Redesign, cross-training improve customer service
Guest relations employees add to the mix
With the aim of enhancing customer service and reducing its accounts receivable days, Valley View Hospital in Glenwood Springs, CO, has consolidated its admitting and patient accounting departments, cross-trained staff, and redesigned its processes, says Kathy Trauger, patient financial services operational leader.
"We found that the whole system was broken," explains Trauger, whose title before the reorgan-ization was patient accounting supervisor. "We weren’t getting the information the billers needed, and the registrars didn’t know why it was needed. We’re working toward having someone or a team of someones’ handle a patient from beginning to end."
There are no measurable results as yet, Trauger says, because of the "catch-up" process involved, partly due to an ineffective outsourcing billing arrangement that is no longer in place. Also, besides combining departments and cross-training staff, Valley has added a new electronic claims system with automatic posting and implemented an optical system. "We had to start pretty much at ground zero with the staff training, even to the point of doing basic training on how to get around a PC, since we had been using dumb’ terminals before," she adds.
Before the consolidation took place, a team made up of the chief financial officer, Trauger, a patient account representative, an admissions representative and the hospital’s continuous quality improvement (CQI) director laid the groundwork during the summer of 1996, she says. "We worked off site, did research, and interviewed patients, hospitals, and other kinds of businesses."
The transition actually began around the first of January 1997, when the entire staff had to reapply for jobs. As part of the redesign, managers in the combined departments were winnowed from three to one, but staff remained at about 37 FTEs. One manager left, and another moved to a different area of the hospital, Trauger notes.
Each of the employees has been cross-trained in billing and registration functions. They are broken into teams according to patient type:
• Medicare, Medicaid, and CHAMPUS;
• commercial and managed care payers;
• self-pay accounts;
• emergency department (ED).
Because the hospital is located on a busy interstate highway, it provides care to a large number of transients and thus processes a higher percentage of self-pay accounts than many other facilities, Trauger points out.
Under the reorganization, the ED and commercial/managed care teams are the biggest because the hospital has a large ED volume and must provide 24-hour staffing there, she explains. There is some "floating" among the teams. For example, some members of the ED team float into the commercial team, and some float into ED technician positions.
Reporting to Trauger are "working coordinators" who oversee the teams. There is a government coordinator, a self-pay coordinator, a commercial/managed care coordinator, and an ED coordinator. A technical coordinator oversees the department’s newly acquired optical imaging system and other technological improvements, and a guest relations coordinator oversees a five-person guest relations staff.
The guest relations staff newly instituted as part of the reorganization are available to process mail, answer phones, greet arriving patients, transport patients to their rooms, and handle an express window, where they take deposits from preregistered patients and finish registration process. They are cross-trained on the optical system and can check the electronic claim system to see whether a claim has been billed.
The department also has a charge analyst, who does internal audits and client billing for the hospital’s reference laboratory, among other duties.
Training, a one-on-one process, has been tough at times, Trauger says, and continues to be a struggle because of the different learning styles of various employees and the need to customize training at times. Still, she says, no one has been let go because of their slower learning pace. "For some it just takes more time."
To facilitate the training process, she says, team members have been divided into pairs, with one employee becoming the billing expert and the other concentrating on registration functions. After about three months or when employees demonstrate certain competencies they reverse roles. "I felt they really needed to learn one area and then move on to the next," Trauger explains. "If after an allotted time, employees do not exhibit competency, they go through some retraining."
Staff are enthusiastic
The staff response so far has been "absolutely wonderful," she says. "We have had some turnover, but not as much as anticipated, and the staff have been excited and willing to learn. They want to make it work for the patients."
Trauger attributes the successful transition in part to a "family feeling" and tradition of loyalty that she says the hospital has managed to maintain despite the departure of its chief executive officer of 15 years. The CEO who subsequently was hired, faced with an unpopular organizational restructuring and hammered by an influx of managed care, elected not to stay, Trauger explains. Now there is a new person in the position "who plans on making some changes in the management structure in the near future."
One of the benefits that’s becoming apparent is the increasing familiarity the teams have developed with the patients they work with most closely, she notes. The focus is made more specific because of the alpha split within the teams. Staff "are working with the same patients over and over and developing a good rapport with them," Trauger adds. "This way, patients know whom to call and that the person will have an understanding of them."
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