Recruitment and Retention in Patient Access:

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1 Recruitment and Retention in Patient Access: Quarterly benchmarking report A supplement to the Patient Access Resource Center

2 Dear reader, The role of the front end in the healthcare revenue cycle is more critical than ever. Patients want price estimates before they commit to a hospital, and starting this year, the government is making sure they get them. Beginning September 1, CMS will require facilities to provide cost estimates for patients on the new Advance Beneficiary Notice (ABN) of Noncoverage form, which it released March 3. It is up to the patient access manager to hire and retain efficient, competent staff members who can deliver these cost estimates accurately and ensure the patient s first impression is a good one. As a patient access manager, recruitment and retention of quality staff members is crucial. How does your facility compare to others in terms of your front-end staff? What is your turnover rate? What steps do you take to improve it? How do you hire the right candidate? And once you have the right staff members, what do you do to keep them happy? The Patient Access Resource Center knows how important it is to assemble the best access team for your facility. That is why we dedicated our second-quarter benchmarking report to recruitment and retention of access staff members. This report will reveal facts about the people facilities are hiring for access: their ages, their education levels, how much they get paid, the reasons they leave, and what type of training they are offered. It will discuss how often access managers give performance reviews and whether their departments have a career ladder. We hope this report helps you think about your access team in a new way and that it gives you ideas for hiring, training, and forming the best access team possible. After all, your facility s revenue cycle is only as good as your front end. Sincerely, Dom Nicastro Senior Managing Editor HCPro, Inc. 781/ , Ext Recruitment and Retention in Patient Access

3 The access employee: High school diploma, middle-aged Ninety-two percent of survey respondents said they have staff members who earned only a high school diploma (Figure 1). Thirteen percent said they have employees who hold a bachelor s degree, and only one respondent has an access representative with a master s degree. About two-thirds of respondents said they have representatives who leave before their fifth anniversary (Figure 2). Forty-four percent stay at a facility for three to five years, and only 18% remain at one facility for 1 or more years. Access managers are hiring employees between the ages of 35 and 5 (Figure 3). More than 7% of respondents said their employees fall into that range, followed by the 25- to 35-year-old category (55%). Regardless of the age range of your staff, most respondents seem to agree that, when hiring a registration representative, you need to have a person who can work well with patients and coworkers. Hire people who like to meet people, with demonstrated skills (computer, detail, accuracy) in previous activities, one respondent said. Then identify in each one how that excites them and keep it that way. n Figure 1 What is the education level of your staff? 1 High school diploma 92% Bachelor s degree 8 Master s degree No diploma % 1% % Figure 2 What is the average length of service? Figure 3 What is the age range of your staff? 1 year years % 3 5 years 5 9 years 1 or more years % 72% and older 3 31% 5 22% 18% % 27% 1 1 1% June 8

4 Cash a common incentive for employees As an access manager, your feedback, praise, and constructive criticism are integral to a healthy access team and, ultimately, a healthy revenue cycle. But what are your facilities offering in return for good work? What are the incentives for your access representatives to do a good job? Sixty percent of facilities said they do not have an incentive program (Figure 4). For those that do, incentives for cash collection drew the most responses in our survey. Twenty-six percent said they give incentives for cash collection, followed by registration accuracy (17%), and Medicare Secondary Payer accuracy (3%). Based on other responses from our survey, examples of areas for which access managers have incentive programs are: Overall performance Meeting goals in all aspects of collections Productivity Customer service awards Patient satisfaction Perfect attendance What do you give in return? We asked managers to tell us what their incentives are. Incentive rewards included gift cards and cash (36% each) and a celebration luncheon (24%) (Figure 5). One respondent said his or her facility distributes tokens to employees who meet or exceed their goals. They can be used at the facility for certain rewards. Others said they give praise within their department and across the entire healthcare facility. Recognition, recognition, recognition, said one manager who took the survey. You need to make them a part of improvement and change. Change, as one manager noted, is not always a good thing for access representatives. Give them a process that does not change too frequently, and offer incentives when needed, the manager said. I also think praising them for a job well done is also required, he added. We as managers sometimes only focus on the errors that our staff make and rarely give them a much needed pat on the back. n Figure 4 My facility offers incentives for quality work for 6% Figure 5 If you do have an incentive program, what is the incentive? % 24% 36% 27% 3 26% 17% 14% % Registration accuracy Medicare Secondary Payer accuracy No incentive program Other, please specify 5 Cash Gift cards Cash collection A celebration luncheon Other, please specify Recruitment and Retention in Patient Access

5 Pay usually in the $1 $12-per-hour range In access departments, representatives are typically paid $1 $12 per hour. According to our survey, 21% said they pay their employees less than $1 per hour, 47% receive $1 $12 per hour, and 34% get paid $12 $15 per hour (Figure 6). Only 8% of managers said their access employees earn an hourly rate of more than $15 per hour. Of course, where your facility is located factors into pay. And compensation is important today with changing government regulations and more responsibility falling on registrars. CMS is mandating pricing transparency from access staff members on the new Advance Beneficiary Notice (ABN) of Noncoverage, which CMS released March 3 and which will be mandatory for facilities to use by September 1. If your representative fails to give a cost estimate on the new ABN, you could lose your reimbursement. Access managers need to hire staff members who are capable of accurately completing these complex forms. So just how is pay determined for new hires? Fifty-three percent of respondents said an employee s hourly rate is increased with education and experience, 35% base it on experience alone, and 15% said they have the same starting salary for each employee (Figure 7). In addition, access managers said employees start at different rates depending on which union represents them. n Figure 6 What do you pay your registration staff per hour? Figure 7 How is your pay scale determined for each new hire? % 34% % % 21% 3 1 % Minimum wage 8% 1 7% Experience 15% 6% Less than $1 Education $1 $12 Experience and education increase hourly rate $12 $15 Same starting salary More than $15 Other, please specify June 8 5

6 Turnover rate always an issue for managers The turnover rate among patient access staff members is 3% 4% in some cases (Figure 8). But that represented only 7% of our respondents. Forty-six percent of respondents reported turnover rates of % 1%, and 33% said they have a turnover rate of 1% %. As for a career ladder, an overwhelming 71% of respondents said they do not have one (Figure 9). Emergency departments (ED) are thought to have the highest turnover rate among patient access staffs. However, our survey revealed that in only one out of four facilities, the turnover rate in the ED is higher than that of other access departments (Figure 1). Fifty-seven percent of managers said their turnover rate in the ED is the same as other registration departments, 29% said it is higher than other access units, and 14% said it is lower. n Figure 9 Do you have a career ladder for staff members? Yes Figure 1 Finish this sentence: Is your emergency department staffing turnover 6 57% Figure 8 What is your turnover rate? 5 46% % 1% 1% % % 14% 7% % 3% 3% 4% More than 4% 1% % No % % 1 14% The same as all turnover 1 Higher than other access units Lower than other access units 6 Recruitment and Retention in Patient Access

7 Poor pay, lack of promotions send staff members packing Managers chose pay as the major reason for access staff members leaving their jobs. Thirty-one percent of respondents cited low pay as the top reason they lose representatives (Figure 11). A lack of promotional opportunity was close behind at 19%. Respondents also cited several other reasons for losing representatives, including: Long hours, night shifts, and too much stress Students who move on after graduating from college Work shifts that cause problems at home Less free time on weekends and holidays Promotions within the organization A high patient volume Increasing expectations and high accountability So what s the best advice for keeping employees happy and on board as part of your registration team? You need to have a team that works well together, one manager said. Complementary personalities make the work flow smoother and You need to have a team that works well together. Complementary personalities make the work flow smoother and increase happiness. Patient access manager and survey respondent increase happiness. We don t try to keep staff if they want to go, although pay and benefits are some of the > continued on p. 8 Figure 11 Upcoming audioconference What is the top reason for staff members leaving patient access? 31% Pay 19% 17% 13% Lack of promotional opportunity Skill set not matched to position We don t conduct exit interviews Other, please specify 48% June 3 Registration Hiring: Best Practices to Find the Right Fit for Registrars, Your Front-End Team, featuring Stephanie Smithson, patient access manager at Dunn Memorial Hospital in Bedford, IN, and Catherine M. Pallozzi, CHAM, CCS, director of patient access at Albany (NY) Medical Center. The front end of any healthcare revenue cycle needs to be sharp, focused, and customer-service oriented. Just how do you form that type of patient access team? It happens in the recruitment and interviewing process. And once access representatives are on board, only the best training and monitoring will help them improve and contribute to a healthy revenue cycle. Join HCPro on Monday, June 3, at 1 p.m. (EST) for the live 9-minute audioconference. Smithson and Pallozzi will discuss how their facilities formed their access teams and have kept the turnover rate down. For more information, please call 8/ or June 8 7

8 Poor pay < continued from p. 7 best around in our small community. We are the largest employer, and if you want to live in this wonderful place, you may need to make compromises that will reflect that. One respondent suggested managers get out from behind their desks and work directly with the front-end staff. Work the front line with them, the respondent said. You know the issues they deal with if you are involved. Listen to what they say. Make sure they are informed and are aware of the goals of the department and know they are the key to success of the department. Some other responses to the question about motivation were: Address low performers and move them up to middle, then to high-performers pay range. High performers do not enjoy working with low performers. Do not micromanage employees. Be accessible, listen to employees concerns, and be in their court. Try to make positive changes in the department. Invite employees to give input to the department s processes and to work independently as much as possible. Allow as much flexible scheduling as possible and provide promotion opportunities. n 6/8 SR288 This special report is published by HCPro, Inc., Hoods Lane, Marblehead, MA Copyright 8 HCPro, Inc. All rights reserved. Printed in the USA. Except where specifically encouraged, no part of this publication may be reproduced, in any form or by any means, without prior written consent of HCPro or the Copyright Clearance Center at 978/ Please notify us immediately if you have received an unauthorized copy. For editorial comments or questions, call 781/ or fax 781/ If you have questions, contact customer service at 8/ , fax 8/ , or Opinions expressed are not necessarily those of the editors. Mention of products and services does not constitute endorsement. Advice given is general, and readers should consult professional counsel for specific legal, ethical, or clinical questions. HCPro is not affiliated in any way with The Joint Commission, which owns the JCAHO and Joint Commission trademarks. 8 Recruitment and Retention in Patient Access

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