Providers are struggling to stay profitable while also striving to keep patient satisfaction from being negatively impacted. Denials are on an upward trend, payors are becoming tighter around what is demanded of the providers, and patients are being squeezed to pay more out-of-pocket with the ongoing shift to self-pay and high-deductible plans.
What many may not realize is that these financial challenges rear their head from the moment the patient walks through the door or schedules an appointment. This means the first face or voice the patient interacts with becomes the poster child of these financial trials that the organization will face much later down the road, after the patient has already received care.
But who is this ‘face’? It is the Patient Access staff, a department often with the highest attrition and who receives the least amount of training on how to navigate this extremely complex world they face today.
The Patient Access department is one of the most essential pieces to the financial and operational success of hospitals and facilities, namely because this team of professionals touches every patient that walks through the doors. The criticality of Patient Access comes through determination of patient eligibility, entry of required billing data, collecting co-pays, coding and tracking claims, and in many cases, represents the first interaction the patient has with the organization.
It is imperative that hospitals recruit, retain and develop skilled revenue cycle staff for all essential revenue cycle functions to be successful. However, finding and retaining skilled, front line Patient Access staff has been a challenge for providers for many years, due to the above-mentioned high attrition, lower median salaries, and limited training provided to them.
So, what have we done as an industry to strengthen this critical piece and empower it to drive financial performance and patient satisfaction? Well, if we look at trended denial and patient satisfaction data, we haven’t done enough. We have often looked to technologies, Electronic Health Records (EHRs), workflows, prompts and a host of other technology-first solutions, but we have forgotten the most important part of the equation. The employee, the patient access professional, who needs to follow protocols, know complex rules and regulations, understand insurance and coverage, collect large sums of money from the patient prior to and/or after service, and most importantly provide an outstanding patient experience.
If you thought the job of a cast member at Disney is tough, dealing with millions of kids and grumpy parents in 90-degree weather, then you have not been hanging out in the Patient Access department recently. So, let’s stop looking at technology investments alone to solve our challenges and instead invest in the most critical asset in the process, our people.
Implementing an effective and efficient program to turn a hospital’s or community’s existing population into quality front line staff will help to solve the supply challenge. But where do you begin? When Mission Health Patient Access built their own workforce through education re-design, they experienced the positive impact it had on the department as well as improvement in Revenue Cycle Key Performance Indicators.
Mission Health is the only non-profit, locally owned and governed health system in western North Carolina. It operates six hospitals, numerous outpatient and surgery centers, post-acute and long-term acute care providers and the region’s only dedicated Level II trauma center. The health system is the largest employer West of Charlotte, with more than 12,000 employees.
In 2017, Mission Health Revenue Cycle leadership recognized opportunities to address patient access team member deficiencies to improve Registration Quality, Point of Service Collections, Denial Prevention and Patient Experience. In general, team members lacked knowledge of revenue cycle best practices, departmental goals and Key Performance Indicators (KPI). After carefully analyzing the current issues, Mission Health recognized the opportunity to re-train current team members and re-design new hire education in order for patient access to perform in the new paradigm of health care. The patient access onboarding classroom curriculum was system/application oriented, meaning it was focused on how the Practice Management and technology worked, not on the life cycle of the patient’s encounter.
Team members were receiving training in the unit and on the floor that was not consistent from facility to facility, causing challenges in the goal to standardize and provide better flexibility in staffing. Refresher courses were provided to resolve some of those recurring issues, but they had low attendance rates. Communications and updates were distributed via email, but they were often handled by super users and not verified and confirmed as the standardized approach and process. Overall, the lack of additional team member education was preventing patient access from achieving departmental goals.
When assessing the current state of the patient access performance and the growth needed, Mission Health revenue cycle leadership decided it was in their best interest to grow their own teams and began by looking internally at individuals already working within their organization.
The approach began by having all patient access employees, regardless of role description, complete a Financial Counseling Assessment that established a baseline score in this critically, important function of a patient access professional. This tested group included Schedulers, Pre-Access Coordinators, Authorization Specialists, Financial Counselors, and Registration Representatives. The assessment covered hospital finance basics, insurance and coverage, collections, patient communication, deductibles and coinsurance scenarios. From this score, it was easy to distinguish the areas the staff needed further education to bring success to the patient access department.
The initial results showed strengths and weaknesses by individuals across the department which led to one-on-one coaching by management and assignment of on-demand eLearning courseware to meet the competency level necessary. The goal here was not to use a ‘buck shot’ approach with the education and train people on every problem found, but rather tailor a plan to each person’s need, avoiding unnecessary training and optimizing the time spent with the education. After completing the educational courses, the assessment was given once more, and there was a tremendous improvement in not only overall competency, but speed, information recall, and productivity.
As a result, team members now have a more complete understanding of the revenue cycle and revenue cycle metrics, including Days in Accounts Receivable (AR), Cash as Percent of Net Patient Revenue, and AR%>90 days. They also gained a better understanding of patient access metrics and how their work relates to the revenue cycle, including Registration Quality Assurance, Point of Service (POS) Collections, Patient Experience and Denial Experience.
Within the last year, Mission Health patient access has improved their registration quality, increased POS Collections and reduced eligibility denials. Now they are using education to empower team members and apply payor responses to resolve registration alerts and accurately identify coordination of benefits. Through a standardized on-boarding and competency management program that leverages eLearning, classroom instruction, and analytics, they are now able to employ a “grow your own” approach to develop team members from the system’s community and internal organization. The results show the importance of investing in team member education to improve performance.
If providers look right outside their doors, there are many left unemployed, uneducated and struggling to make ends meet. But they are motivated, hardworking people that just need to be given an opportunity. Military veterans are, unfortunately, a large portion of our population that are struggling to find, not only a job, but an actual career. First-term veterans have the hardest time landing a job, with 16.2 percent of veterans in the labor force between the ages of 18 and 24 years old are jobless.
Men and women of our armed forces have served their country so bravely around the world and the attributes they possess are strongly needed in today’s health care industry. They are extremely knowledgeable and have the ability to learn quickly. With proven leadership skills and the understanding of teamwork and diversity, these individuals are able to excel in the health care environment. They hold a much stronger understanding of how to perform under pressure while remaining professional and respectful.
The traditional approach is to hire externally to quickly fill gaps and improve opportunities, but this revolutionary approach of building a workforce within an organization and from the local community will provide a workforce that is loyal and dedicated, highly motivated to develop and grow within the organization, while also being easily adaptable to a hands-on approach when it comes to training. These individuals will help to resolve operational challenges, meet financial goals, and offer not just jobs but careers that will revitalize the community.
About the Authors
Beth Ottinger is the Senior Director of Educational Consulting and Quality at nThrive consulting arm of nThrive Education and ensures the quality of all educational products provided to multiple health care populations across the nation.
Michael Maggard is the Executive Director of Patient Access for Mission Health System, a not-for-profit health system in Western North Carolina. With over 10,000 employees Mission operates six hospitals, numerous outpatient and surgery centers, post-acute care and long-term acute care facilities and is Western North Carolina’s only dedicated Level II Trauma center. Michael has worked at Mission Health for 6 years and currently oversees approximately 350 Patient Access professionals, including Scheduling Coordinators, Pre Access Insurance Verification and Authorization Representatives, Financial Counselors and Patient Registration Representatives.