2008 Salary Survey Results

Patient access facing great challenges and opportunities

Trends 'bode well for access staff'

The shift from handling verification, eligibility, and collection issues on the front end - before or during registration - is continuing, and this is good news for patient access.

"There is widespread recognition that the best reimbursement opportunities occur during the period from when patients are scheduled to when they present," says Peter Kraus, CHAM, CPAR, business analyst with patient financial services at Emory University Hospital in Atlanta. "This bodes well for access staff and managers who understand patient accounting and aggressively pursue their expanding role in the revenue cycle."

Access managers traditionally make less than patient accounts managers, but "the potential for parity has never been greater," says Kraus - if access presses its case for the impact it can have in getting accounts properly categorized and collected, while maintaining the traditional functions it always has been responsible for.

According to the 2008 Hospital Access Management Salary Survey, 17% of respondents fell into the $40,000 to $49,000 range, with 9% earning less than that amount. Another 15% earn between $50,000 and $59,000, and 19% make over $100,000. Nearly half of respondents (49%) reported a 1-3% increase in salary in the last year, and 28% received a 4-6% increase.

"Salaries are always a struggle," says John Woerly, senior manager at Indianapolis-based Accenture.

Gradual salary increase

Woerly adds that in his experience, as his position has grown and he has demonstrated success, managerial flexibility and skills in bringing new talents and new services to his employer, his salary has grown. This held true when Woerly worked as a director of patient access, as well as presently within consulting.

"This is not something that I have gone into with the intent to increase my salary or advance my career laddering," he says. "It has happened because I have had a personal and professional interest and commitment in developing a new strategy and seeing it through development and implementation. I then have been rewarded by my employer with a salary increase and/or bonus."     

Katie M. Davis, director of patient financial services at Carolinas Medical Center in Charlotte, NC, says that her department has seen a gradual increase in patient access salaries over the past few years. "This has come with increased responsibility in job functions," she reports. For example, patient access managers are now a more integral part of the facility management team, and are included in major projects and issues.

Other key findings of the survey:

• About one-quarter of respondents (26%) work between 41 and 45 hours, and 34% work between 46 and 50 hours, but over a third (35%) put in more than 50 hours.

• Although 12% of respondents have worked in patient access for only one to three years, and another 20% for between four and six years, 24% have worked in patient access for 25 or more years.

• Twenty-one percent of respondents were over age 55.

Role continues to evolve

"Savvy access professionals will be knowledgeable and proactive if they want to prosper in their careers," says Kraus. "More passive shops may be blown about by the prevailing economic winds."

Kraus recommends the following:

• Be aware of what access salaries are both locally and for comparable facilities throughout the country. Kraus recommends looking into the National Association of Healthcare Access Management's salary surveys to gain a national perspective. "Perhaps local access organizations have done the same, formally or informally, and can offer a regional or local perspective," he adds.  

• Network to determine what functions access professionals in other facilities are responsible for.

To advance, Davis says that patient access professionals need the same leadership qualities as other management positions in health care or elsewhere. "They need to be able to inspire and grow others, have good decision-making skills, and have an understanding of the big picture - not just the patient access world," she says. "Certainly having extensive knowledge of the revenue cycle helps."

At Carolinas Medical Center, patient access is involved in collections, eligibility, denial management, financial counseling, preparing for Recovery Audit Contractors, and other functions, many of which were previously considered the responsibility of patient accounting.

According to Woerly, patient access continues to evolve, "not necessarily in a revolutionary manner, but more in an evolutionary manner."

"We have gone beyond simply registering and/or admitting patients to our facilities, and are now responsible for larger portions of the overall revenue cycle," says Woerly.

This can entail patient scheduling, medical necessity review, bed management, financial clearance (pre-registration, insurance eligibility/ benefit verification, pre-certification/authorization, referral management, liability estimation, financial education/collections), financial counseling, point-of-service collections, cashiering, charge capture, and more.

Many large institutions are investing in Customer Relations Management (CRM) technology, and creating contact centers for patient scheduling and financial clearance activities.

"Additionally, I have seen progressive organizations who have introduced case management/utilization review activities within the patient access 'umbrella' of responsibilities," says Woerly.  

Woerly says that the motto of "Doing it at the right time, the right way and by the right people" rings true as patient access moves forward. 

"As the population of uninsured and underinsured continues to grow, I can see that revenue cycle activities, previously done at the back end, will continue to move to the front end," he says. "With that in mind, technology will be deployed in a greater degree to the front end. That will in turn require more sophisticated, better trained staff!"

Woerly says that this trend toward front-end liability resolution and collection presents an important opportunity for patient access professionals to increase their clout, and for organizations to focus on strategies and resources needed to increase cash collections.

"The more progressive health care organizations are already realizing this and restructuring accordingly," he says. "I also see a more advanced job role within the larger organizations - such as corporate director of patient access or vice president of patient access - being created."

In order to take advantage of these new and expanding opportunities, Woerly says to "embrace change, be proactive in career development by continually learning and being proactively involved, and take a more encompassing interest in all aspects of revenue cycle and health care operations as a whole."

Staffing remains a challenge

Rapid, accurate, high-quality registrations are becoming more critical, as automated clinical systems require patient accounts to be established online prior to treatment, says Kraus.

"As always, but maybe particularly as the economy takes a turn for the worse, there will be tension between hiring and retaining staff with enhanced clerical, financial, and guest relations skills, vs. saving money to meet scaled-back budgets," says Kraus.

Kraus adds that some facilities will short-change their front-end in order to fund advanced clinical projects or simply to reduce costs. "This may prove counter-productive in terms of being able to collect the dollars needed to justify future growth and/or sustain a viable enterprise," he says.

Davis says that her department continually tries to control staffing, which can be driven by volume or by the physical layout of any given facility. "As either of these items change, we have to re-evaluate our staffing," she says. "We are also constantly on the look-out for new ways, either processes or with technology, to make processes more efficient so we can at least hold staffing to current levels."

Woerly expects that staffing in patient access will continue to be a challenge, both in terms of retention and recruitment. It's not easy, he says, to find and keep associates who are willing to work odd hours in highly stressful work environments such as emergency department registration or high-volume call centers, which require staff who are well-trained in new technologies.  

"Salary is only one drawing card!" says Woerly. "Managers will need to be creative in their resourcing approaches." For example, patient access managers may need to offer bonus and incentive plans based upon productivity, quality and other defined outcomes, create career ladders, and promote those associates with proven talents.

Also, patient access managers must effectively work with Baby Boomers, Generation X, Generation Y, and Generation Z personalities, each with different working styles, motivators, career expectations, and skill sets. 

To learn to work with such a diverse mix of employees, he recommends reading up on the topic and keeping in mind that each group may have different motivators. "I learned many years ago that what was a motivator for me, such as approval to attend an outside conference, may not be a motivator for the next person," says Woerly. "Treating each employee as an individual is important, while balancing the entire team in such a way that you don't isolate populations or are perceived as showing differential treatment."

The key is to embrace these differences in personalities, says Woerly, as "the right blending will make a very successful department and drive positive outcomes."

Additionally, the patient access department of the future also needs to blend different educational backgrounds and experiences - clinical, clerical, financial, and technical.  

"Realizing these differences in associates' work ethics and educational agendas will allow our future patient access managers to successfully blend these talents and meet future challenges," says Woerly. "Versatility, stamina, and commitment to our customers - patients, physicians, payers, and internal associates - will make the manager successful and ultimately meet or surpass customer expectations."