Patient Access
Career Ladder
Presented By: Linette Farris
Sandra Clay-Hillyard
September 2011
Purpose:
In response to:
• the Press Ganey Employee Satisfaction
survey
• employees’ indication that they needed
additional career growth opportunities within
their positions
• improving overall employee development
• improving retention
a Career Ladder was developed modeled
after the Nursing Division’s Clinical
Advancement program.
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In the beginning (2003)…
• Solution was sought to reward veteran
staff members – LEAD Position
– One per area per shift
– Application and interview process open to
current staff
– Candidates would provide
• Departmental training
• Availability for flexible shifts
• Assistance to managers/supervisors
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While the intent was worthy …
• To reward long term staff who were
very capable but no longer eligible for
merit increases due to reaching scale
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The result was not productive …
• Selection criteria was too limited
• Inconsistent accountability regarding
required tasks (example: some LEADs
never did training)
• Limited opportunity based on available
positions
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The staff were EXTERNALLY
motivated.
• The LEAD positions actually served as
demotivators.
– Non-LEAD staff felt they had no authority or
autonomy to effect change
– LEAD staff did not uniformly perform the
anticipated tasks
– LEAD staff were not held accountable on a
consistent basis
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Intrinsic Motivation
“Three key goals of people at work
To maintain the enthusiasm employees bring to their
jobs initially, management must understand the three
sets of goals that the great majority of workers seek
from their work—and then satisfy those goals:
• Equity: To be respected and to be treated fairly in areas
such as pay, benefits, and job security.
• Achievement: To be proud of one's job,
accomplishments, and employer.
• Camaraderie: To have good, productive relationships
with fellow employees.”
Why Your Employees are Losing Motivation - by David Sirota, Louis A. Mischkind, and Michael
Irwin Meltzer, April 10, 2006, Harvard Business School
http://hbswk.hbs.edu/archive/5289.html
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Take 2 – The Career Ladder
• Provide a Career Path for all Patient
Access staff
• Recognize and Reward long term staff
who were capable and enthusiastic
about stretching the limits of their job
descriptions
• Tap in to the Informal Leaders on the
team
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WHO ?
Patient Access Teams
• PSRs (Patient Service Reps)
– ED Registration
– Patient Service Center
• Pre-Registrars
– Call Center
• Benefit Reps
– Financial Clearance Unit
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WHAT ?
The Career Ladder is an
incentive for which an
employee applies
through a defined
process. The incentive
is NOT part of the
employee’s base pay.
Employees must reapply during each
performance review.
APRIL 2008
• TIER 1
– New to field or new to
LGH
• TIER 2
– 5 years experience
– $1/hour
– $2080 FTE annually
• TIER 3
– 8 years experience
– $2/hour
– $4160 FTE annually
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TIER 1
MINIMUM STANDARDS
• Individual upholds LGH Standards of
Performance
• Quality Assurance Accuracy of 95% or
better
• Successful completion of the
departmental Annual Competency
Evaluation
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Standards of Performance
•
•
•
•
•
•
•
•
•
•
Appreciation
Attitude
Presentation
Sense of Ownership
Communication
Commitment to Fellow Employees
Timeliness of Service
Privacy
Safety Awareness
Accountability
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Quality Assurance Accuracy
• LGH Campus Wide Stats - 2011
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Pre-Services – August 2011
QA Stats
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Departmental Annual
Competency
The competency validation process will include
evaluation of nine general competency topics.
These topics include:
–
–
–
–
–
–
–
–
–
–
Auto Accidents
Consent Forms
Medical Records
Insurance, Insurance Verification
Medicaid/MassHealth
Medicare
Paragon
Patient Rights
Workers’ Compensation
In addition to the general competencies you will receive
an area specific quiz for the department/s which you
work. Please complete each quiz and return to your
supervisor.
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Patient Access Department - Registrar Competency Exam
Created By mmatias
•
A timed and scored examination that will measure a Patient Access Representative's ability to perform basic registration and
insurance verification functions. This test is a mandatory examination that requires a passing score for continued employment.
Q.1) Per The Joint Commission standards, what is the minimum number of
patient identifiers required to verify the identity of a patient?
A. One
B. Two
C. Three
D. Four
E. None of these
Q.2) An 8 year old patient is registering for a Radiology appointment. His
mother and father each have separate insurance coverage through their
employers. The child is covered by both policies.
Mother: BCBS - Mother's DOB 04/10/1970. Employed by PepsiCo,
which has over 100 employees.
Father: Oxford-. Father's DOB 01/17/1969. Works at local pharmacy,
Alvin's Drugs, and has 9 employees.
Which policy is primary?
Q.3) A patient arrives for an outpatient appointment. As you verify eligibility,
you notice that the patient has Medicare part A only. His Medicare part B
is inactive.
How should this patient be registered?
A. Using Medicare Part B
B. Using Medicare Part A
C. Self-pay
http://www.proprofs.com/quiz-school/story.php?title=patient-access-department-registrar-competency-exam
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TIER 2
APRIL 2008
• Tier 1 Minimums
• 5 yrs experience w/ 1 at
LGH
• 97% QA for 3 months
• Meets all productivity
standards
• Cross Trained in at
least one other access
area
• CHAA or CHAM
• No disciplinary action
within past 6 months
TAKE 3
OCTOBER 2011
• Tier 1 Minimums
• 2 yrs experience w/1 at
LGH
• 97% QA for 3 months
• Meets all productivity
standards
• Cross Trained in at
least one other access
area
• CHAA or CHAM
• No disciplinary action
within past 6 months
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PRODUCTIVITY STANDARDS
• Collections
– PSC, ED, Pre-Services: 8/month, Current Residuals or
Prior Balances
– Financial Clearance Unit: Per Cent of Potential
• Call Completion
– Call Center: Not Ready Time, Return Calls to Queue,
Dropped Calls
• Number of Registrations
• Customer Service
– Call Monitoring
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CUSTOMER SERVICE
•
Our personnel acknowledge callers promptly and courteously with a pleasant
expression and tone of voice.
•
Our personnel use words that express respect, patience and understanding
when talking with patients and/or other staff members.
•
Our personnel care for people with kindness and gentleness, rather than with
roughness and cold indifference.
•
Our personnel answer the telephone quickly and courteously. They identify
themselves by name and department. They provide callers with the
opportunity to respond to a request, to be placed on hold and to learn where
their calls are being transferred.
•
Our personnel protect the confidentiality of patients, coworkers and others who
use our facility.
•
Our personnel consider the effects of what they say and do in the presence of
patients and staff. They refrain from conducting personal (not work related)
conversations in front of patients or staff.
•
Our personnel refrain from discussing other staff members, organizational
policies, problems or medical care in public areas.
•
Our personnel maintain and utilize hospital equipment and facilities in an
appropriate and cost-effective manner.
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TIER 3
APRIL 2008
• Tier 2 Minimums
• 8 yrs experience w/ 2 at
LGH
• 97% QA for 6 months
• Embodies an individual
w/ positive professional
manner
• Peer Interviewer or
LGH/PA Committee or
Conducts Seminar
• Conducts In-Class
Training or Department
Training
TAKE 3
OCTOBER 2011
• Tier 2 Minimums
• 5 yrs experience w/2 at
LGH
• 97% QA for 6 months
• Rates 4 or 5 on Attitude
in SuccessFactors
• Peer Interviewer or
LGH/PA Committee
• Conducts Seminar
• Conducts Training for
New Employees
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PATIENT ACCESS SEMINARS
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PEER INTERVIEWER
• Peer Interviewing is the practice of
including members of a work group in
the hiring process.
– 3-5 peers participate
– Meet with candidates, ask appropriate
questions and answer any candidate
questions
– Peers determine whether candidate is the
right “fit” for the organizational culture
– Peers communicate and discuss with
supervisor/manager best candidate
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TRAINING
Admission Process 10/09
Admissions Newborns
08/10Advance Directive Healthcare Proxy 08/10
Bed Assignments 10/09
Bed Board 08/10
Birth Announcements 10/09
Career Ladder 08/10
Cash Accounts _
Collection of Deposits 10/09
Census Changes 10/09
Code Triage 08/10
Collecting Bad Debt at POS 10/09
Commercial Insurance 10/09
Communication and Handling of Secured Patients 10/09
Condition of Admission 08/10
Condition of Admission - Limited English Speaking Patients 12/10
Confidentiality 10/09
Consent For Treatment of Minors 08/10
Continuing Education 10/09
Copay Collections Emergency Department 10/09
Critical Bed Shortages 08/10Customer Service 10/09
Death Register Certificates 08/10
Department Patient Education Plan 08/10
Department Performance Improvement Plan 10/09
Designating Patient as VIP Status 10/09
Determining Primary Insurance 10/09
Disciplinary Action 10/09
Downtime Procedure 12/10
Dress Code 08/11
Earned Time Requests 08/09
Emancipated Minor Rule 05/10
Emergency Department Registration 08/10
Ethnicity-Race of Patient 10/09
Facility Directory Patients Right to Opt Out 10/09
Faxing PHI 10/09
Fetal Remains 08/10
Gore-Tex 10/09
Harassment - Sexual Either Sex 10/09
Hospital Services Brochure 08/10
IC – Admission of Communicable Diseases 10/09
IC - Hand washing 10/09
IC - Isolation Precautions 08/10I
C - Standard Precautions 08/10
Infection Control 10/09
Inpatient Copay Coinsurance and Deductibles Collections 10/09
Interdepartmental Relationships 10/09
Intrafacility Transfers 10/09
Maternity Pre-Registrations 10/09
Medicaid - MassHealth 10/09
Medical Clearance 10/09
Medical Screening Examination 08/10
Medicare 10/09
Medicare - An Important Message from Medicare 4/11
Medicare - Procedure for Non-covered Services ABNs 10/09)
Medicare - Questions 04/09Mission and Philosophy 10/09
New Employee Orientation and Training 10/09
Newborn Pre-Reg Admission
SheetOutpatient Copay Coinsurance and Deductible Collections
10/09
Patient Access Quality Assurance 10/09
Patient Admission and Permanent Record 08/10
Patient Advocate 10/09
Patient Identification 10/09
Patient Service Center Time Log Procedure 10/09
Patients' Right to Request Treatment 10/09
Payroll Time and Exceptions 10/09
Per Diem 10/09
Personal Telephone Calls - To and From Employees 10/09
Preferred Language Labels 10/09
Pre-Registration Process 10/09
Pre-Registration Schedules 10/09
Privacy Practices - Notices and Distribution 08/10
Registration 10/09
Registration - Auto Accidents 12/10
Registration - Daycare 12/10
Registration - Express Registration 10/09
Registration - Nonpatients 04/09
Release of Patient Information 10/09
Safety - Conduct to Minimize Violence 10/09
Safety - Department Safety 10/09
Safety - Department Safety Training and Orientation 10/09
Safety - Recognizing Inappropriate Behavior 10/09
Sick Call Notification 04/09
Special Care Nursery Transfers 12/10
Standards of Patient Service 10/09
Valuables 08/10
Verification of Insurance Eligibility 12/10
Weekend Outpatient Admissions 8/10
Workers Compensation 12/10
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SUCCESSFACTORS
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SELF EVALUATION
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PATIENT ACCESS BY THE
NUMBERS
• 81 Employees (plus
7 management
positions)
• 58.25 FTEs (plus
7.0 FTE
management
positions)
– Four TIER 3s
– Six TIER 2s
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PATIENT ACCESS TENURE
• Employee Years of Service
– 6.5 Average
– 4.1 Median
– 37.5 Longest
LGH PATIENT ACCESS TENURE
YEARS OF SERVICE
40
35
30
25
20
15
10
5
0
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RATE OF TURNOVER
LGH PATIENT ACCESS RATE OF TURNOVER
% TURNOVER
25.00
20.00
21.69
16.67
15.48
15.00
13.95
10.00
5.00
0.00
2007
2008
2009
2010
Current YTD Turnover as of August 31, 2011 for Patient Access is
7.95% (projected to be at 11.36% at year end at current rate of
turnover).
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$$$$
• Cost of Career Ladder Program Annually = $29,704.
• Cost of Turnover 2007 compared with Cost of Turnover
projected 2011 = 5% savings.
• Cost Savings of 5% in budgeted salaries alone =
$182,921.
– 5% of 81 staff members - the turnover savings is
4.05 employees X $52,500 (150% of 35000) =
$212,625. Net savings to the organization taking
out career ladder expense is $182,921.
• Gain in Employee Satisfaction –
PRICELESS.
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Questions?
Comments?
THANK YOU FOR ATTENDING!
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