Access career ladder targets burnout, turnover
'I want to promote from within'
Demonstrating leadership ability, obtaining a professional certification, and meeting collection goals are among the key requirements of a comprehensive access career ladder being implemented at The Children's Hospital in Denver. (See ladder.)
"The biggest thing our staff would need to do to go to Level II is to pass the CHAA exam," says Stephanie Benintendi, CHAM, director of patient access.
Staff who work the day shift typically are cross-trained in other access areas, she notes, so that requirement is accomplished pretty quickly. Another requirement for Admissions Representative Level II is to participate in a departmental quality initiative.
That could be, for example, a customer service program now under way aimed at raising the hospital's Press Ganey scores, Benintendi says.
All 21 admission representatives, by virtue of qualifying for the job, are at Level I of the ladder, she adds, which equates to 15.52 full-time equivalents, including part-time and PRN employees.
The organization's focus on upfront collections is reflected in all three levels of the career ladder. Level I status requires that the employee maintain the collection goal set in the annual evaluation; and to qualify for Level II, the access representative must exceed the Level I figure by at least 10%. To achieve Level III, employees must consistently meet a goal that must be at least 15% higher than that for Level II.
To assist staff in collection of copays, Benintendi explains, there is an established path for them to follow.
"When a person is scheduled for inpatient or ambulatory surgery, our team calls and gets their benefits and other insurance information and loads that in the record," she says. "If the patient is checking in, [the registrar] says, 'I see that part of your benefit is a $250 copay. How do you want to take care of that?'"
If the patient is being preregistered over the phone, Benintendi adds, staff will try to direct the family member to look at the insurance card to see if there is a specific copay, and then say, "We will anticipate collecting that amount when you check in."
The hospital uses a registration system from Madison, WI-based EPIC that allows money taken from a patient to be automatically posted to that account, she notes. Reports can be pulled showing collection totals, which are tracked on a weekly basis.
"We can get down to the representative level, even to the individual account detail," she says. "We can see that, for example, someone collected 17 copays this month. We're not good at [determining], 'You collected 17, but should have collected 50.'"
During a weekly quality review process, an admissions supervisor pulls five random cases to check for collection effectiveness, Benintendi notes. "If the copay is listed on the insurance card and the screen and the admissions representative didn't collect, she has to document why she didn't collect."
If there is not a good reason, she adds, that is reflected in the person's score.
The quality review score also plays into the career ladder requirements. Level I reps must maintain an accuracy rate of 2.7 (out of 3) and meet productivity standards, while Level II reps must maintain the same accuracy rate and consistently exceed productivity standards. Level III reps must consistently exceed the 2.7 accuracy standard.
To reach the top of the admissions representative career ladder — Level III — employees also must pass the CHAM exam, demonstrate a working knowledge of spreadsheets and data collection, and initiate at least one performance improvement project for the department annually that results in a change of process, among other requirements.
NAHAM forum sparked interest
Benintendi says she decided to pursue the development of a career ladder after participating in an access forum sponsored by the National Association of Healthcare Access Management (NAHAM), which created and administers both the CHAA and the CHAM designations.
"I learned about another [hospital] that had done something similar that seemed pretty successful," she adds. "I thought, 'If they can do it, I'll see if I can.'"
After designing the career ladder in October 2003, she brought it to the hospital's human resources department in 2004 and began working to get approval for the program, Benintendi says. She finally received that OK in the first quarter of 2006.
While she had the career ladder virtually completed before bringing it to human resources, in retrospect, she notes, she would have involved the department "early and often," which is her advice to those working on a similar project.
"Typically, without HR understanding from the beginning why you're doing [a career ladder], your intent, and how you will manage and communicate it, it takes a lot of time to get them up to speed," Benintendi says. "I've spent a lot of time going back and forth with them, with them asking, 'Now, why do you want to do this, and how are you going to do it?'
"It's been two and a half years since my initial submission," she adds, noting that if she had the process to do over she would have contacted HR for input as she was designing the ladder.
At least two staff members already have expressed interest in working to complete the requirements for Level II, Benintendi says, and she anticipates that interest will grow as the first few employees are successful in their efforts.
"I expect about a third of the staff will be interested in moving forward, and the other two-thirds will be a little hesitant at first," she adds.
"In an ideal world, if all of the staff were at Level III, they would need little supervision, which is the intent we had in mind," Benintendi notes. "We want to improve training and education and increase retention."
Employee burnout, resulting in extremely high staff turnover, was an issue when she became director, she says, noting that stress levels have been particularly high among staff working in the emergency department.
"We don't have a central admissions area for inpatients," Benintendi says. "They now go through the ED and have to be screened by an attending physician if they are direct admits."
Children's Hospital is a level one trauma facility, she adds, and 2.5 admissions FTEs are designated for the trauma area, where they stay 20 hours a day waiting to register those patients. There are about 40,000 visits a year to the hospital's ED, Benintendi adds.
The career ladder, she suggests, will lead to more job satisfaction, and will help admissions employees have a greater sense of ownership in the department. Another goal is to groom staff to become supervisors or to move up to the management level, she adds. "If one of our managers leaves, I want to be able to promote from within."
An access representative could progress from Level III to supervisor, and from there to business analyst or departmental trainer, Benintendi says.
"We want [employees] to know that if you're good at the job you do, and there is more you want to do, you don't necessarily have to leave us."
[Editor's note: Stephanie Benintendi can be reached at (303) 764-8021 or by e-mail at [email protected].]
Demonstrating leadership ability, obtaining a professional certification, and meeting collection goals are among the key requirements of a comprehensive access career ladder being implemented at The Children's Hospital in Denver.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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