2009 Salary Survey Results

Downturn, reform are the two big challenges for access

But lots of opportunities are out there

It's unlikely that many patient access professionals are seeing huge raises these days. "With the economy as it's been, I would imagine increases are minimal and folks are scrambling to hold on to their jobs," says Peter Kraus, CHAM, CPAR, a business analyst with patient financial services at Emory University Hospital in Atlanta.

This is probably the case for most hospital departments, says Kraus, except perhaps in facilities where there is a nursing shortage.

At the same time, patient access departments are being challenged to do more with less. "Hospitals are delaying hiring and trying to develop ways to reduce FTEs," says Cheri S. Kane, MSA, FHFMA, CHFP, FACMPE, division president of The Outsource Group in St. Louis and former vice president of revenue cycle at Grady Memorial Hospital in Atlanta. "Some hospitals have moved to four 12-hour shifts, similar to nursing. Some hospitals froze wages in 2009."

However, there is a big bright spot: The role patient access plays is more acknowledged and appreciated by the health care industry than it was even 10 years ago. "I suspect that going forward, patient access's role will continue to gain respect. Salary increases will at least match industry standards as the economy improves," says Kraus.

According to the 2009 Hospital Access Management Salary Survey, 14% of respondents fell into the $40,000 to $49,000 range, with 11% earning less than that amount. Another 8% earn between $50,000 and $59,000, and 25% make more than $100,000. About a third (36%) of respondents reported a 1% to 3% increase in salary in the last year, and 21% received a 4% to 6% increase. Notably, 29% reported no change and 4% said their salary decreased.

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The survey, which was administered in July and tallied, analyzed, and reported by AHC Media, publisher of Hospital Access Management, identifies some of the factors impacting salaries and benefits in patient access.

Other key findings of the survey:

• Thirty-two percent of respondents work between 41 and 45 hours, and 28% work between 46 and 50 hours. A third (35%) put in over 50 hours.

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• Eight percent of respondents have worked in patient access for only one to three years, and 11% for between four and six years. Twenty-one percent have worked in patient access for 25 or more years.

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

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Kraus says that access leaders need to be as knowledgeable as possible about hospital finance and administration, with a comprehensive understanding of how a hospital is managed.

"It is also helpful to have knowledge of how the departments access interfaces with are run," says Kraus. "Access leaders aiming for the top should look for, or at least never say no to, opportunities to assume management of other areas. The more comfortable an access leader is with how other departments are run, the less fear and risk there will be of accepting added responsibility, and the greater likelihood the leader will be tapped for the job."

Kraus advises access professionals to stay attuned to trends that develop from health care reform. "This can be both tricky and time-consuming, because many proposals will turn out to be dead-ends," he acknowledges. "Perhaps a high-level approach is appropriate at this stage. But if and when changes begin to be felt, top-flight access leaders will know what's driving them."

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You'll want to respond proactively rather than reactively to those changes that affect your department. "Although one never knows what Congress will come up with in the end, it is safe to assume that health care reform will impact health care reimbursement," says Kraus.

In addition, the public may have more opportunity than ever to judge hospitals on successful outcomes and attentive service to their patients. "Running lean and mean and constantly looking for ways to do more with less while maintaining quality are old adages that never go out of style," says Kraus.

Technology use will increase

Kane says that she expects to see a continued increase in automation and a decrease in decision making in the field of patient access. "As these positions become more automated, they will require staff that are more educated in providing excellent customer service with less knowledge of the patient access function," she says.

There is no question that the economic downturn has put some technology investments on hold, even those that ultimately would result in cost savings.

"Budget cuts have definitely impacted patient access, in that money for some of these purchases has been cut as well as staffing. This has created a double whammy for patient access," says Beth Keith, manager of ACS Health Care Solutions. "However, some organizations have moved forward with automation to support staffing cuts. It is a mixed bag."

Keith says that one technology trend she sees involves an ongoing focus on quality data collection. This can support accurate insurance identification, upfront collections, demographics, and ultimately streamlined reimbursement.

"If everything is done properly in the beginning, the back-end follow-up and rework is eliminated except as related to poor payer procedures," says Keith. Scheduling, pre-registration, medical necessity, address verification, insurance verification, income verification, charity review, and charge estimate software tools are some examples.

"These provide significant benefit to the access professional in carrying out their vast array of responsibilities in a programmed, consistent manner," says Keith. "This limits human error and omission of important steps in the process. The more automated the process, the better potential for streamlining the outcome."

It is also critical that patient access leaders be involved in the denials management process, to understand where the pain points in their process contribute to financial loss. "Because access professionals understand so many pieces of the puzzle, progression to the overall revenue cycle management roles is a natural career growth move, in my opinion," says Keith.

With today's economy, most hospitals are experiencing a substantial increase in bad debt. To battle this phenomenon, companies are offering increased automation to the patient access staff to estimate the patient's amount due after insurance. "Many companies have created payment estimators that provide custom scripts and use insurance and patient-specific information as tools," says Kane.

Here's how to advance

To advance in the patient access field, it's necessary to become more educated about the revenue cycle in total. Understanding the charge capture process, assisting the hospital in finding the root cause, decreasing denials, and assisting in developing ways to increase point-of-service collections are key goals. "These are the changes that will help you be noticed and open that next opportunity," says Kane.

Completing a formal undergraduate program or obtaining a master's degree always helps you differentiate yourself from other candidates. "But, it is not always the key to achieving the next promotion," says Kane. "I am seeing new positions for managers in quality and productivity and training to drive quality excellence in the department. Getting yourself noticed, communicating, and delivering solutions is a surefire way to achieve the next management promotion!"

Kane recommends obtaining certifications offered by patient access organizations and attending hospital training programs in Excel, Word, PowerPoint, and other tools to help you improve how you communicate to senior leadership.

"If your hospital doesn't have an electronic quality tool, develop a manual one. Use these employee results to drive departmental, as well as one-on-one training programs," says Kane. "In addition, place employees on personal improvement plans."

Another area is tracking and trending point-of-service collections to increase cash. "This is key for CFOs," says Kane. "Develop a method to track weekly and monthly cash collected by employees, and then reward the employees."

These don't have to be monetary rewards that increase employee compensation. "Often, recognizing employees may be as easy as an employee of the month or sending handwritten notes with a small gift card," says Kane. "That will make employees achieve better collections and quality registrations."