “Patients tend to get upset when someone new tries to perform a full registration on them,” Logan says. Many patients have been coming in for a week or more without fielding basic demographic questions every time.

To keep skill sets such as these current, employees need exposure to the area at least once every couple of weeks. Scheduling and rehabilitation are the most challenging.

“There are so many little intricacies that these two areas have to keep on top of. It’s difficult to remember them all if you are not performing the tasks day in and day out,” Logan says.

Rehab scheduling involves multiple appointments scheduled out for weeks in advance. Staff must schedule the correct number of appointments on days that work for the patient and therapist. If an appointment is missed, the therapist’s schedule fills up, meaning patients have to extend their rehab out further. “This can impact their recovery and their satisfaction,” says Logan, noting that this is where the EMR’s auto-scheduling function comes in handy. “It helps us not have to remember every conflict in a department’s schedule.”

Cross-training helps more than just efficiency; it also boosts morale because employees have better working relationships.

“They all get to know each other a little better this way,” Logan says. “They get to help each other in areas where they lack.”