Coworkers often are the best teachers

A patient access supervisor, however supportive, probably isn't the first person an employee would ask for help if struggling to remember a certain payer requirement. That employee is more likely to turn to a colleague.

"I think sometimes the manager makes the employees nervous. They may think the manager expects them to know the answer. They may feel more comfortable with someone on their own level helping them," says Vicki Lyons, a patient access manager at Baptist Hospital East in Louisville, KY. "I have sat with employees to just oversee the registration process and have had the employee say that I make them nervous watching them."

For this reason, seasoned employees at Baptist Hospital East are expected to routinely help their fellow employees learn more about the patient access process. "It helps the employee to sit with someone who does an excellent job at customer service and knows the patient registration process inside out," says Lyons.

More experienced employees may offer their own "shortcuts" in performing a process, so their co-worker can improve his or her own speed while maintaining accuracy.

Although a patient access trainer works with all of Baptist's new hires, once they are out in the "real world," other coworkers are the ones they turn to. This gives the newer staffers added confidence. "It helps for the other long-term employees to offer suggestions to the new folks," says Lyons. "The older employees started out as they are and know what the employee is going through. The saying 'put yourself in that person's shoes' is so true. They know what they are going through. They, too, have been there before."

Occasional help from coworkers does more than improve speed, though. It's a way to prevent morale from deteriorating.

"It seems that there is a lot of negativity in patient access due to so much information that is gathered in a sometimes tough situation," says Lyons. "Patients or families may not feel like answering questions, and possibly give incorrect information because of being upset."

Shadowing new hires

At Baptist Hospital East, access staff with low error rates and excellent customer service skills are sometimes asked to shadow a new employee. "The trainer has to train many other employees in other areas for their registration needs, so she is not available at all times," says Lyons.

If the new employee seems to be asking a lot of questions about a certain area, the person shadowing can alert the trainer to this. The trainer will then set up a time for the newer employee to come to her office, so she can go over the issue in more detail.

A common question involves completion of the Medicare Secondary Payer form, which is filled out at registration on all Medicare patients. "A lot of the new employees have trouble with the computerized information because it is confusing," says Lyons.

In this case, an employee with a very low error rate on the Medicare Secondary Payer form offers some pointers. The employee may tell them to copy their work and go back and view the Medicare Secondary Payer or other information. This ensures that they have filled in the necessary fields. "They may also tell them the areas that seem to cause the most errors," says Lyons. "Sometimes it is more helpful coming from a fellow employee than the trainer or the manager. It really seems to work."

'Trapeze buddies' are used

Aaron McDaniel, director of patient access at Palomar Pomerado Health in San Diego, says that his key strategy is to provide staff with the education they need to understand the concerns that patients may have. However, the employee won't necessarily know the answer every time.

For this reason, McDaniel makes sure they always have a point of contact in the hospital who will. Those contacts are called "trapeze buddies."

"Their role is to support the people they work with toward their common goal of patient satisfaction," says McDaniel. "The trapeze buddy doesn't just give the answer. They explain and coach for better results."

The trapeze buddy concept is informal, yet it is an integral part of the patient access department. For example, a financial counseling team has subject matter experts on government aid programs. These staff can be called by anyone to come and help staff, physicians, patients, or family members discuss how to apply for aid and determine their eligibility. "They will make the request a priority. They are the true experts and the best people to help," says McDaniel.

Patient access staff have become very enthusiastic about the "trapeze buddy" concept. "We have even started a 'trapeze buddy of the month' program to highlight how our many subject matter experts are there to help and support each other," says McDaniel. "They catch you and keep you from falling, like a good trapeze buddy should. We have subject matter experts all over the department."

Insurance verifiers are experts on benefits and eligibility rules. These employees can be called upon to help explain why a patient's out-of-pocket payment is a certain amount. They're also the best people to explain to a new mother how the coordination of benefits rules work, to determine whether it is her benefits or her husband's that are primary for their newborn.

An authorization coordinator works with government programs to obtain authorization for inpatients. This person attends case manager/utilization review meetings with nursing to act as an expert on authorization and coverage.

"She can work with physicians, patients, and our own staff as her customers," says McDaniel. "She has even gone to physician offices to train them on getting authorizations, which forms to submit, and how to use the online tools."

Although "subject matter expert" is really an unofficial title, the staff certainly know if they have it. "Many different positions in the department actually have 'subject matter expert' duties written into their job descriptions," says McDaniel. "These duties would include the requirement to draft official department procedures, train other staff, or present topics at staff or other department meetings."

[For more information, contact:

Vicki Lyons, Patient Access Manager, Baptist Hospital East, 4000 Kresge Way, Louisville, KY 40207. Phone: (502) 897-8159. E-mail:]