Career Path’ is incentive for access advancement

Employees boost skills, paychecks

The comprehensive training that access representatives receive at ScrippsHealth in San Diego includes a new tri-level "Career Path" program that allows self-motivated employees to increase their expertise and paychecks.

For each advanced competency level they reach, access reps can boost their salaries by 5%, in addition to being eligible for an annual merit increase of up to 5%, says Mollie Drake, MBA, access director. Completion of the first competency level is required of all access employees.

The genesis for Career Path came after Scripps formed a committee in February 1999 to investigate the causes of the system’s unsatisfactory levels of bad debt, accounts receivable days, and employee attrition, Drake says. "We went out to all of the six Scripps facilities and the central business office and asked a member of the line [access] staff to join the committee to take a look at all this and what we could do to correct it."

With feedback from the committee and the results of a staff survey, "we realized a lot of problems had to do with motivation and training," she notes. "Training was inadequate, employees were not motivated, and access representative was a dead-end position. There are 400 access representatives. The next level is access coordinator, and there are only 25 of those in the system."

Based on that information, the committee designed a three-tiered Career Path, "so it was created by peers," Drake points out. (See training matrix chart, pp. 42-43.)

Level 1, called the "core competencies," is the only one required of all access representatives and includes mastery of information in these areas:

• fundamentals of all insurance payer types, including Medicaid, health maintenance organizations, and managed care organizations;

• point-of-service collections;

• coordination of benefits;

• overview of hospital billing;

• professional skills such as customer service and communication;

• patient confidentiality.

The information is covered in 21 classes taken either in a classroom setting or through a self-directed workbook, and Scripps is working to set up a computer-based teaching program, Drake says. The alternative methods allow the program "to reach out even to the person in emergency department on the odd Friday graveyard shift." New hires are exposed to the information in a nine-day "boot camp," she adds, and then have one chance to pass the level 1 core competency test. (For additional information on ScrippsHealth training and collections practices, see Hospital Access Management, March 2000, pp. 25-30.)

At that level, existing employees may choose to take classes covering only the areas they are weakest in before taking the level 1 test, Drake notes; for levels 2 and 3 they are required to complete all the courses.

Existing staff were given 90 days’ notice, on Dec. 15, 1999, that they would be required to pass the core competency test, she says. Training classes began then and were offered through March 15, at which time employees got their first chance to take the test, Drake explains.

"They get three chances to take the test," she says. "If they fail it the first time, we will sit down with them and show them their weak areas. They can get additional training and try again in 30 days. If they still fail, we review again." If the employee fails the test a third time, the reasoning is that he or she should not be in that position, and the failure could lead to termination or to a move to a position such as receptionist or cashier, Drake adds.

To attain access level 2, which is optional, employees must complete a more advanced series of 27 classes, which address hospital financing and patient accounting, she says. The following topics are covered:

• how a payer contract is negotiated;

• how to read a payer contract;

• more on Medicare compliance;

• how a risk pool works;

• trouble-shooting and other in-depth computer skills;

• negotiating self-pay contracts.

After successfully completing those courses, the employee seeking advancement completes an application form demonstrating how he or she has applied the course work to the job, Drake says. "For example, [the employee] may have taken on more difficult accounts, provided an inservice to co-workers, or resolved complex problems that before might have escalated. We don’t want them to go through the training and then walk away and not utilize it."

The application goes to the oversight committee, made up of the employee’s peers, which decides if the applicant has made an adequate demonstration of his or her skills, Drake says. "This takes out the element of the manager will never think I’m doing enough.’"

Employees who complete and pass the peer review are promoted one salary grade and receive the promotional pay increase, Drake adds.

The 26 classes required for access level 3 focus on individual professional development and cover these areas, among others:

• project management;

• cost-benefit analysis;

• mastery of Microsoft Office Suite products;

• continuous quality improvement mastery.

Applicants are asked to submit a proposal for a performance improvement project they will lead, Drake says. One such project, for example, might be running a series of reports and coming up with an average cost by length of stay for various procedures. "This could be used as a tool for others."

The proposal must be approved by an access leadership team to make sure no one else is working on the same idea and that it is within the scope of the employee’s activities, Drake explains. Once the leadership team approves the idea, it assigns the employee a mentor who has expertise in that area. "For example, if the project is to make changes in the chargemaster, the employee would be assigned someone from that department."

Employees seeking level 3 certification may submit a proposal as soon as they complete level 2, so as they take the level 3 courses, they can work on their project simultaneously, Drake says. "To achieve level 3, the employee comes back to the leadership team and presents the results of the project. The team will determine if [the project] has been adequate to promote the employee."

Peers teach the courses

Although Scripps employs a professional educator who provides information on how to educate the adult learner, trainers for Career Path courses come from the employees’ peer group, she points out. "They were senior staff members before we started Career Path who usually were tapped for training anyway. Now they are full-time trainers and are called access training specialists.’

"If [the trainers] don’t understand something [in the course material], they have to go out and find a system expert," Drake says.

The training and development department — not the access managers — oversee the Career Path program, she notes, which prevents any conflict of interest. "The [access] managers don’t decide who gets to strive for a level. They can’t look at a budget and say, I can’t promote that person. I’m over budget on payroll right now."

For the most part, access staff have reacted positively to the new program, Drake says. "They’re very appreciative of the chance to advance and excited about the formal training because the training has been so hit-and-miss in the past. Many who are longtime employees were already hitting the [salary] ceiling of level 1, so they had been without the opportunity to increase their pay for a while. This opens that up for them, because the ceiling is raised as they go up the ladder."

Some employees are apprehensive about the required core competency test, Drake adds, "but as we continue to provide workbooks and classes, they’re getting a comfort level."

Staff initially were concerned there might be "trick" questions or the program was a way for management to decrease staff, she says. "We’ve assured them that, since we have no vacancies, the last thing we want to do is get rid of people. We just need an objective way to know if they have a basic understanding of the business."