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Push under way for more training, higher pay
In a dramatic turnaround from just a few years ago, the health care industry appears to be experiencing a resurgence of recruitment and opportunities for strong patient access managers.
Coupled with that trend is a focus by cutting-edge organizations on obtaining better educated, more highly skilled frontline access employees and paying them accordingly.
The profession continues to evolve and expand, according to leaders in the access field who talked with Hospital Access Management in connection with its annual salary survey report.
"It is increasingly difficult to recruit capable candidates who have the breadth of knowledge needed to manage increasingly complex operations," says John Woerly, RRA, MSA, CHAM, director of patient intake for St. Vincent Hospitals and Health Services in Indianapolis.
"Patient access is much more diverse than what appears to the naked eye," he adds. "It is a mixture of finance, health information services, patient relations, systems design, information services, management engineering, and clinical aspects. That is what makes it so exciting but, at the same time, a high burn-out profession."
Woerly says he has seen a growing level of recruitment for patient access management positions, noting that the market for all levels - including the associate level - has tightened in most areas of the country.
Perhaps in connection with that growing demand, the overwhelming majority of access managers and directors responding to the Hospital Access Management 1999 salary survey said they received raises in the past year. Just under 70% of the respondents reported salary increases of between 1% and 6%, but a fair number (12.8%) said their raises were between 7% and 10%.
The salaries of access managers and directors responding to the survey ran the gamut, from the low $20,000s to the low $100,000s, but the highest concentrations were between $60,000 and $75,000, which included a little more than 40% of respondents. Nearly half of respondents said the number of employees in their departments had increased in the past 12 months, and for most of the remainder - just under 40% - the number of employees remained the same.
Several leaders in the field told Hospital Access Management the beleaguered access manager of a few years ago has been revived, in some cases emerging stronger than before.
Charlene Overfield, RN, CHAM, a Tigard, OR-based consultant with Gustafson & Associates and former access manager, says she is seeing a reversal of the move toward eliminating access management positions that occurred when hospital mergers began.
"I’m from a part of the country where consolidation happened five or six years ago, and a lot of hospitals were coming together under a health care system that flattened out’ management," Overfield adds. "They tried to have a director of access over the system, instead of a manager or director at each facility. A lot of that shake-up has been completed, and where access positions were lessened or eliminated, they have been put back into place."
Because of the movement of insurance verification and other traditional business office functions to the point of service, access "has become more of a focal point," she notes. "Organizations realize they can’t have a good bottom line unless they have a good front line."
Bringing staff up to par
With that in mind, health care organizations are putting more resources into getting qualified managers and bringing the status of access staff up to par, she says. "Because there has been a lot of turnover, which is very costly, administration has realized they need to increase qualifications and increase salary scale, especially with today’s low unemployment rate."
Through conversations with recruiters looking to fill access positions, Overfield notes, she has noticed an increase in the salaries being offered for access managers. While her observation has been that managers at a single facility may be paid between $50,000 and $70,000, she adds, that figure can jump significantly as responsibilities increase.
When a person goes from being an admitting manager to truly being an access manager or director, that should mean overseeing more than just registration activity, Overfield points out. In cases where, for example, utilization review, transportation, and other departments fall under an access professional’s purview, she adds, "I have seen directors at single facilities with salaries in the six digits.
"The more [organizations] bring processes upfront that the business office used to have, like financial counseling and insurance verification, that gives the access director a lot more responsibility and also makes the salary higher," she says. Salaries for regional access directors typically range from "$80,000 to $100,000-plus," Overfield notes, "and the more consolidation they have, the higher the salary."
In line with their increased responsibility, many access directors are moving toward reporting to finance or to the chief financial officer of a hospital or health system, rather than to operations, says Rosalind Conner, director of patient access for Duke University Medical Center in Durham, NC.
"Our presence with respect to the financial stability of our organizations is key, as well as in meeting the many compliance demands," she adds. "Organizations have a better appreciation of our strengths and expertise, not only in the financial arena, but also in understanding the larger picture with regard to overall hospital/health system operations."
ScrippsHealth, a six-hospital system in San Diego, is offering its hospital access managers a chance to move up the salary scale by adding enterprisewide responsibilities to their on-site duties, says Jack Duffy, FHFMA, corporate director of patient financial services.
"Our basic salary structure for access is from $41,000 to $61,000 for a single-unit manager, with the average salary at about $55,000," Duffy says. However, these on-site managers are now taking on responsibilities such as point-of-service collection management and training, which cover multiple sites, he adds. The range for access profess - ionals with enterprise duties is $52,000 to $82,000, Duffy notes.
"Instead of their salary peaking in the $50,000s," he says, "these managers can now move into the $70,000s."
Recognition of the crucial role access now plays in a health system’s financial health also is spreading to frontline employees, who traditionally have been paid lower salaries than their colleagues in the business office, says Martine Saber, CHAM, director of admitting for Baycare Health System in Clearwater, FL.
Saber has designed a career ladder for access representatives that will compensate employees based on education, certification, and skill level, she adds. The proposal, now under review by Baycare’s president, has drawn praise from persons throughout the organization, Saber notes, including Baycare’s patient business services directors.
"They see that it will promote professionalism," she adds. "The back end can no longer afford to clean up the mistakes of the front end."
Saber says she also has plans to require cert ification for frontline access employees, whether it be the certified patient accounts technician (CPAT) designation offered by the American Association of Healthcare Administra tive Management, or the newly announced certified health care access associate (CHAA) credential being offered in January by the National Associa tion of Healthcare Access Management.
"With certification, more professionalism at the front end, there is less clean-up at the back end," she adds. "There will be a new breed of frontline professionals."