Registrars no longer at bottom of pay scale barrel
Turnover will decrease, director predicts
When Baycare Health System decided to standardize titles and pay for access services positions throughout its 11 hospitals, the first inclination was to stick with the traditional job hierarchy, says Martine Saber, CHAM, regional admitting director for the Clearwater, FL-based system.
That meant registrars would be at the bottom of the pay scale, with financial counselors and schedulers higher up the ladder, she says. "But then I said, Let’s list all the skills required for each position and see how different they are.’"
She discovered, Saber says, there weren’t many functions a scheduler performed that a registrar did not. And with responsibility for a clean bill being pushed more and more to the front end, it didn’t make sense anymore to put registrars at the bottom automatically, she adds.
"The registration process is so important to customer satisfaction, and so many goals are based on that," Saber points out. "We hired Professional Research Consultants [PRC, Omaha, NE] to look at customer satisfaction, not only for the patient, but for the physician. With financial counseling, one important function is to know charity guidelines and how to collect money. How do you weigh which position is more important? Financial counselors don’t deal with patients as much as registrars do."
After studying the skill sets for the access positions, Saber says, she realized several things: "They all had to have some sort of customer service skill, and they all had to know about insurance [requirements]. The registrar has to know as much about insurance as the financial counselor because it’s not just the financial counselors calling for authorization. We can’t wait that long."
Even schedulers have to understand insurance, she notes. They must know when scheduling an exam whether the patient’s insurer has contracted with the facility in question and if authorization is needed. She concluded there were few differences among the positions.
With that in mind, Saber, assisted by a team of employees from all of Baycare’s hospitals, designed pay ranges based on skill level rather than job title. Expanding on a model used by Sarasota (FL) Memorial Hospital, Saber eliminated the myriad access titles throughout the Baycare hospitals and created four categories:
1. Patient access services representative I: This employee may be hired "right off the street" and trained to perform at level one of any of the access services jobs. To qualify, the applicant must type. Computer skills and knowledge of medical terminology are preferred.
2. Patient access services representative II: This employee must have at least two years of hospital experience related to access services and be skilled in medical terminology. In addition, he or she must know at least 50% of the jobs in the department, which might include registrar, financial counselor, cashier, scheduler, data technician, and receptionist, among others.
3. Patient access services representative III: This employee must have three years of experience in patient access services, certification through the CPAT (certified patient accounting technician) exam, and skills in all of the jobs in the admitting department.
4. Patient access services coordinator: This is a "lead" position within the admitting department, which no longer has supervisors. This employee must know all the departmental functions and have the CPAT certification. An associate degree is preferred, and leadership skills must be demonstrated. This job is a proving ground, designed to provide candidates for any managerial positions that come open.
Four ranges of pay accompany the job categories, Saber says, with compensation ranging from $7.85 to $11.38 per hour for access representative I; from $8.31 to $12.05 for representative II; from $8.81 to $12.78 for representative III; and from $9.93 to $14.40 for the coordinator position.
Before, the overall pay range for admitting positions was $6.90 to $12-plus, she adds, but employees were paid by position and seniority, not by skill level.
Under the new pay system, Saber predicts, the majority of the access employees will eventually be at level two, with relatively few making it to level three. "There’s one person who’s on the borderline between level one and level two," she says. "We’ve said she could stay in level two but has nine months to get a medical terminology class."
No one will have his or her salary reduced, Saber adds, "but they might reach a point where they won’t make any more money."
There is some dissent regarding the new ranges, she says. "Four financial counselors feel that because tradition is that financial counselors always got paid more, they don’t want to change and learn more [skills]. They are unwilling to adapt to cross-training."
Team members who are not receptive to the changes probably won’t stay on the job for long, Saber adds. "They will choose to leave because they won’t be comfortable. This is a new era of access services."
Pay adjustments called for under the new arrangement will cost roughly $60,000 the first year, Saber says, a cost she predicts will be offset by reduced turnover. "We have found that it costs the health system about a year’s salary when someone leaves," she explains. "[Access employees] average about $17,000 a year. Last year, about 97 left, which was a 45% turnover and a total cost of $1.7 million."
Fifty percent of those who left, Saber adds, did so because of dissatisfaction with pay. In return for her boss’s approval of the new pay ranges, she has promised to reduce that part of the turnover — amounting to about $850,000 in costs to Baycare — by half, which would save the health system $425,000, she says.
At the Baycare facilities where access employees previously were paid the least, turnover has been the highest, Saber points out, while at those paying the most, fewer employees left and almost none because of money.
"I’ve said I’ll make half of that [dissatisfied] population happy," Saber notes. "So an investment of $60,000 will save the health system $425,000. It’s one of my goals for next year."
The new pay ranges are exciting, she says, because they allow her to pay employees more, not just because they’ve been around forever, but because their skill level is higher. "In the past," Saber adds, "I haven’t been able to offer competent people the money."
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