Patient AccessCareer LadderPresented By: Linette Farris

Sandra Clay-Hillyard

September 2011

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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 ? APRIL 2008

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 re-apply during each performance review.

• 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 2011QA Stats

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Departmental Annual CompetencyThe 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 BB. Using Medicare Part AC. Self-pay

http://www.proprofs.com/quiz-school/story.php?title=patient-access-department-registrar-competency-exam

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TIER 2 TAKE 3

APRIL 2008 OCTOBER 2011

• 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

• 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 TAKE 3

APRIL 2008 OCTOBER 2011

• 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

• 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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TRAININGAdmission Process 10/09Admissions Newborns 08/10Advance Directive Healthcare Proxy 08/10Bed Assignments 10/09Bed Board 08/10Birth Announcements 10/09Career Ladder 08/10Cash Accounts _Collection of Deposits 10/09Census Changes 10/09Code Triage 08/10Collecting Bad Debt at POS 10/09Commercial Insurance 10/09Communication and Handling of Secured Patients 10/09Condition of Admission 08/10Condition of Admission - Limited English Speaking Patients 12/10Confidentiality 10/09Consent For Treatment of Minors 08/10Continuing Education 10/09Copay Collections Emergency Department 10/09Critical Bed Shortages 08/10Customer Service 10/09Death Register Certificates 08/10Department Patient Education Plan 08/10Department Performance Improvement Plan 10/09Designating Patient as VIP Status 10/09Determining Primary Insurance 10/09Disciplinary Action 10/09Downtime Procedure 12/10Dress Code 08/11Earned Time Requests 08/09Emancipated Minor Rule 05/10Emergency Department Registration 08/10Ethnicity-Race of Patient 10/09Facility Directory Patients Right to Opt Out 10/09Faxing PHI 10/09Fetal Remains 08/10Gore-Tex 10/09Harassment - Sexual Either Sex 10/09Hospital Services Brochure 08/10IC – Admission of Communicable Diseases 10/09IC - Hand washing 10/09IC - Isolation Precautions 08/10IC - Standard Precautions 08/10Infection Control 10/09Inpatient Copay Coinsurance and Deductibles Collections 10/09

Interdepartmental Relationships 10/09Intrafacility Transfers 10/09Maternity Pre-Registrations 10/09Medicaid - MassHealth 10/09Medical Clearance 10/09Medical Screening Examination 08/10Medicare 10/09Medicare - An Important Message from Medicare 4/11Medicare - Procedure for Non-covered Services ABNs 10/09)Medicare - Questions 04/09Mission and Philosophy 10/09New Employee Orientation and Training 10/09Newborn Pre-Reg Admission Sheet

Outpatient Copay Coinsurance and Deductible Collections 10/09

Patient Access Quality Assurance 10/09Patient Admission and Permanent Record 08/10Patient Advocate 10/09Patient Identification 10/09Patient Service Center Time Log Procedure 10/09Patients' Right to Request Treatment 10/09Payroll Time and Exceptions 10/09Per Diem 10/09Personal Telephone Calls - To and From Employees 10/09Preferred Language Labels 10/09Pre-Registration Process 10/09Pre-Registration Schedules 10/09Privacy Practices - Notices and Distribution 08/10Registration 10/09Registration - Auto Accidents 12/10Registration - Daycare 12/10Registration - Express Registration 10/09Registration - Nonpatients 04/09Release of Patient Information 10/09Safety - Conduct to Minimize Violence 10/09Safety - Department Safety 10/09Safety - Department Safety Training and Orientation 10/09Safety - Recognizing Inappropriate Behavior 10/09Sick Call Notification 04/09Special Care Nursery Transfers 12/10Standards of Patient Service 10/09Valuables 08/10Verification of Insurance Eligibility 12/10Weekend Outpatient Admissions 8/10Workers 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

0

5

10

15

20

25

30

35

40

YE

AR

S O

F S

ER

VIC

E

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RATE OF TURNOVER

LGH PATIENT ACCESS RATE OF TURNOVER

16.67

21.69

15.4813.95

0.00

5.00

10.00

15.00

20.00

25.00

2007 2008 2009 2010

% T

URNO

VER

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!