One-on-one education is key to Virtua success

Auditor/educators play big role

By implementing a comprehensive full circle of training for patient access employees — which ultimately led to the creation of two new areas within the department — Marlton, NJ-based Virtua Health has dramatically increased both registration accuracy and employee satisfaction, says Diane Mastalski, corporate multisite administrator for patient business services for the 1,051-bed system.

"In early 2000, we got a new assistant vice president [AVP] for patient business services, and his dream was to put together a training program for patient access and patient accounting, which are both under the same AVP," Mastalski explains.

The patient business services department includes 100-125 patient access employees, she adds, and 100 patient accounting employees. An additional 150 employees who do not report to patient access perform registrations in the five-hospital system’s ancillary areas and at one of the hospital’s emergency departments, Mastalski notes, and are included in access education initiatives.

The new AVP’s vision led to the establishment of a training and development department for patient business services that has a manager, a supervisor (Mastalski’s job at the time), two access trainers, and two accounting trainers, she adds. "We realigned staff; we didn’t outlay any money."

In the process of establishing the new department, Mastalski points out, "we met with our organizational effectiveness people who do systems training, inservices, and training seminars. We looked at what we were doing right and what we needed to do better."

About 10 years ago, there was no formal training for registrars at all, she recounts. New hires learned from a person who already was in the job, "so if I [was taught by] Mary, I learned one thing, and another person [who was taught by] Jane learned differently."

With the implementation of a new computer system in 1994, three days of classroom training was added to the mix, but that time was spent primarily on computer training, Mastalski adds.

Training targets new and current staff

The initiative that began in 2000, however, has a comprehensive training agenda that targets new and existing employees and covers a wide range of registration topics. In 2003, Virtua upgraded its health information systems (HIS) program and, at the same time, increased the initial training session from three days to four, primarily to allow more time for insurance education, Mastalski notes.

The insurance piece of the training is now much more detailed, she says, with instruction on how to read each payer’s insurance card and identify plan code, billing address, etc. "In the past, it was much more general," adds Mastalski. "We might get specific with Medicare and one other [insurer]. Now we’re breaking it down, saying, Aetna has this; Blue Cross Blue Shield has this.’ It’s more geared toward the individual plan."

In the four days of training, she adds, registrars also cover such topics as "how to post cash, scripting, patient consents, HIPAA [Health Insurance Portability and Accountability Act] information," among others, along with "any special requests that come in." Because trainers have become more efficient in presenting information, there’s still enough time for the computer training, Mastalski says. "Plus, our new HIS system is easier than the previous version, so we can cover that more quickly and give them more meat and potatoes," she notes.

One of the things Mastalski finds particularly effective about the four days of training, she explains, is that they are scheduled with insurance information as the last session of one day, and instruction on the Healthcare Data Exchange (HDX) on-line verification system at the end of another. "So if existing registrars needs reinforcement, they come in at the end of the day and get a refresher class [with the new hires]," Mastalski continues. "It gives the new employees an opportunity to meet those who are already out in the field and makes for more interesting interaction," she says.

Another requirement for new hires is that, prior to the classroom training, they spend time at the campus where they will work, Mastalski adds. "They’re not on the computer; they may answer the phone, but basically they’re there to observe. It gives them an opportunity to see what the job is about, but we realize it’s a double-edged sword, if the person they’re looking at has bad habits, they may pick them up," she explains.

To counteract that possibility, Mastalski says, "we start class saying, We’re going to do things the correct way. If you’ve seen something different, let us know.’"

That initial campus time can be anywhere from eight hours to 20 or even 40 hours, she notes, depending on the person’s availability and when he or she is hired in relation to when the next training session begins.

Evaluating training effectiveness

With all of the training pieces in place, Mastalski continues, scores on employee opinion surveys were "OK, but not as high as we had hoped. We didn’t feel we were doing all we could to make training good for them."

With that in mind, training and development managers met with patient access leadership to decide on the next step, she adds. They took a hard look at what the patient accounting department deemed the errors, or edits, that access was letting through and tried to find a way to improve accuracy by making better use of staff. As a result, the auditor/educator position was created in late 2000, again without significant outlay for new employees, Mastalski explains. "We realigned staff at each of our campuses to audit the registrations and do immediate education. We may have added one person," she says.

Seven auditor/educators cover the five hospitals, she notes, including two at each of three larger facilities, and one who covers two smaller hospitals. The employees report to the campus manager, Mastalski notes, with a dotted line to the training and development team. "The auditor/educators have a big job to do because they are at the front lines with the registrars," she says. "They spend about 25% of their time auditing and the remaining 75% performing the necessary education."

In addition to identifying areas of deficiency and targeting those problem areas with individualized, one-on-one training sessions," Mastalski continues, they are responsible for following a policy/procedure specifically geared toward registrar accuracy and accountability. "In the past, there was finger-pointing based on the audit results," she says, "but now we utilize the results to reinforce one-on-one development of our most important asset: the employee."

Using a 12-point checklist, the auditors identify deficiencies in individual registrations and do one-on-one follow-up education, Mastalski says. "Then they monitor to see if more [instruction] is required. If so, they either do more one-on-one [training], or send the employee back to us for a refresher course."

The intensive monitoring and immediate education are "what makes us unique," she says, also crediting the Six Sigma data collection and process improvement tools the organization employs.

The effort paid off in improved scores on the training and development section of the employee opinion surveys — which went from 75% in 2002 to 86% in 2004 — as well as a more efficient way to measure the effectiveness of training, Mastalski adds. In the four years since the advent of the audit/ educators, she points out, registration accuracy has increased from 78% to 97%, with the largest increase over the past two years. "We do a percentage-based audit — a sampling, not 100% — and the people with lower accuracy rates have a higher percentage of their charts audited," Mastalski notes. (See staff accuracy rates.)

Auditor/educators also are responsible for providing education at staff meetings, customer service training, registrar scripting, helping out with classroom training as needed, and conducting e-mail education, she adds. "When we identify that many employees have the same deficiency in one of the insurances, for example, they put together an e-mail and send it to all the staff. It’s a quicker and more efficient way to reach everyone when one-on-one education is not feasible," Mastalski explains.

Another training resource is a public folder in the departmental e-mail system that allows managers to keep files available for quick-and-easy reference by registrars, she adds. "We have all our registration tools there, so that if a registrar needs, [for example], an address for an insurer, it’s available. Any lists we use — our cheat sheets — are there," Mastalski says.

In addition, at least three times a year, training and development staff put out a newsletter geared specifically to patient business services employees, she notes. "It may include information an insurance company has released, a breakdown of new training initiatives, or information on a new product we’re putting in," Mastalski adds.

The staff newsletter is appropriately called "The Journey, because the journey starts with them. We strive for 100%, and if we don’t start at the beginning, they’ll never get there," she adds.

[Editor’s note: Diane Mastalski can be reached at (856) 248-6369 or by e-mail at]