Executive Summary
Patient access leaders interviewed by Hospital Access Management report greatly expanded roles and continual changes in their jobs. Some of their toughest challenges:
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Keeping up morale when two healthcare systems merge.
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Managing departments in disaster mode when emotions are running high.
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Stepping into a new role to replace a well-respected patient access leader.
Change. Like many patient access leaders, Ginger Beard, MBA/HCM, CHAM, network director of pre-services at Phoenix-based HonorHealth, sees this area as her biggest challenge. Here, patient access leaders share some of their toughest moments:
• Managing patient access departments during a merger of two healthcare systems.
Scottsdale Healthcare and John C. Lincoln Health Network recently merged, forming HonorHealth. “For our patient access areas, it involves many different aspects,” says Beard. These aspects include writing new job descriptions, integrating salary structures, introducing new electronic medical record (EMR) systems to staff, and redesigning workflows.
“With that comes the challenge of keeping up staff morale, while still having the goal of increasing employee engagement scores,” Beard says.
Two pre-services departments are merging into one physical location. “This needs to be done without negatively impacting the bottom line,” Beard says. This goal means no decrease in pre-registrations or point-of-service collections, and no missed prior authorizations or inpatient notifications.
Both pre-services departments verify insurance eligibility and benefits, secure prior authorizations, perform pre-registration, and provide financial counseling. However, each has a different salary structure and different job titles. The two merging organizations also have different EMR systems. “So the patient access departments are quite different and quite similar at the same time,” Beard says.
At one organization, the admitting department processed only same-day and next-day add-on accounts. “This left pre-services to work accounts further out, so they reflected healthy key performance indicators for lead days,” says Beard.
However, the other organization’s pre-services department works all accounts, with a heavy volume of same-day or next-day radiology add-on accounts. This process results in them continuously working next-day accounts. “They are never able to get further out on their lead day metric,” says Beard. With the integration, the same-day and next-day add-on accounts are being moved to the responsibility of the admitting department.
• Being promoted to the position of patient access director after the tragic death of the previous director.
Brenda Sauer, RN, MA, CHAM, FHAM, patient access director at New York City-based New York Presbyterian Hospital, worked with the previous patient access director in the last three months in his battle with cancer. “Senior leadership felt that having a nurse in the role would help with patient throughput and tapped me for the position,” says Sauer.
The previous director was well-respected by members of the staff, and, as with any death, they needed to mourn his passing. “Yes, I helped with patient access, but my background in oncology nursing is what got us through this very difficult time in the department,” says Sauer.
Sauer was able to answer the staff’s many questions regarding end-of-life care, including pain management. “There had been employees who never knew someone dying from cancer,” she notes. “After his death, I provided them time to grieve.” Sauer also provided individual and group sessions for staff members to discuss what they were feeling.
• Managing the patient access department on Sept. 11, 2001.
Sauer and her staff first stood in disbelief after being called into the waiting room where the television was located and seeing the first plane hit the World Trade Center. “After a minute or two, I realized that the building was on fire, and that the burn patients would be coming to us as the regional burn unit,” she recalls.
The hospital was in disaster mode. “We were preparing for many patients to be brought to our ED. In the end, only 36 came,” she says. “You would walk in the ED hoping to see patients, and they never came.”
Sauer had to manage both her own emotions and those of the staff, so they could continue working. “What we were not prepared for were the hundreds of people who came looking for their loved ones and leaving pictures so we could identify them,” she says.
Employees who worked in admitting needed to be rotated out frequently. “Many times, they would break down crying at the stories we heard,” says Sauer.
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Ginger Beard, MBA/HCM, CHAM, Network Director, Pre-Services, HonorHealth, Phoenix. Phone: (623) 879-3809. Fax: (623) 434-6208. Email: [email protected].
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Brenda Sauer, RN, MA, CHAM, FHAM, Director, Patient Access, New York Presbyterian Hospital, New York, NY. Phone: (212) 746-4630. Fax: (212) 746-2891. Email: [email protected].
