Access is too often shortchanged with staffing: Justify your needs!

Data can prove need for additional FTEs

Recently, patient access leaders at Tufts Medical Center in Boston finally were able to hire a dedicated FTE focusing on denials.

"This person has become a key resource in denials management and identifying processes upfront to prevent the denials," says Alyson Landry, manager of ambulatory operations and training.

Without this approach, claims denials become "downtime" work, and staff members are not fully engaged in this process, says Landry.

Tufts’ patient access leaders were able to justify this additional FTE by demonstrating the volume of denials related to lack of authorization and attaching a dollar amount to it. "In our organization, access has historically been overlooked as far as staffing. We have worked to improve this over the last three years, but we continue to have challenges," says Nicole Marsoobian, manager of patient access.

First, patient access leaders need to appropriately measure staffing to justify it, emphasizes Tanya Powell, patient access director at Ochsner’s Northshore Region Facility and Clinics in Slidell, LA. "For registrars, there is so much prep’ work done, that is not measurable, to get the patient in the door," Powell says.

Initially, Tufts Medical Center’s patient access leaders lacked the ability to track volume of work, productivity, and integrated statistics from various systems and tools. "The issues that arose as a result include a backload of registrations, billing denials, and overworked, disengaged staff," says Marsoobian.

Justifying staffing is increasingly important for patient access in light of continual changes in insurance plans and pre-visit requirements, she says. "We have had many discussions around shifting some of the resources in the billing area to focus on previsit work, in order to prevent the volume of work and denials after the fact," says Marsoobian. "The next step is to figure out how to do this."

Data is the key

Landry says patient access leaders need the following data: Call volumes, new patient volumes, referral and authorization volumes, volume of uninsured and underinsured patients, and additional work stemming from updates received via fax, forms from clinics, and updates from billing.

According to Landry, closely tracking these numbers is the key to justifying additional FTEs. (See related story, p. 135, on technology to help patient access prepare for a surge in volume.)

"We have certainly put in place various tools to assist in understanding productivity," says Landry. "However, what we struggle with most is the manual processes that are still in place. These do not allow us to track the additional work efforts of our staff." These manual processes include emails, backline calls, and faxed updates.

Landry and other patient access managers do "intense manual audits," which entail spending full eight-hour days with the staff. "We assess everything that is coming to them," she says. "We actually spend time performing the access function to fully understand the issues."

SOURCES

• For more information on justifying staffing levels in patient access, contact:
• Alyson Landry, Manager, Ambulatory Operations & Training, Tufts Medical Center, Boston. Phone: (617) 636-7627. Fax: (617) 636-9895. Email: alandry@tuftsmedicalcenter.org.
• Nicole Marsoobian, Manager, Patient Access, Tufts Medical Center, Boston. Phone: (617) 636-2271. Fax: (617) 636-8803. Email: nmarsoobian@tuftsmedicalcenter.org.
• Tanya Powell, Patient Access Director, Northshore Region Facility and Clinics, Ochsner, Slidell, LA. Phone: (985) 646-5132. Fax: (985) 646-5426. Email: tpowell@ ochsner.org.