Different focus creates new access paradigm
ScrippsHealth goes outside usual job mix
It’s time to find a different design for access services. At least that’s the view at ScrippsHealth in San Diego, where top managers are thinking outside the box, emphasizing employee education access priorities.
With that in mind, the health care organization is advertising two positions aimed at helping create the access department of the future: quality audit specialist and compliance educator. Each position will require a person with specialized skills, and each will have a pay range of between $48,000 and $61,000, says Leonard Womack, CPC-H, manager of coding management and compliance.
The quality audit specialist position, he says, is in part an outgrowth of ScrippsHealth’s recent commitment to becoming certified in ISO 9000, a quality management system created by the International Organization for Standardization in Geneva. (See Hospital Access Management, October and November 1998.)
"We were already compliant with the traditional JCAHO [Joint Commission on the Accreditation of Healthcare Organizations] regulations," Womack says. "But from the business office standpoint, JCAHO doesn’t really impact the patient’s perception of quality. JCAHO requires certain things to ensure good record keeping and patient confidentiality. However, the patient is never asked what it is about their experience that they see as quality problems."
Such problems might include presentation of the bill, follow-up collection letters, and staff performance or attitude, Womack says. In working toward ISO certification, which in part requires surveying customers and then acting on the results, Scripps is conducting patient focus groups.
"We develop questions about things we can fix, and then we ask patients for their input," Womack adds. "We wouldn’t want to ask what they think about the UB-92 claim form because we can’t change that. However, with our own itemized claim, we have more flexibility."
After one focus review, which involved four patient groups, the results have been interesting, he says. "One thing we heard loud and clear was that people would like to have a financial counselor assigned to them, one person they can go to for the right answer or who will get the answer for them. We were kind of surprised at the overwhelming response."
There likely will be a change in response to this feedback, Womack says, providing it is borne out by quantitative surveys involving larger groups, which will be done next.
In addition to overseeing the ISO 9000 activities (see related story, p. 65), the quality audit specialist will act as a facilitator for the organization’s continuous quality improvement (CQI) groups, which have been brought under the ISO umbrella, he explains. "In the business office operation, we currently have eight to 10 CQI groups focused on different parts of the billing process," Womack notes, "each with six to 10 employees from billing and collections."
The new employee also will facilitate ScrippsHealth’s QUEST team, a group of 10 directors and managers overseeing most of the ISO documentation effort, which requires a high level of involvement from senior management, he adds.
ISO certification is obtained through an audit, and the quality audit specialist will have the responsibility of organizing that process, as well as overseeing one or more mock audits that will be done before the real thing, Womack says. "Once we obtain certification, the quality audit specialist will be responsible for maintaining that and expanding into other areas of the organization."
Certification for the business office is anticipated by the end of 1999, he notes, at which point the effort will roll out to the entire access department and, eventually, into clinical areas.
A successful candidate for the position must have experience in the ISO certification process and ideally would have, or be willing to obtain, certification as an ISO auditor, Womack says. "The perfect candidate would have done that activity in a health care organization. However, there are not too many hospitals certified at this point, so that may be difficult to find."
Formalizing education
The new compliance educator position comes from ScrippsHealth’s intent to formalize the educational process in access management, he says. "There are a lot of professional areas in the hospital that have educational activities built into licensure or certification, but that hasn’t been the case for those in [access services]. When we did surveys on how people learned to do their job, we found that we had a lack of formal training and a lot of what we call tribal knowledge.’ That is knowledge passed from person to person, position to position, but with no documentation on what makes somebody proficient."
Such a system is inherently frustrating for staff seeking to improve their work, he points out. "For those people to be good, they have to be good at something they’ve only heard about."
The plan, Womack says, is to hire a person for compliance educator with a background in curriculum development, probably with a teaching background, who can develop and conduct educational programs. First of all, these programs would be consistent with the appropriate federal and state regulations, he says. "Next, they would include policies of our various private or other third-party payers and would be specific to the professional needs of the staff."
When applicable, Womack says, the compliance educator will identify existing certification opportunities and will tie the ScrippsHealth program to obtaining that certification. He cites, for example, the Washington, DC-based American Association of Healthcare Administrative Management exam that leads to the certified patient administrative manager credential. "We would see this as a goal for persons interested in obtaining a management position."
The ideal candidate for compliance educator, Womack says, will have strong computer skills because part of the job will include overseeing an on-line educational program the organization recently purchased. (See related story, p. 64.)
Much of the educational effort, he notes, has to do with wanting to retain good employees who are frustrated because of the lack of opportunity for advancement. "We will develop tiers within the job structures, and higher tiers will be accessible through completion of these programs. There will be base goals for some, and others for those interested in moving on."
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