Poor economy could work in favor of patient education

Value of patient education, its ability to reduce expenses

The state of the economy is impacting every industry, and health care is not immune, say the patient education managers we interviewed about the results of the 2009 Patient Education Management Salary Survey.

The uncertainty is resulting in a cap on salary increases.

"If there were any salary increases this year, they were very limited across the board in health systems, not just in patient education. Some systems opted for no increase to avoid having to lay off workers," says Diane Moyer, BSN, MS, RN, program director, patient education for The Ohio State University Medical Center in Columbus.

Readers answering the 2009 survey reported that a 1% to 3% salary increase was the norm, and this seems to reflect raises in many health care settings. According to Annette Mercurio, MPH, CHES, manager of Patient, Family and Community Education at City of Hope National Medical Center in Duarte, CA, staff in human resources report that merit increases within hospital settings are between 2% to 2.9%.

"We're just heading into performance evaluations, and the range that we have to work with is 2% to 5%, with an average increase of 3%," says Mercurio.

The current economy is not only affecting whether patient education coordinators/managers will receive a pay raise; fewer dollars often influences how patient education is being done, experts say.

According to Moyer, her colleagues have said that they are dropping or cutting back on the use of video-on-demand (VOD) systems. For example, institutions typically are either paying a yearly fee to maintain such a system with the contracted providers or have purchased video content for a system, which requires paying yearly broadcasting rights fees. Also, institutions typically can't track the usage of VOD to justify the expense, Moyer says.

In addition, some facilities have lost positions for dedicated patient educators in such areas as smoking cessation or diabetes.

"The push to do more with very limited resources is very strong," says Moyer.

Hospitals are finding less expensive methods of producing print materials and using web sites for patient education, says Mary Szczepanik, RN, BSN, MS, a breast health specialist at OhioHealth Breast Health Institute in Columbus.

In addition to impacting the methods used to deliver education to patients, fewer dollars also can influence a PEM's workload.

Mercurio says some of her colleagues are now performing non-patient education responsibilities and/or having to assume responsibilities of staff whose positions have been eliminated in their department.

The reason that patient education can be a target for cost reduction is that it is typically non-revenue generating or is cost-neutral, explains Magdalyn Patyk, MS, RN, BC, patient education program manager at Northwestern Memorial Hospital in Chicago. However, when patient education is done well, it has a positive impact on patient safety and patient satisfaction, she adds.

Patient education reduces hospital readmissions and improves health outcomes, which reduce the cost of health care, says Fran London, MS, RN, a health education specialist at The Emily Center at Phoenix (AZ) Children's Hospital.

She says the current state of the economy could actually result in more support of patient education.

"It is going to force people to look at health care costs. This will lead them to the research that shows patient education is cost-effective and saves money," says London. "In addition, health promotion is much less expensive than treatment."

Mercurio says the perceived value of patient education is advancing. She sees more and more administrators acknowledging the link between patient and family education and a positive care experience, which results in higher levels of patient satisfaction.

Also, colleagues in patient care services are recognizing the need to tailor education to the individual according to his or her preferences, she says.

Monetary value of position

While the perceived value of patient education may be on the rise, it does not seem to result in a consistent salary range for the position of patient education manager. The salary survey found the annual gross income of this health care position ranging from $40,000 to $49,999 at the low end to $130,000 or more.

The variance is simple to explain, according to Moyer. Salaries vary based on the requirements of the position, she says. For example, if a patient education manager position requires a job candidate who is a registered nurse, it may pay more to attract quality candidates from the clinical side.

"Experience and education level also plays a part, as do overall job responsibilities. Some of the PEM survey responders may be managers of other staff and may oversee other departments or functions within the organization. Most often the positions are salaried, with no added pay for overtime or certifications, and regional differences can make a significant difference in salaries," adds Moyer.

According to Szczepanik, most hospitals conduct an annual salary analysis to be sure their salaries are competitive with others in the area. "I think the salary would be most dependent on the market in which the facility is located," she states.

Many factors influence the amount of salary a person is paid, says Mercurio. Not only will a patient education manager with a nursing degree most likely receive a higher salary, the level of the educational degree required can play a factor. For example, the applicant might need a master's degree or a PhD to apply. Job title, such as director versus manager or coordinator, will impact salary, as will the number of years of work experience required, she says.

The job description also may dictate how many hours a patient education manager works, whether 31 to 40 hours, 41 to 45 hours, or 65 plus hours. In the salary survey, the numbers varied.

Patyk asks, "Is the person in the position charged with writing brochures or coordinating all patient activities house-wide?" If the latter, the position will require much more than 40 work hours a week, she says.

Workload at any given time can be influenced by a number of factors, says Moyer. For example, it is affected by the number of projects clinicians bring to the patient education department for development. Currently, the medical system Moyer works for has several hospitals that are trying to achieve certain accreditation rankings. That has generated a need for either new materials or major revisions of materials, says Moyer.

"We are also working on a video-on-demand system, an ongoing project with translations of patient education content, and we are about to move forward with a new electronic medical record system, so we are pushed to the limit. Squeeze in the occasional community project and revisions of existing inventory, and we could keep a department twice our size working full time," says Moyer.

Most of the readers answering the survey were seasoned health care workers, and they also were registered nurses. According to Patyk, such data could simply reflect the average age of the RN.

"Many times, the person who takes on a patient education role is one who has worked the floors for some time and sees a need to improve the resources for patients. There are not a lot of these type positions to move into, and once a person is in the position, they likely will stay for some time," says Moyer.

She adds that being an RN is an advantage, because someone with that job experience has knowledge of the processes, and what staff and patients need.

Szczepanik agrees. Nurses make good patient educators and can more effectively manage a patient education program as they are generalists, she explains. Allied health professionals would not have as broad a knowledge base and understanding of the scope of what the patient needs, she adds.

Patyk says it is important for a person aspiring to be a patient education manager to have worked in a "clinically relevant" job, so they understand the challenges of patient care. It could be anyone who has worked on the units professionally, whether an RN, dietitian, pharmacist, physical therapist, or occupational therapist, she says.

What can patient education managers look forward to addressing in 2010?

Mercurio says that at least in cancer education, there is a move to integrate patient education with psychosocial services, such as clinical social work, psychiatry, palliative care, and spiritual care.

Moyer says that with the new linguistic and cultural standards coming from The Joint Commission, based in Oakbrook Terrace, IL, there is an increased awareness to provide content to patients in a way they can easily understand. As a result, patient education managers are being consulted on plain language writing for documents throughout the health systems.

In addition, Moyer says there will be an increased need to deliver patient education resources through web portals so patients can review content before and after their physician's visit, surgery, or treatment.

Functional health literacy is a focus, says London. Also health disparities, or the differences in health services people from different patient populations receive, which result in different health outcomes, she adds.

People used to think health disparities were related to culture or race, but they are now finding that people who belong to different socioeconomic groups show the most disparity, explains London.

The use of technology to communicate information, such as text messages, web sites, and webinars, are also trends to watch in patient education, says London.

Patient education activities will continue to be driven by the trend toward public reporting and transparency in regard to quality, patient safety, and patient satisfaction scores, says Patyk.