Don't want to cut training? Tie it to the bottom line
Clarify role of director
Training and education costs are often the first items on the "chopping block" when it's time for budget cuts at hospitals, which is bad news for patient access.
"Doing more with less is no longer a concept - it is an expectation," says Jessica Murphy, corporate director of patient access services at Methodist Le Bonheur Healthcare in Memphis, TN.
To address this, the role of the department's trainer/educator was expanded. "That was critical in order to ensure the position provided for a much broader range of responsibility," says Murphy. The job description was modified, resulting in a new role as an analyst for patient access services who identifies problem trends and patterns and provides education and information to the areas that need help in correcting these issues.
"She still facilitates two-and-a-half days of training for patient access services associates, but the schedule has moved from every month to every other month," says Murphy. "As she analyzes the opportunities and issues for access, she also decides if a quality report would be helpful in addressing the problem."
If so, the trainer writes the template and specifications and provides these to the information services revenue cycle team to create the report. "Stopping errors that hit patient financial services edits or result in denials represents a significant impact to the bottom line," says Murphy. "Additionally, our trainer has picked up some education classes for patient financial services, as part of our partnership commitment to them."
Julie Johnson, CHAM, BSHA, director of patient access and health information management (HIM) at Mt. Graham Regional Medical Center in Safford, AZ, reports that she has been challenged to cut the department's education budget for outside training.
"We have teamed up with our in-house education department to maximize the educational offerings we choose, so these will benefit more than just patient access," says Johnson.
For instance, a free webinar was recently sponsored by a vendor, which covered the Health Information Technology for Economic and Clinical Health Act, security breach laws, and the Health Insurance Portability and Accountability Act. "These items affect patient access, HIM, quality, and patient accounting. Each of these departments attended the webinar," says Johnson.
Another vendor has given staff free training on up-front collections. "When potential vendors present a sales demo, ideas can be gleaned from these demonstrations to help our facility learn about new rules and regulations or simply how to make a process easier," says Johnson. "This idea generation will help us, regardless of whether or not we purchase the product."
Since access staff are now only allowed to obtain training in their own state or a few surrounding states, there is increased reliance on online offerings. "We also gather free information, such as white papers and vendor-sponsored PowerPoint presentations," says Johnson.
Prove connection to data quality
Even during the recession, some organizations are finding that they are able to justify not only maintaining their current resources for staff training, but expanding these efforts as an integral part of improving the hospital's bottom line.
"Data quality has always been important, but it continues to grow in importance," says Mary Best, corporate director of access services at Dallas-based Baylor Health Care System. "We need to have trained staff who know why they need to get information from a patient, and also, what information they need to communicate to the patient, because compliance is obviously a big piece of this as well."
In order to accomplish this, Baylor uses a formalized training program for patient access staff at each of its 14 facilities, with one full-time dedicated trainer and another being added. While the organization currently has a two-day access services orientation for new staff, it is in the process of developing a two-week orientation program.
"Although it is specific to access services functions and responsibilities, it is not uncommon for others to attend who want to know more about what we do and why we do it, as well as others who perform some level of access services responsibility but do not report to access services," says Best.
The current program focuses on policies, compliance, customer service, and point-of-service (POS) collections. Employees are tested before and after, to assess their competency and the value gained from the class. The expanded class will incorporate system training for all applications used by access services, as well as the related processes.
In addition, a training room recently was constructed exclusively for patient access staff, located in the organization's corporate office."There is a recognition of the value that quality training brings to the organization," says Best. "Our challenge is finding creative ways to do that, being spread out across multiple counties. Thus far, we have not been asked to ratchet back, but we are expected to be good stewards."
Best says that to demonstrate this, various financial metrics are tracked. This connects the hospital's bottom line to registration accuracy. "Even beyond that point, there are measures in a variety of arenas that tie into access data quality and patient satisfaction. It all begins at the point of registration," says Best.
Training had a clear impact on the organization's POS collections. "We conducted multiple, interactive training sessions at each facility," says Best. "The outcome was a year-over-year improvement of 26% in increased collections, during a time when it is increasingly challenging to collect front-end payments."
The health care system is redesigning its processes as part of a transition to a new front-end system. "There has been a huge amount of dollars invested in the system and hardware and all of the component pieces that it takes to implement this," says Best. "So for that to be successful and for us to accomplish what we need to, we have to invest in staff training. The development of the training program for this transition blends well with our planned expanded training for new hires."
The classroom is critical to being able to provide standardized training for new employees coming on board and to do specialized training, says Best. "So while the investment is appreciated, it is not excessive for the size of the organization," she says. "The other piece is creativity. We need to find ways to push material out in different ways that help defray the need to continuously expand the number of trainers."
At Baylor, a wide variety of methods to educate staff are used. These include onsite training, live meeting training, and online resources. Here are several approaches:
"Super users" are used to supplement formal training.
These individuals are not involved in curriculum development but can effectively get urgent material covered very quickly. "This is something that we need to do if something is very time-sensitive," says Best. Since the trainer might not be able to get to every facility in a timely way, the "super users" inform staff.
For example, super users recently updated access staff on the requirements of Senate Bill 1731, newly passed legislation that had a major impact on the department. "It required a significant amount of effort for staff to understand the bill. There were a lot of requisites for what they needed to communicate to the patient," says Best.
The bill requires staff to provide written notification to every patient at the point of registration, or discharge in the emergency department, whether they are in network with their particular insurance coverage, and to provide specific policy information upon request of the patient. "There were half a dozen policies that we needed to educate staff on, as well as the process to provide copies if requested," says Best.
Material on various topics is posted online.
Whenever staff need information on a certain topic, they can go online to pull up all the training materials that have been developed, including forms and frequently asked questions.
"This is an interactive site that is very easily used," says Best. In addition, employees are encouraged to submit their own individual questions to their manager, who in turn takes the question to the training department. The answer is posted online for all staff to view. "If they are asking a question about something we have put out training material on, we tie it back to that," says Best. "If we have done any updates subsequent to that, these are included in the FAQs section."
Additionally, the lead trainer is certified to develop on-line training courses for all access services staff. "Our focus for using this tool is primarily compliance refresher training at this time," says Best. "Once the course is developed and designed, the trainer is able to assign it to all staff and monitor completion." Refresher training on the Medicare Secondary Payer Questionnaire was recently completed through this method, and will be done annually.
Contests are held for the best answers to e-mailed questions.
The patient access trainer regularly sends out information about certain topics, called "Baylor Bits" to the nearly 500 patient access staff members at the various facilities. The focus on the initial training "push" was the language, race, and ethnicity data elements.
"The content covered the importance of capturing the correct information, how it is used, who uses it, and how to communicate to the patient," says Best. The information is prepared and sent out by the access services trainers.
As a follow up to the training, an e-mail with a question relating to the material is sent out to all staff. A prize, such as a shirt, pin, or gift card is given to the staff person with the fastest and most in-depth answer, for the day, night and weekend shifts. The group is notified of the winners and the correct answers.
"That was recently introduced and is really picking up speed now. Folks are starting to pay attention," says Best. "A lot of the material is pretty dry, so games and prizes keep people engaged. We will also be using this method to 'test' for educational opportunities by randomly sending out questions and gauging training needs based on the responses."
Additional staff will attend "train the trainer" courses.
Best says that another planned approach is to provide training for certain staff members beyond what "super users" receive, with the goal of supplementing the formal training given by the two full-time trainers.
While right now, "super users" are used to push material out to people at their facility, Best envisions a "true train-the-trainer course" that will enable the trainers to utilize a number of different techniques for training.
"We are looking at implementing that either later this year or early next year. We would identify individuals at the facilities who would be interested in going through a training course on adult learning and training techniques," says Best.
[For more information, contact:
- Mary Best, Corporate Director of Access Services, Baylor Health Care System, Dallas, TX. Phone: (214) 820-0947. Fax: (214) 820-3046. E-mail: [email protected].
- Julie Johnson, CHAM, BSHA, Director Patient Access and Health Information Management, Mt. Graham Regional Medical Center, Safford, AZ. Phone: (928) 348-4027. Fax: (928) 348-4093. E-mail: [email protected].
- Jessica Murphy, CPAM, Corporate Director for Patient Access Services, Methodist Le Bonheur Healthcare, Memphis, TN. Phone: (901) 516-8162. E-mail: [email protected].]
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