Don’t fear consultants — just educate them first

Make sure outside firm grasps your staff’s abilities

The idea of working with an outside consultant can strike fear into the hearts of access managers, but it doesn’t have to be that way. Several access professionals who have had productive encounters with consultants share with Hospital Access Management the ways they’ve found to maximize the experience — and come away with information they can really use.

Before consultants can give you effective advice, you must give them the necessary education, says Anthony M. Bruno, MPA, director of corporate admissions and registration at Crozer-Keystone Health System in Chester, PA.

"Consultants quite often, not consciously, have certain ideas based on their experiences that they think will be helpful," adds Bruno, "but they just don’t fit into the culture of the organization. Try to give them a sense of perspective for the history of the department — where you’ve been, where you are, where you think you’re heading — so they can fit their ideas into the situation."

Make sure consultants have, for example, a realistic picture of the skills and ability of your staff, he says. If 10% or 15% of the staff are the "worker bees," another 10% or 15% don’t contribute a lot, and the remainder are followers who are somewhere in the middle, the consultant needs to know, Bruno points out.

"If you have a larger group on top [the worker bees], then you can do more with less, but typically you don’t have that," he says, "which makes it more difficult to pull off goals and objectives. You can’t cut [staff] across the board." Consultants should be aware that cutting a staff of 25 down to 20 may seriously hamper operations because the most productive people may not be those with the most seniority, Bruno adds.

Point out that [the solution] may not be about cutting staff but about increasing revenue, he suggests. "If you have more staff, you can do a better job of collecting deductibles, providing financial counseling. It’s about thinking out of the box."

Don’t feel threatened by consultants. Just think of them as another resource, Bruno adds. "Don’t be scared to give them information. If you work with them and show you want to be part of the solution, you get better results."

A good consultant will hear about disparate issues and comprehend not only what the issues are, but how they affect the institution, says David Morgan, managing partner of Health Care Systems Management, a consulting firm in Framingham, MA. (See related story, p. 15.) "People will tell you what they think is the answer, but if you talk to four people, you get four different answers," he says. "The consultant must be able to sit back and say, This issue in preregistration is related to that issue in pharmacy.’"

Do your comments resurface?

A common complaint among access managers is that they see their own comments parroted back to them in a consultant’s report. However, that’s not always a bad thing or even a cop-out on the part of the consultant, Morgan suggests. Staff many times are too busy to "sit back and take a global view," he says. "They knew [what was wrong] but didn’t have time."

Because many hospitals have eliminated their management engineering departments, there are often no internal resources to do the work, Morgan notes.

"Line employees tell me things I never heard, and I’m going to use [that information]," he adds. "[Clients] will see a lot of those suggestions in my work product. There’s someone listening to take this stuff and give it a form."

On the other hand, many institutions fall into the trap of "throwing a lot of money, getting a report, and considering they’ve looked into it," Morgan points out, which is also a mistake. He cites one meeting in which three people were talking about what should be done at a particular hospital and not one of them was a member of the staff. "They were busy doing other things."

Martine Saber, CHAM, director of patient access services for Baycare Health System in Clearwater, FL, says she experienced the counterpoint to that situation in her dealings with a consultant brought in to address her organization’s accounts receivable (AR) days.

The consultants, part of a small firm, worked closely with Saber’s staff, she says, giving them their first true understanding of how admitting operations affect AR days. "Admitters hate collecting cash, but now they understand that cash collections bring AR days down. Now we all own the AR days and are finding new ways to collect cash."

The consultants paid her department a high compliment, Saber says, noting in their report that "our process was so tight and so good that they didn’t find any of the lost error days coming out of admitting." They did point out, however, that the department’s training process was lacking and went to work remedying the situation, she adds.

"They put a training program together and gave us a computer training manual explaining the different kinds of insurance, why it was important to call for authorization, and what happens if we don’t get it."

Staff historically were trained on the computer and then "thrown to the wolves" because there was no time to help them understand why they did what they did, Saber notes.

"We had heard [consultants] would come in, change everything, and more or less tell us what’s wrong, and then leave," she says. "[This firm] was very down to earth and asked, What do you need me to do? What can I do for you?’"