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With the economy in a state of uncertainty and compliance concerns continuing to plague the health care industry, the good news is that access professionals responding to Hospital Access Management’s annual salary survey still are getting increases in pay and in the number of employees they oversee.
There also is evidence that access managers and directors with proven abilities — particularly in the area of patient satisfaction — will see their ability to demand higher salaries increase, according to an executive with a national health care recruiting firm.
Although 20% of survey respondents said there was no change in their income in the past 12 months, 27.3% received a pay raise of between 4% and 6%, and another 35% saw their salary increase by between 1% and 3%. Eleven percent actually got a raise of between 7% and 10%.
A whopping 67.3% of those surveyed said the number of employees in their departments had increased in the past 12 months.
Looking at the survey respondents by job title, results show that 36.4% of access managers make between $50,000 and $59,000 a year. Another 27.3% of access managers make between $30,000 and $39,000, and 27.3% make between $40,000 and $49,000.
Of those who gave their title as director, access management, 33% said they made between $60,000 and $69,000, and another 33% reported a salary of between $70,000 and $79,000. Smaller numbers of access directors — about 11% in each category — reported making between $40,000 and $49,000, between $50,000 and $59,000, or between $80,000 and $89,000.
About one-third of the access supervisors who responded to the survey said they made between $30,000 and $39,000, while another third reported making between $50,000 and $59,000. About half the remainder made less than $30,000, and the rest made between $40,000 and $49,000.
As hospitals and health care systems get relief from the Balanced Budget Act of 1997 and improve their reimbursement rates from managed care entities, a number of them are beginning to see positive bottom lines where previously there had been losses, says Dennis Kain, senior vice president for Atlanta-based Tyler & Co., a recruiting firm that specializes in executive health care positions.
At the same time, he notes, their attention is starting to acutely focus on customer satisfaction. "To that end, creative solutions regarding the admission process which are customer-focused have been well received."
Access managers and directors who can show high scores on patient satisfaction surveys for their areas, or marked improvement in those scores, "will definitely be in demand," Kain adds.
"As our company recruits vice presidents, CFOs, and CEOs, it is clear to us that boards of directors and senior managers are specifically looking for middle managers who have successful patient satisfaction track records," Kain adds. "They anticipate that there will be much more ability on behalf of patients to select their providers, and that with the increasing importance of report cards,’ hospitals will be rated like good hotels and restaurants."
There is "an upward push" on salaries at the middle management level, he says, "but with the pressure on health care resources overall, facilities are intent on hiring only those people who have good track records."
As access managers look out for their own financial well-being, there is increasing concern about their ability to hire and retain competent frontline staff, and to pay those employees a competitive wage.
At Community Medical Center in Scranton, PA, the starting salary for registrars was recently increased to $8 an hour, from $7.60, notes Ellen Byrne, CHAM, RN, director of patient access services. That’s still no more than they could get at McDonald’s, she points out, where compliance and reimbursement expertise is not part of the job description. The upper end of the range is $11.75, she says.
"That’s just not enough for the amount of knowledge they have to have," adds Byrne, particularly with the new emphasis on increasing upfront collections. She says she is exploring with the human resources department ways to better compensate her staff, including offering incentives for good collection results.
At Shands Hospital at the University of Florida in Gainesville, the frontline access staff are divided into two tiers, says Beverly Varshovi, associate director for admissions. "We’ve pretty much eliminated the registrar level. We have financial representatives — outpatient financial specialists, inpatient financial counselors — who have full responsibility for the account."
Each financial representative is charged with "creating a billable account — the quality of the data, the auditing and compliance, verification, all belong [to that person]," Varshovi explains. Employees’ pay ranges from $8.62 to $13.75, she adds.
Emergency department and off-shift personnel have the title of admissions assistant, and are two levels lower, Varshovi notes. They are paid between $6.70 and $10.25.
Most of the staff in the higher-level jobs earns between $10 and $12, she says. "In Gainesville, the two main industries are the University of Florida and hospitals, so there is lots of competition for the candidates I’m looking for to fill those jobs. [Shands’ pay] compares pretty favorably with the local market."
When the area of the city in which North Philadelphia Health System is located was designated an "empowerment zone" during the Clinton administration, funds became available to upgrade salaries, including those for access employees, notes Gilda Chinnichi, CHAM, director of patient access services.
"I was very happy to bring [starting pay] up to $12.80 an hour," she says. "It was $10.25." Interestingly, Chinnichi does not have to deal with the high turnover rates that many of her colleagues at other hospitals face.
Many of the access employees, who belong to a union, have worked for the hospital for many years, which brings its own set of issues, she adds. "Sometimes, it’s not good because they’ve gotten away with doing things their way for many years. Now there are new policies, guidelines, compliance issues — the work routine has changed so much."
With that in mind, Chinnichi — a member of the hospital’s compliance committee — is conducting staff training. She also is discussing with union representatives the possibility of having employees take the National Association of Healthcare Access Management’s certified healthcare access associate exam.
"That would be another incentive to learn and study and retain," adds Chinnichi, who says she is working toward establishing a financial incentive for certification.