Access gaining new respect, observers say
Downsizing trend may be reversing
When one veteran access services director found himself in the job market recently just a year after taking the consulting post he was about to lose due to the company’s decision to dissolve he got a pleasant surprise: More access positions were available than the year before.
At least some evidence exists that what this professional who found himself with a choice of three excellent job offers describes as a "wonderful, positive trend" is exactly that. Whether it’s a reaction to the dubious results of patient-focused care initiatives, the recognition that strong front-end management is crucial in the increasingly complex managed care environment, or something else, managers with expertise in the admitting and registration arena are attracting renewed respect, some health care observers say.
Anne McCune, who recently left a position as senior manager with management consultants KPMG Peat Marwick in Chicago to become senior vice president for hospital financial operations at City of Hope Medical Center in Duarte, CA, says the way access services are viewed by top management is definitely changing. In her job as a Peat Marwick consultant, McCune says, she worked with more than 10 hospitals in 1997 where the consulting project resulted in reversion to the traditional hospital model of a person in charge of access services.
"As [organizations] were trying to improve performance because they had eliminated functions on the front end, thinking they were trivial they saw they needed strong management, policies and procedures, really good controls" upfront, she says. "They were losing money because of inaccurate bills and authori-zations not properly coordinated."
Shoring up the access function
That trend showed up again when McCune, whose background is in access management, returned to the hospital setting. "I found here that we needed to put a lot of investment of money and effort in rebuilding our access services everything from technical data management to customer service," she says. "I ended up bringing in a high-level person, a director of patient access services, who could coordinate all of our access functions."
That move was a departure for the medical center, which had employed some front-end managers but never a director, McCune says. The previous managers were line supervisors who didn’t have the technical knowledge to pull processes and systems together or the skills to coordinate interactions with clinical departments, financial areas, medical records, social work, and housekeeping, she adds.
Anthony M. Bruno, MPA, director of admissions at Albert Einstein Medical Center in Philadelphia, says he’s heard comments recently indicating a newfound esteem for the access function. "It makes a lot of sense," he notes. "There was a trend to close down admissions, go to patient-focused care,’ but what’s happened is that with all the managed care contracts and capitation, [the front-end processes] have become so much more complex."
That complexity and the critical link of front-end functions to financial outcomes has led many institutions to re-examine how they’re handling registration, Bruno adds. Along with this is a renewed interest in having a strong leader overseeing access, he says, although the position might be called something different, perhaps associate business manager.
There is an increased awareness that access is much more than an extension of the business office, Bruno says. "On the front end, you have to be actively involved in JCAHO certification, in giving patients their rights and advance directives. It’s much more intently customer service-focused, and the relationship extends quite naturally to physician offices. [Access] interacts with just about every other department, whereas the business office doesn’t."
That doesn’t mean, however, that there should be a "soft approach" to access, Bruno emphasizes. Access managers "should be concerned about accounts receivable, should be making sure they know about every data field that must be completed to have a bill pass through successfully."
The right stuff
Part of the reason admitting and registration departments have been maligned in the past has been the failure to have "the right people with the right training doing the right jobs," he says. "You need to establish a business relationship with the patient. With more capitated contracts and managed care, you’ll start to see that with the right management, a true collaboration, and the energy to build a strong front end, everyone benefits."
That kind of success requires "a real effort to get the right people, train the right way, and do the right job," Bruno says. "You can collect the [name of] the primary care provider, but if it’s not the right primary care provider, what’s the point? Take time to do the proper investigation."
Betty Bamonte, CHAM, acting director of patient admissions at Louisiana State Univer-sity Medical Center in Shreveport, notes that during a recent computer installation, for the first time the vendor representative in charge had a background in access rather than patient accounting.
"I told them over and over again how much better that was," she says, explaining that it was just one more indication of the increased value that’s being placed on access services and its accompanying skill set.
All of a sudden,’ AMs are experts
Because her own position necessitates inter-action with nearly every hospital department, she increasingly is consulted when changes to the computer system are considered. "If somebody wants to add something to the system or if there’s a problem, the majority of the time, before they make any changes, they call and ask me what I think about it to make sure it’s going to work correctly in my areas and in others."
She recently was given the password to the testing portion of the new system and asked to work on it for a few days and then call with her feedback. Meanwhile, she had just returned from a meeting on physician billing.
"They wanted me to consult with them on a new system before they put it in."All of a sudden, they realize that registration sees everybody that comes in the door 450,000 [patients] a year in this office and that we’re the beginning and affect everything that goes on in this institution."
Because of her experience over the years with computer systems and processes, Bamonte has developed skills that qualify her "for things I never would have thought I qualified for. You sit in meetings and pick up on things and before you know it, somebody asks a question and you know the answer and nobody else does."