New era of access allows a role reversal

Reorganization eliminates 19 FTEs so far

Patient access and patient accounting positions at the Ohio State University Medical Center have been turned upside down. Access employees — traditionally the scapegoats of the hospital business staff — have moved up three pay grades in a re-engineering featuring a more advanced computer system.

Along with the increase in pay came more responsibility, says Joseph Denney, CHAM, director of patient access and financial services at the Columbus-based facility. The upgrades are part of a reorganization that places increased emphasis on the front-end process for "getting bills out the door clean," says Denney.

The newly empowered access role is the result of discussions between Denney and the hospital’s chief financial officer that began when Denney assumed responsibility for both patient accounting and access services a little more than two years ago, he explains.

Job descriptions have been rewritten to put employees on the front end a pay grade higher than those on the back end, Denney says. "Traditionally it’s just the opposite, and yet everyone would point fingers at access when something went wrong.

"What we’ve done," he adds, "is say, ‘We’ll give you tools to help you do a better job, and we’ll expect a much better quality product.’" Those tools include a new computer system to replace the hospital’s 25-year-old system, additional inservices, and a newly appointed "super user" who will be on call to assist access staff with difficult registration questions.

Over the next 14 months, during the installation of the new computer system, the senior manager for patient access — who is responsible for education, orientation, and data quality — will canvass all inpatient and outpatient registration sites to determine where it’s appropriate to do registration, Denney says. The goal is to get the numbers of people performing access functions down to a manageable level, he says.

"Right now we have a couple of hundred people in the medical center who do registration," he says. "We’re getting a handle on how many occur at what location and how many people are just doing it occasionally."

Among the questions that will be asked, he adds, are, "Are the people there doing enough registrations to allow them to be proficient? If not, can we offer an alternate solution — another centralized [registration] location where those registrations can be done to improve quality?"

At the registration sites that are large enough to remain separate, staff will be given additional help to do a good job, including more detailed insurance and managed care information, Denney says. The new computer system includes the capability for registrars to determine at the point of service if the patient has a previous balance, collect that money, and post the payment at the time of registration, he adds.

"What new systems can offer you is better edit capabilities," he notes. "With the current system, [registrars] can bounce through without collecting new information. Once we have the new computer system in place, there will be rhyme to the reason [of the reorganization]. You don’t want to computerize bad processes."

Multifunctional positions are a key part of the new arrangement. Patient access and patient financial services have been decreased by 19 FTEs "because of combining everything," Denney explains.

Before the reorganization began, the hospital had separate inpatient and outpatient business offices. Those are now combined both physically and functionally, he says. On the access side, every staff member has been cross-trained to work in the outpatient, inpatient, emergency department, and obstetric registration areas.

"We used to have a receptionist, a bed board person, a patient placement person," Denney says. "Now everybody has one title — admitting representative."

That position has been upgraded three pay ranges. Smaller groups of people on the front end of patient accounting, such as a five-member customer service staff that handles 400-450 calls a day, also earn the same pay range as admitters, he says.

No salaries were reduced as a result of the reorganization. Billing and cash posting employees went up one pay range, Denney notes. But because of the reduction in FTEs, the changes resulted in overall savings. He says he expects further staff reductions once the computer system is in place.

The newly designed patient access and financial services staff includes about 100 people — down from about 120. The access side includes admitting, outpatient registration, centralized scheduling, and the transfer center functions. Patient financial services includes patient accounting, credit and collection, and cash management.

A key player in access services will be the new "super user," a position Denney describes as one level above admitting representative. This super user will be extremely proficient on the computer system and in all aspects of registration, he says. This person "will know insurance cards inside and out," among other things, and will be available by pager for anyone at any registration site who is not sure how to code something in the system or who has a question on anything out of the ordinary that may come up, Denney adds.

The super user also will help the senior access manager with additional inservices, the exact schedule of which has yet to be determined, he notes.

Employees have responded very positively to the reorganization, Denney says, although it’s too early for them to have had actual experience with the changes.

"I really believe they want to do a job," he adds, "and we’re going to give them the tools — education and a state of the art [computer] system — to do it."