It's time for patient access to obtain parity with business office
Outdated compensation model is costly
[Editor's Note: On 6/24/13, we sent an e-bulletin to Hospital Access Management subscribers on a report concluding that organizations need new revenue cycle tools. If you didn't receive it, it means we don't have your email address. You can receive future bulletins by contacting customer service at email@example.com or (800) 688-2421.]
Salaries of patient access employees are too low in light of their greatly expanded role, and there are serious consequences if this under-compensation isn't corrected, argue revenue cycle experts interviewed by Hospital Access Management.
"Access has become very vital, but the perception in the industry hasn't changed to accept that yet," says Michael Hester, vice president of the revenue cycle in the finance department at Nationwide Children's Hospital in Columbus, OH. "There are still too many people who think access is just a meet-and-greet position."
Hester estimates that at least a 30% to 40% increase in compensation is needed for patient access employees in his department. "Patient access salaries need to be brought not just in line with the business office, but above the business office," Hester emphasizes. "My goal is that the front end will be a higher level than the back end."
Patient access leaders must make sure hospital administrators never forget the key role access plays in the hospital's financial well-being, says Pete Kraus, CHAM, CPAR, FHAM, business analyst for revenue cycle management at Emory Hospitals in Atlanta. Short-changing patient access staff limits the organization's ability to retain and attract competent staff with the right qualifications, argues Kraus. "Just as a poorly paid business office is likely to be deficient in billing and collections, performance issues are likely to impact poorly paid, understaffed access departments," he says.
The biggest selling point for patient access leaders seeking to attain parity with the business office, or perhaps even pulling ahead of those salaries, is the shift in collections responsibility to the front end, says Kraus. This includes both point-of-service collections and accurate completion of patient financial records prior to billing to produce a clean claim.
"To do this well involves a level of staff training and expertise at least the equal of business office billing and collections staff," he explains.
Who they're putting in the front end
More than half of revenue cycle executives are now staffing the front end with their strongest revenue cycle employees, according to a recent survey.1 Steven S. Lazarus, PhD, president of Boundary Information Group, the Denver healthcare consulting firm that conducted the survey, says, "Some of the skill sets that are being moved to the patient access departments have historically been performed in the business office collections operations." Examples include financial discussions during appointment scheduling, pre-registration, and collection of more detailed demographic information.
The migration of financial counseling from the back end to the front end prevents unpleasant surprises with billing and collections because it puts a patient's finances in order prior to date of service, says Kraus. "The increase in responsibility and accountability applies across the range from entry-level staff to director," he adds.
Perform your own analysis
The outdated compensation model for patient access is clearly failing, argues Hester. "That's why we need to create a new model, with patient access no longer perceived as an entry-level position," he says. "There is a need to basically create an entire new job code within the industry, with a new salary range specific to that.
To demonstrate the return on investment that will come from increasing patient access salaries, Hester says to take these steps:
1. Increase the requirements for patient access roles.
Currently, most job descriptions for patient access focus primarily on entry-level customer service skills. "These are still critical, but inadequate in our current environment," says Hester. "The position is a dynamic, multi-faceted role that changes from day to day." Computer skills, independent thinking, a college degree, interpersonal skills, and conflict resolution skills are just some of the necessary requirements, he says.
"We need to market the value of the patient access rep," says Hester. "Make it more of a career path, instead of a 'Get your foot in the door until you find another job' type of position."
He says lack of qualified staff results in too much turnover, which is something that was financially acceptable when patient access was an entry-level position, but no longer. "If we can reduce turnover by just a couple of percentage points, that has a wide effect not just on the cost of recruiting, but also HR, and overtime to fill that vacant position while we are waiting for somebody to take it," Hester says.
2. Evaluate the potential cost of failing to getting the information correct on the front end.
"Denials will be reduced, and can be quantified," he adds. "Even taking a conservative approach of anticipating a reduction of bad debt by 20% and denials by 40% will still produce an ROI [return on investment] for increasing front-end salary ranges."
3. Evaluate the dollars collected on the front end, compared to historical trends.
"For every dollar we collect on the front end, we have just reduced our bad debt by 50 to 60 cents," says Hester.
4. Calculate dollars that can be saved by reducing back end staffing.
"Through the improvements on the front end, you should see a reduction of necessity on the back end," says Hester. "It is a reallocation of resources."
After patient access salaries are increased, FTEs on the back end can be reduced over the next 12 to 18 months, he says. If the front end is doing their job correctly, the back end's responsibilities should be relegated to verifying that payments were posted correctly, explains Hester.
"Nowadays, it's much more clear-cut that if you bill appropriately, you get paid appropriately," he says. "You don't need as high a technical skill on the back end as you did previously."
5. Present your analysis to senior leaders.
"Show them the positive return on investment, after you have put all those details together," says Hester. "Once they put the resources into patient access, everything else will fall in place."
1. Boundary Information Group. The impact of growing patient financial responsibility on healthcare providers. June 2013; Denver. Available at www.boundary.net.
• Michael Hester, Vice President, Revenue Cycle, Nationwide Children's Hospital, Columbus, OH. Phone: (614) 722-2085. Email: firstname.lastname@example.org.
• Pete Kraus, CHAM, CPAR, FHAM, Business Analyst, Revenue Cycle Management, Emory Hospitals, Atlanta. Phone: (404) 712-4399. Fax: (404) 712-1316. Email: email@example.com.
• Steven S. Lazarus, PhD, President, Boundary Information Group, Denver. Phone: (303) 809-9337. E-mail: firstname.lastname@example.org.