Patient Access Career Ladder

1. Patient AccessCareer Ladder Presented By: Linette Farris Sandra Clay-Hillyard September 2011

2. Purpose: In response to: the Press Ganey Employee Satisfaction survey employees’ indication that they needed additional career growth opportunities within their positions improving overall employee development improving retention a Career Ladder was developed modeled after the Nursing Division’s Clinical Advancement program.

3. In the beginning (2003)… • Solution was sought to reward veteran staff members – LEAD Position • One per area per shift • Application and interview process open to current staff • Candidates would provide • Departmental training • Availability for flexible shifts • Assistance to managers/supervisors

4. While the intent was worthy … • To reward long term staff who were very capable but no longer eligible for merit increases due to reaching scale

5. The result was not productive … • Selection criteria was too limited • Inconsistent accountability regarding required tasks (example: some LEADs never did training) • Limited opportunity based on available positions

6. The staff were EXTERNALLY motivated. • The LEAD positions actually served as demotivators. • Non-LEAD staff felt they had no authority or autonomy to effect change • LEAD staff did not uniformly perform the anticipated tasks • LEAD staff were not held accountable on a consistent basis

7. Intrinsic Motivation “Three key goals of people at workTo maintain the enthusiasm employees bring to their jobs initially, management must understand the three sets of goals that the great majority of workers seek from their work—and then satisfy those goals: • Equity: To be respected and to be treated fairly in areas such as pay, benefits, and job security. • Achievement: To be proud of one's job, accomplishments, and employer. • Camaraderie: To have good, productive relationships with fellow employees.” Why Your Employees are Losing Motivation - by David Sirota, Louis A. Mischkind, and Michael Irwin Meltzer, April 10, 2006, Harvard Business School http://hbswk.hbs.edu/archive/5289.html

8. Take 2 – The Career Ladder • Provide a Career Path for all Patient Access staff • Recognize and Reward long term staff who were capable and enthusiastic about stretching the limits of their job descriptions • Tap in to the Informal Leaders on the team

9. Patient Access Teams PSRs (Patient Service Reps) ED Registration Patient Service Center Pre-Registrars Call Center Benefit Reps Financial Clearance Unit WHO ?

10. The Career Ladder is an incentive for which an employee applies through a defined process. The incentive is NOT part of the employee’s base pay. Employees must re-apply during each performance review. TIER 1 New to field or new to LGH TIER 2 5 years experience $1/hour $2080 FTE annually TIER 3 8 years experience $2/hour $4160 FTE annually WHAT ? APRIL 2008

11. TIER 1 MINIMUM STANDARDS • Individual upholds LGH Standards of Performance • Quality Assurance Accuracy of 95% or better • Successful completion of the departmental Annual Competency Evaluation

12. Standards of Performance • Appreciation • Attitude • Presentation • Sense of Ownership • Communication • Commitment to Fellow Employees • Timeliness of Service • Privacy • Safety Awareness • Accountability

13. Quality Assurance Accuracy • LGH Campus Wide Stats - 2011

14. Pre-Services – August 2011QA Stats

15. Departmental Annual Competency The competency validation process will include evaluation of nine general competency topics. These topics include: • Auto Accidents • Consent Forms • Medical Records • Insurance, Insurance Verification • Medicaid/MassHealth • Medicare • Paragon • Patient Rights • Workers’ Compensation • In addition to the general competencies you will receive an area specific quiz for the department/s which you work. Please complete each quiz and return to your supervisor.

16. Patient Access Department - Registrar Competency Exam Created By mmatias • A timed and scored examination that will measure a Patient Access Representative's ability to perform basic registration and insurance verification functions. This test is a mandatory examination that requires a passing score for continued employment. Q.1)  Per The Joint Commission standards, what is the minimum number of patient identifiers required to verify the identity of a patient?  A. One B. Two C. Three D. Four E. None of these Q.2)  An 8 year old patient is registering for a Radiology appointment. His mother and father each have separate insurance coverage through their employers. The child is covered by both policies. Mother: BCBS - Mother's DOB 04/10/1970. Employed by PepsiCo, which has over 100 employees. Father: Oxford-. Father's DOB 01/17/1969. Works at local pharmacy, Alvin's Drugs, and has 9 employees. Which policy is primary? Q.3)  A  patient arrives for an outpatient appointment. As you verify eligibility, you notice that the patient has Medicare part A only. His Medicare part B is inactive. How should this patient be registered? A. Using Medicare Part B B. Using Medicare Part A C. Self-pay http://www.proprofs.com/quiz-school/story.php?title=patient-access-department-registrar-competency-exam

17. Tier 1 Minimums 5 yrs experience w/ 1 at LGH 97% QA for 3 months Meets all productivity standards Cross Trained in at least one other access area CHAA or CHAM No disciplinary action within past 6 months Tier 1 Minimums 2 yrs experience w/1 at LGH 97% QA for 3 months Meets all productivity standards Cross Trained in at least one other access area CHAA or CHAM No disciplinary action within past 6 months TIER 2 TAKE 3 APRIL 2008 OCTOBER 2011

18. PRODUCTIVITY STANDARDS • Collections • PSC, ED, Pre-Services: 8/month, Current Residuals or Prior Balances • Financial Clearance Unit: Per Cent of Potential • Call Completion • Call Center: Not Ready Time, Return Calls to Queue, Dropped Calls • Number of Registrations • Customer Service • Call Monitoring

19. CUSTOMER SERVICE • Our personnel acknowledge callers promptly and courteously with a pleasant expression and tone of voice. • Our personnel use words that express respect, patience and understanding when talking with patients and/or other staff members. • Our personnel care for people with kindness and gentleness, rather than with roughness and cold indifference. • Our personnel answer the telephone quickly and courteously. They identify themselves by name and department. They provide callers with the opportunity to respond to a request, to be placed on hold and to learn where their calls are being transferred. • Our personnel protect the confidentiality of patients, coworkers and others who use our facility. • Our personnel consider the effects of what they say and do in the presence of patients and staff. They refrain from conducting personal (not work related) conversations in front of patients or staff. • Our personnel refrain from discussing other staff members, organizational policies, problems or medical care in public areas. • Our personnel maintain and utilize hospital equipment and facilities in an appropriate and cost-effective manner.

20. Tier 2 Minimums 8 yrs experience w/ 2 at LGH 97% QA for 6 months Embodies an individual w/ positive professional manner Peer Interviewer or LGH/PA Committee or Conducts Seminar Conducts In-Class Training or Department Training Tier 2 Minimums 5 yrs experience w/2 at LGH 97% QA for 6 months Rates 4 or 5 on Attitude in SuccessFactors Peer Interviewer or LGH/PA Committee Conducts Seminar Conducts Training for New Employees TIER 3 TAKE 3 APRIL 2008 OCTOBER 2011

21. PATIENT ACCESS SEMINARS

22. PEER INTERVIEWER • Peer Interviewing is the practice of including members of a work group in the hiring process. • 3-5 peers participate • Meet with candidates, ask appropriate questions and answer any candidate questions • Peers determine whether candidate is the right “fit” for the organizational culture • Peers communicate and discuss with supervisor/manager best candidate

23. Admission Process 10/09 Admissions Newborns 08/10Advance Directive Healthcare Proxy 08/10 Bed Assignments 10/09 Bed Board 08/10 Birth Announcements 10/09 Career Ladder 08/10 Cash Accounts _ Collection of Deposits 10/09 Census Changes 10/09 Code Triage 08/10 Collecting Bad Debt at POS 10/09 Commercial Insurance 10/09 Communication and Handling of Secured Patients 10/09 Condition of Admission 08/10 Condition of Admission - Limited English Speaking Patients 12/10 Confidentiality 10/09 Consent For Treatment of Minors 08/10 Continuing Education 10/09 Copay Collections Emergency Department 10/09 Critical Bed Shortages 08/10Customer Service 10/09 Death Register Certificates 08/10 Department Patient Education Plan 08/10 Department Performance Improvement Plan 10/09 Designating Patient as VIP Status 10/09 Determining Primary Insurance 10/09 Disciplinary Action 10/09 Downtime Procedure 12/10 Dress Code 08/11 Earned Time Requests 08/09 Emancipated Minor Rule 05/10 Emergency Department Registration 08/10 Ethnicity-Race of Patient 10/09 Facility Directory Patients Right to Opt Out 10/09 Faxing PHI 10/09 Fetal Remains 08/10 Gore-Tex 10/09 Harassment - Sexual Either Sex 10/09 Hospital Services Brochure 08/10 IC – Admission of Communicable Diseases 10/09 IC - Hand washing 10/09 IC - Isolation Precautions 08/10I C - Standard Precautions 08/10 Infection Control 10/09 Inpatient Copay Coinsurance and Deductibles Collections 10/09 Interdepartmental Relationships 10/09 Intrafacility Transfers 10/09 Maternity Pre-Registrations 10/09 Medicaid - MassHealth 10/09 Medical Clearance 10/09 Medical Screening Examination 08/10 Medicare 10/09 Medicare - An Important Message from Medicare 4/11 Medicare - Procedure for Non-covered Services ABNs 10/09) Medicare - Questions 04/09Mission and Philosophy 10/09 New Employee Orientation and Training 10/09 Newborn Pre-Reg Admission SheetOutpatient Copay Coinsurance and Deductible Collections 10/09 Patient Access Quality Assurance 10/09 Patient Admission and Permanent Record 08/10 Patient Advocate 10/09 Patient Identification 10/09 Patient Service Center Time Log Procedure 10/09 Patients' Right to Request Treatment 10/09 Payroll Time and Exceptions 10/09 Per Diem 10/09 Personal Telephone Calls - To and From Employees 10/09 Preferred Language Labels 10/09 Pre-Registration Process 10/09 Pre-Registration Schedules 10/09 Privacy Practices - Notices and Distribution 08/10 Registration 10/09 Registration - Auto Accidents 12/10 Registration - Daycare 12/10 Registration - Express Registration 10/09 Registration - Nonpatients 04/09 Release of Patient Information 10/09 Safety - Conduct to Minimize Violence 10/09 Safety - Department Safety 10/09 Safety - Department Safety Training and Orientation 10/09 Safety - Recognizing Inappropriate Behavior 10/09 Sick Call Notification 04/09 Special Care Nursery Transfers 12/10 Standards of Patient Service 10/09 Valuables 08/10 Verification of Insurance Eligibility 12/10 Weekend Outpatient Admissions 8/10 Workers Compensation 12/10 TRAINING

24. SUCCESSFACTORS

26. SELF EVALUATION

27. PATIENT ACCESS BY THE NUMBERS • 81 Employees (plus 7 management positions) • 58.25 FTEs (plus 7.0 FTE management positions) • Four TIER 3s • Six TIER 2s

28. PATIENT ACCESS TENURE • Employee Years of Service • 6.5 Average • 4.1 Median • 37.5 Longest

29. RATE OF TURNOVER Current YTD Turnover as of August 31, 2011 for Patient Access is 7.95% (projected to be at 11.36% at year end at current rate of turnover).

30. $$$$ • Cost of Career Ladder Program Annually = $29,704. • Cost of Turnover 2007 compared with Cost of Turnover projected 2011 = 5% savings. • Cost Savings of 5% in budgeted salaries alone = $182,921. • 5% of 81 staff members - the turnover savings is 4.05 employees X $52,500 (150% of 35000) = $212,625.  Net savings to the organization taking out career ladder expense is $182,921. • Gain in Employee Satisfaction – PRICELESS.

31. Questions? Comments? THANK YOU FOR ATTENDING!