"Flex up" staffing while staying budget-neutral with cross-training
Patients, employees, and hospital all benefit
Cross-training has allowed the patient access departments at St. Joseph's Wayne Hospital and St. Joseph's Regional Medical Center, Paterson, NJ, to supplement staffing while staying budget-neutral.
"We are able to 'flex up' our staffing, wherever the need may be," reports Sandra N. Rivera, RN, BSN, CHAM, director of patient access.
At Swedish Covenant Hospital in Chicago, essential job functions such as outpatient and emergency department (ED) registration recently were merged with appointment scheduling and referral coordination.
Carlos Collazo, patient access applications trainer, says, "The intention is to provide our patients with options to schedule their outpatient testing either by walk-up or by phone. We anticipate our central scheduling call volumes to decrease from 5 to 10%."
Coverage in ED
At St. Joseph's Regional Medical Center, patient access includes the information desk, the previsit service department, outpatient registration and emergency room registration.
"Our volumes in our emergency department continue to grow," says Rivera.
To support the ED registration staff, outpatient and previsit registration staff were cross-trained so they could work during peak times in the ED. The registrars, who already were experienced with patient registration and the hospital's Admission/Discharge/Transfer (ADT) system, were assigned for observation on the first day. "The second day, the employee was assigned to work with an ED registrar who provided elbow-to-elbow support," says Rivera. Finally, the employee was assigned to go to the ED for a minimum of two hours, until he or she was comfortable and knowledgeable.
"Often, we provide coverage so the ED staff is able to go on scheduled breaks and lunches, in addition to being back-up support during normal hours," says Rivera.
This approach has allowed the staff to be comfortable with the processes used in the ED. "In the beginning, the staff was apprehensive because they were working in a new area. But once training was provided, their fears subsided," says Rivera. She pointed out to registrars that while the ADT screens are a little different, all of the knowledge required on how to register a patient is the same.
"We worked with the staff to explain to them that registration is registration, regardless of location," she says.
Staff members need right mindset
Cross-trained staff members need enough practice to feel comfortable in the area they're covering. To reach this comfort level, says Rivera, "the staff needs to keep up their skills, not just go to the area once in a while."
While it is important to have multi-skilled staff, it is equally important for staff to have the right mindset, says Collazo. The mindset is especially important if staff members are discussing financial liabilities with a patient.
Cross-training helps patient access managers to keep costs under control while supplementing current staffing on an as-needed basis. "If staffing needs change due to an increase in volume, however, this is not the long-term solution," cautions Rivera. Because cross-training increases the skills the employee has, it makes them more valuable and marketable, she says. Collazo has seen these benefits from cross-training:
- reduced denials, due to increased staff ability to identify authorization and referral requirements;
- increased collections because more staff are comfortable asking patients for payment;
- the ability to provide staffing coverage when and where it is needed without incurring overtime;
- improved morale, because staff members like to have more variety in their jobs.
"It is also one of the best ways for leadership to identify hidden skills and who your true team players are," says Collazo.
Collazo uses himself as an example to illustrate the benefits of cross-training. He started his career at Swedish Covenant Hospital as an outpatient registrar. After one year, he was given the opportunity to cross-train in patient appointment scheduling, financial counseling, physician referral, and insurance verification.
"I really enjoyed the training aspect of it and offered to work with leadership on expanding staff training material to include developing competency testing for both on- and off-campus registration users," he says. In 2013, he was offered his current position of patient access applications trainer.
The advantages of cross-training by far outweigh the cost and time it requires to do successfully, Collazo says. "Cross-training provides job security when specific tasks or responsibilities become obsolete because they are replaced by systems or software," he adds.
Eliminate redundant work
Kathleen B. MacGillivray, MHA, director of access management services at Robert Wood Johnson University Hospital in New Brunswick, NJ, recently hired a patient accounts manager to bring "back office" knowledge to her employees on the front end.
"Her first assignment was to develop a training module that enhances the front office staff's skill sets," MacGillivray says.
The training module covers scripting, upfront collections, insurance eligibility, and how to determine the patient's out-of-pocket costs. "For access, our role in the revenue cycle is becoming more and more valuable, as it relates to a clean bill drop," says MacGillivray. This change means that redundant work on the back end must be eliminated, she says, "so a front-end manager with back-end knowledge can immediately focus staff on their shortcomings and opportunities for improvement."
MacGillivray is exploring whether it's feasible for staff to develop payment options for patients. "I will do whatever I can to make the front end stronger," she says. "For me, the pressure is on for access management."
MacGillivray is considering developing a new "hybrid" registrar, to handle the functions of access with a strong financial component.
"There's so much riding on our success," she says. "We need to be able to pre-register patients, check eligibility, identify pre-certification requirements, and most challenging, collect the patient responsibility portions. It's a lot." (See related stories on training registrars to do scheduling, this page, and being flexible with staffing solutions, p. 16.)
- For more information on cross-training in patient access, contact:
- Donna J. Aasheim, CHAM, Director, Patient Access Administration, Eisenhower Medical Center, Rancho Mirage, CA. Phone (760) 773-1508. Email: DAasheim@emc.org.
- Carlos Collazo, Patient Access Applications Trainer, Swedish Covenant Hospital, Chicago. Email: CCollazo@schosp.org.
- Kathleen B. MacGillivray, MHA, Director of Access Management Services, Robert Wood Johnson University Hospital, New Brunswick, NJ. Phone: (732) 937-8909. Email: Kathleen.MacGillivray@rwjuh.edu.
- Sandra N. Rivera, RN, BSN, CHAM, Director, Patient Access, St. Joseph's Wayne Hospital/St. Joseph's Regional Medical Center, Paterson, NJ. Phone: (973) 754-2206. Fax: (973) 754-4662. E-mail: firstname.lastname@example.org.