Justify need for additional FTEs

Patient access areas can quickly become short-staffed if leaders don’t pay attention to changing patterns of patient flow, warns Mitch Mitchell, president of T.T. Mitchell Consulting, a Liverpool, NY-based consulting firm specializing in revenue cycle and technology.

Another common problem is that patient access fails to work with ancillary departments that provide outpatient services, he says. For example, many hospitals have a high influx of patients coming in the early morning to have lab work done before heading to work.

"The same thing can happen the first hour after 3 or 4 p.m., when people like to stop in before heading home," says Mitchell. Similarly, some urban hospitals typically have a high rate of patients coming into the emergency departments (EDs) on Friday and Saturday nights. "But they rarely staff them well enough," says Mitchell.

This situation sometimes occurs because patient access leaders don’t take the time to observe registration areas during all shifts. "So they create schedules based on what they think is happening and not what is actually happening," says Mitchell.

Because every hospital tracks admissions and admission times, Mitchell says patient access leaders can put those numbers to use. "Figure out when admissions are higher on a regular basis," he advises.

Working for other departments

Some departments habitually use patient access staff to do work, and management is unaware that they’re doing this work. This situation results in longer wait times in registration areas.

"I remember making spot checks here and there, and not seeing registration personnel anywhere, because of an errand some doctor or nurse sent them on," says Mitchell.

At large hospitals, registrars are sometimes asked to handle some of a department’s administrative work, particularly if a position was eliminated in that department. "It’s possible that they might also be asked to run errands for medical records or even take lab work to the lab. I’ve seen it happen," says Mitchell.

In one case, Mitchell had to put a stop to registration staff being asked to do work for the ED. "They were putting down linens and sometimes running to the cafeteria to get meals for extended stays in the ED," he says.

By putting a stop to these practices, patient access leaders can reduce registration wait times.

"There’s always plenty of work within the department for them to do when things slow down; at least I’ve always found that to be true," says Mitchell.

Quantify FTEs needed

The National Association of Healthcare Access Management (NAHAM) is working on quantifying the value of patient access professionals at their respective facilities, reports Mike Copps, executive director of NAHAM. "Our recently released Registration/FTE Calculator is a step in this direction," he says.

The Registration/FTE Calculator is an online tool to help patient access managers to prepare budgets, determine appropriate staffing, respond to workforce cutback recommendations, and advise senior management on future staffing needs. (For more information on NAHAM’s Registration/FTE Calculator, which is available only to NAHAM members, go to http://www.naham.org/?FTE_Calc.)

The tool helps determine and document staffing requirements for both pre-registration and registration areas. "It groups numerous patient access tasks and processes into 20 distinct components and helps determine the time required to perform each component," says Copps.

Based on the data that is input, the tool calculates the total time expected to complete a registration, as well as the FTEs and cost required to perform them. "Staff are also able to compare registration times and FTE requirements to peers," adds Copps.

SOURCES

• T. T. "Mitch" Mitchell, T. T. Mitchell Consulting, Liverpool, NY. Phone: (315) 622-5922. Email: mitch@ttmitchellconsulting.com.