Access Management JournalOfficial Journal of the National Association of Healthcare Access Management Volume 35, Number 1

National Association ofHealthcare Access Management

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The Use of Barcode Medication Administration to Safeguard Patient Safety 6

What’s in a Number? 9Pre-Registration Key in Reducing Days

in A/R: A Process Redefined 10

Access Management Journal Author Guidelines

The NAHAM Access Management Journal is published by the National Association of Healthcare Access Management (NAHAM). It is designed to share ideas and experiences, and to learn about trends and developments in the field of Access Management. The Journal welcomes news, articles, and story ideas from members and other writers.

Article TopicsThe NAHAM Access Management Journal accepts unsolicited articles but does not guarantee publication of all submissions.The Journal accepts a variety of article types, including: • First-hand experience with trends in the field• New projects that your organization is developing or

implementing • New products or services that have increased your job

productivity • News from committee or affiliate meetings• Trends or problems emerging in the workplace or the field

in general • Reports on legislation or policy issues that affect the field• The “lighter side” of the workplace• Book reviews related to work or the field • Articles on topics of special relevance to front-line staff

The NAHAM Access Management Journal welcomes submissions from the industry. Specific products or companies cannot be endorsed in editorial pieces and therefore should not be mentioned in the body of the article. Company and/or product information may be included in a brief description contained in the author biography at the end of the article.

Submission FormatArticles should be submitted in English, by e-mail in a Microsoft Word file. If e-mail is not available, files can be sent on a CD via mail. Times New Roman 12 pt. or Arial 10 pt. font is preferred. Articles should be accompanied by a cover sheet that includes the article title, author(s) name(s), address, telephone number, e-mail address, and brief biography (one to two sentences that contain the author’s name, credentials, current position, and committee name and/or chapter affiliation, if applicable).

Quotes and statements from sources must be attributed. Facts (such as statistics) must be referenced. Do not use abbreviations. Acronyms may be used after the first full reference.

Photos or graphics must be camera-ready and can be submitted as an attachment via e-mail along with the article. Acceptable photograph file formats are JPG, TIF, and PDF. Photos must be high resolution (300 DPI). Hard copy photographs also may be mailed. Graphs, tables, and charts also may be submitted to further illustrate the article.

Copy EditingAll articles are subject to editing by the editorial staff.

ExclusivityArticles should not be under consideration for publication by other periodicals, nor should they have been published previously (except as part of a presentation at a meeting).

CopyrightAuthors must agree to a copyright release, transferring copyright ownership to the Access Management Journal before an article is published.

Publication Schedule

How to SubmitAll articles and accompanying photos or graphics should be submitted via e-mail to the NAHAM editorial team at journal@naham.org. Additional information also may be found on the NAHAM website at www.naham.org. Microsoft Word files on CD, hard copy photographs, or supporting materials can be mailed to:

NAHAMAttn: Access Management Journal2025 M Street NW, Suite 800Washington, DC 20036

If you would like your photos or files returned, please include a self-addressed stamped envelope.

Alternatively, articles may be submitted via our secure online form, which can be found at www.naham.org. Before completing the online form, please have an electronic copy (.doc or .txt file preferred) of the article ready for upload. Any accompanying attachments must be sent via e-mail to journal@naham.org.

Submit an article to the Access Management Journal today! Authors earn 3.0 contact hours per published article. To view issues of the Journal online, visit www.naham.org.

Issue Materials Deadline Publication Date

Issue 2, 2011 (Printed Issue) July 1, 2011 September 1, 2011Issue 3, 2011 (Online Issue) November 1, 2011 January 2, 2012Issue 1, 2012 (Online Issue) March 1, 2012 May 1, 2012

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Table of ContentsFeature Articles

6 The Use of Barcode Medication Administration to Safeguard Patient Safety By Michelle Wuebben

9 What’s in a Number? By Julie Johnson, BSHA, AAHA, CHAM

10 Pre-Registration Key in Reducing Days in A/R: A Process Redefined By Misti L. Beck

Departments

5 Editor’s Letter

12 NAHAM Advocacy Update

14 Member Spotlight: Getting to Know Cassandra Acoff

17 CHAA Corner: A Mentor’s Influence

19 Book Review: Fish! A Remarkable Way to Boost Morale and Improve Results

Access Management JournalThe Official Journal of the National Association of Healthcare Access Management

NAHAM BoArd of directorsPatricia Consolver, CHAM, PresidentPam Carlisle, CHAM, Immediate Past PresidentHolly Hiryak, RN, MNSc, CHAM, Vice PresidentSuzan Lennen, CHAM, SecretaryEd Spires, CHAM, TreasurercoMMittee cHAirsPolicy development/Government relations committeeBrenda Sauer, CHAM, RN, MA

certification commission Elizabeth Reason, CHAM

education committeeTammy Wood, CHAM

Publications/communications committee Jim Hicks, III, CHAA, CHAM, CAM, FHAM

Membership committee Jeff Ferrell, CHAA, CHAM

special Projects committee Julie Johnson, BSHA, AAHA, CHAM

reGioNAl deleGAtesNorthwest regional delegateDonna Aasheim, CHAM

southeast regional delegate Betty McCulley, CHAA, CHAM

Midwest regional delegateKatherine Murphy, CHAM

central regional delegateJeff Brossard, CHAM

Northeast regional delegateCatherine Pallozzi, CHAM

southwest regional delegateYvonne Chase, CHAM

ex-officiolegal counsel Michael J. Taubin, Esq.

editoriAl BoArdJim Hicks, III, CHAA, CHAM, CAM, FHAM

Chair, NAHAM Publications/Communications Committee, MedAssets, Fernandina Beach, FL

Donna Aasheim, CHAM St. Louis University Hospital, St. Louis, MO

Terri Boyd, RN, BSN, CHAM Altarum Institute, Alexandria, VA

Tony Lovett, MBA, CHAM Cypress Fairbanks Medical Center, Houston, TX

Betty McCulley, CHAA, CHAM Trinity Medical Center, Birmingham, AL

Brenda Sauer, CHAM, RN, MA New York – Presbyterian Hospital, New York, NY

NAHAM NAtioNAl officeExecutive Director: Steven C. Kemp, CAEProgram Manager: Mike CoppsProgram Associates: Caroline Fabacher and Belle McFarlandSenior Marketing Coordinator: Kevin HurleyCertification Manager: Delicia HurdleEducation Manager: Joyce ArawoleEvents Coordinator: Alexandra Zapple

Access Management Journal (ISSN 0894-1068) is published by:

National Association of Healthcare Access Management2025 M Street NW, Suite 800Washington, DC 20036-3309Telephone: (202) 367-1125Fax: (202) 367-2125Web site: www.naham.org

© Copyright 2011, National Association of Healthcare Access Management.Indexed in Hospital Literature Index, produced by the American Hospital Association in cooperation with the National Library of Medicine.

The printed edition of Access Management Journal is not to be copied, in whole or in part, without prior written consent of the managing editor. For a fee, you can obtain additional copies of the printed edition by contacting NAHAM at the address provided.

The National Association of Healthcare Access Management (NAHAM) was established in 1974 to promote professional recognition and provide educational resources for the patient access services field.

The Access Management Journal subscription is an included NAHAM member benefit. NAHAM 2011 membership dues are $165 for Full Members and $1,500 for Business Partner Members. For more information, visit www.naham.org.

Volume 35, Number 1

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Greetings, NAHAM members:

The last bit of snow has melted and warm temperatures are on the way — spring is here! With the blossoming of flowers and the promise of new life, spring is a season of new beginnings. Embrace this spirit and make spring your time of new goals. With each passing season, you’ll be able to track your aspirations — and who can predict what you’ll harvest next year? While everyone’s New Years’ resolutions have no doubt fallen by the wayside and gyms are no longer bustling with activity, spring is a season to dust off the winter doldrums and start f resh.

But you don’t have to wait for seasons to change to experience a new season in your career and in your hospital. Motivation and new goals give you the power to call for a season of productivity no matter what time of the year it is. However, spring is especially inspiring, given the flurry of activity outdoors that can mirror the changes in our lives.

Many of the articles in this issue highlight the importance of setting goals. In the Member Spotlight, for example, Cassandra G. Acoff discusses personal goals and those she has set for her hospital team. She points out the difference between personal and team goals, and how her personal goals influence her team goals.

She also notes that, when working to achieve goals, it ’s important to avoid making excuses, as they become stepping stones to failure. Determination and a strong sense of perseverance are great ways to ensure that your personal and team goals will not go the way of New Year’s resolutions. So as we look forward to the first signs of spring through a dark winter, goals also give us something to look forward to — something to achieve. Measuring personal and team goals during each season allows us to see forward progress and build up self-confidence.

Nevertheless, before you set goals for yourself and for your team, it is important to be realistic. Nothing diminishes self-confidence more than a goal that is impossible to achieve. Make certain that the aspirations you have are practical. In the feature article “What’s in a Number?” Julie Johnson discusses ways to track and reflect upon the goal-setting process

As an added measure, find someone to cheer you and your team on as you strive to achieve your goals. A mentor — someone who has already reached an aspiration that you have set — can provide accountability and give you motivation. In the article “A Mentor’s Influence,” Kelley Brogden highlights the benefit of having a mentor who you aspire to be like. She describes what it was like to sit in her mentor’s office, admiring the NAHAM certificates and event posters that decorated the walls. Brogden was so inspired by her mentor that she set a goal to receive her CHAA certification.

I hope that this spring will be a source of inspiration. Take it as an opportunity to evaluate the goals you have for yourself and your team. If necessary, do a “spring cleaning” — discard unrealistic goals and set new ones. Find a mentor who is just as passionate about what you hope to achieve. And finally, find a way to measure your success.

Enjoy this season of new beginnings and new accomplishments!

Best wishes,

Jim Hicks, III, CHAA, CHAM, CAM, FHAM

Jim Hicks is a Senior Consultant at MedAssets, serves on the NAHAM Board of Directors, and chairs the Publications/Communications Committee.

Editor’s Letter

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An alarming number of patients have been administered inaccurate doses of medication, leading in some cases to serious adverse side effects. In fact, errors associated with medications are the most f requent cause of adverse medical events. According to the Institute of Medicine, every year there are more than a million injuries and almost 100,000 deaths attributed to medical errors. These errors have forced hospitals to consider measures to prevent further inaccuracies. One such measure is the Barcode Medication Administration (BCMA) system. This system, sometimes referred to as a pharmacy packaging system, is comprised of a barcode reader, a laptop computer, a server, and software. Patients are outfitted with wristbands bearing a barcode with their identification and medication information. Medication containers are also outfitted with barcodes. Before nurses administer any medication, the patient ’s wristband is scanned to verify his or her identity. The barcode on the prescription

container is then scanned to ensure that the medicine is correct, and that the dose is being given at the correct time via the proper method.

Successful implementation of the BCMA leads to fewer fatalities, better inventory management, and increased patient and staff confidence in the drug administration system. Implementation of such a system is straightforward and follows five phases: Initiation, Planning, Execution, Control, and Closing. Each of these phases is equally important and must be followed in order for the project to succeed.

Initiation Phase The initiation phase begins with a scope document noting all stakeholders and the extent of the pharmacy packaging system project. The document should state that the system is being implemented to prevent human errors in the delivery of medication, and ultimately to ensure the safety of patients. The scope outlines time, cost,

The Use of Barcode MedicationAdministration to Safeguard Patient Safety

By Michelle Wuebben

functionality, and the interests of various stakeholders—pharmacy staff, nurses, the IT department, and the vendor assisting in the implementation of this program.

In addition to the initial scope document, several systems must be in place prior to implementation of the BCMA. The project requires a pharmacy packaging system that applies barcodes to all medications, and a wristband system requiring all inpatients to wear barcoded wristbands. The hospital staff must be supplied with scanners, each hospital room equipped with a laptop connected to wireless Internet, and the hospital outfitted with several computer servers and the necessary BCMA software. Finally, certain staff members must be trained as “super users” available to assist other staff members should they encounter problems. These super users will be vital to the success of the project, so they should be chosen carefully. Their guidance will assist other users in mastering the new system, and their

Incorporating several components, the Barcode Medication Administration System ensures that patients receive the correct dosage of medication at the right time.

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feedback invaluable in determining what areas need to be addressed to ensure staff compliance.

TimelineThe timeline to implement this project is roughly six months. Once approved, a team must be selected to oversee the project. The project team is ideally made up of stakeholders f rom various departments who examine the processes within the hospital. The project staff fill out surveys regarding the patient safety culture within the organization and the current processes that help them ensure that safety. The next step is creating current process flow charts and conducting a gap analysis to compare the hospital’s actual performance with its potential performance. Finally, the team must modify the current medication administration to install and incorporate the new technology, including scanners, computers, servers, software, wristbands, and barcoding labels. The time to implement the barcoding system is relatively short, usually a few months.

Once the hardware is installed, the team secures training for the entire hospital staff. Several members of the team—the super users—should be trained first, so they can make themselves available for questions and troubleshooting. Training can last f rom a few days to a week. Pilot testing normally lasts two months. If all goes well with the system and its users, the hospital will not require constant vendor assistance. The biggest risk of the BCMA system involves getting the staff to accept and use the

Continued on page 8.

new system. This risk can be alleviated by allowing members of the project team—the super users—to be involved in the whole project management process. They are the people best able to convey the benefits of the new system to their co-workers in order to generate buy-in. It is also vital that senior hospital management and board members clearly communicate to the staff that acceptance of the barcoding system is necessary to ensure patient safety.

Execution PhaseIt is crucial that the barcode utilization method be carefully integrated into medication administration workflow processes. During the execution phase, prescriptions and wristbands for inpatients must be barcoded by the pharmacy staff. Several servers must be in place to handle the new program. One server is used to help physicians prescribe medications, a second server acts as a legacy database to store prescription information, and a third server collects results f rom the barcode system. During the execution phase, nurses keep track of any problems with the system and report them back to a super user, who troubleshoots the issue. It is imperative that the super user stay in constant contact with the nurses during the initial implementation so that new users are not discouraged from using the system.

Control PhaseThis phase identifies why projects fail and describes the adjustments that need to be made in order for the project to succeed. One important key to ensuring the success of a new

project is to involve the super user staff members f rom the inception of the project through completion. It is also important to help all staff understand the need for the new technology and its benefits. Additionally, staff members must undergo adequate training in order to properly operate the new technology. Staff members should feel confident that if any situation arises after training that the super users will be available to assist them.

Once the barcode system goes live following the training, daily meetings should be held for the first few weeks to identify problems and solve them quickly. Other factors that affect the success of this project involve the dedication of pharmacy staff to adequately labeling the prescriptions and the financial commitment f rom hospital management. Hospitals usually begin implementation of the program within a single department. Upon the success of that department, hospitals can implement the program in others, and use super users f rom the previous department to assist in the process.

Closing PhaseOnce the new technology has been implemented, it should be evaluated. This will involve comparing the number of medical administration errors reported in the period before implementation to the number of errors since implementation. Be sure also to account for other methods of evaluation, such as surveying for nurse and patient satisfaction. Positive media relations and coverage are also worth noting.

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Maviglia SM, Yoo JY, Franz C, et al. “Cost-benefit analysis of a hospital pharmacy bar code solution” Arch Intern Med. 2007;167:788-794

Hook J, Pearlstein J, Samarth A, Cusack C. Using Barcode Medication Administration to Improve Quality and Safety: Findings from the AHRQ Health IT Portfolio (Prepared by the AHRQ National Resource Center for Health IT under Contract No. 290-04-0016). AHRQ Publication No. 09-0023-EF. Rockville, MD: Agency for Healthcare Research and Quality. December 2008.

Patient Safety & Quality Healthcare “Improving Medication Safety with a Wireless, Mobile Barcode System in a Community Hospital” by Mitch Work, May/June ‘05

http://www.psqh.com/mayjun05/casestudy.html

Medscape Today “Bar-Code Medication Administration: A Systems Perspective,” Ronald Schneider, B.S.Pharm., M.H.A.; Jonathan Bagby, R.N., M.B.A., M.S.N.; Russ Carlson, R.N., B.S.N., M.H.A. , 12/19/08

http://www.medscape.com/viewarticle/584453

“Barcode and RFID Medication Administration System” By Mike Hanlon http://www.gizmag.com/go/5707/

http://en.wikipedia.org/wiki/Bar_Code_Medication_Administration

Sources

To date, this system has helped to prevent serious medication errors in numerous hospitals. While the technology may be expensive initially, it is well worth the investment. The BCMA system helps drive patient and staff satisfaction and helps hospitals with their community relations. Implementation of the BCMA system shows a genuine concern for patients and their safety.

Lessons LearnedHospitals should consider implementing the BCMA system. While implementation requires significant upfront costs, the benefits (namely ensuring patients’ safety) are significant. In addition, cost savings f rom possible avoided medical malpractice suits should not be overlooked. During the implementation of the system, senior leadership support is imperative to drive change. Interdisciplinary communication throughout the hospital is also necessary for the successful adoption of this new technology.

Communication between and within departments also provides caregivers a necessary flow of information. Encouragement can lead the way to the successful adoption of a Barcode Medication Administration system, as well as an overall culture of safety within a hospital. Barcode Medication Administration is a useful tool that can allow hospitals to improve their use of technology to prevent errors, as well as to identify and make improvements as part of their patient safety goals. Further, it is important that hospitals that have successfully implemented a BCMA system share their experiences and lessons learned with other hospitals. l

Michelle Wuebben is currently a graduate student in the business/healthcare informatics field. She also works as an accounting/IT consultant for a small development company, and hopes to find an accounting/IT position in the healthcare field once she earns her degree. Michelle currently resides in Cincinnati, where she enjoys leisure reading and spending time with her family.

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Benchmarking and other statistics—do the numbers lie? Healthcare organizations are constantly pursuing benchmarking quality of registrations, number of registrations and up-front collections statistics. Many times statistics are manipulated to make a specific argument. The truth is that each hospital registration department is different. (I know you didn’t want to hear that.)

Patient Access is unique. Let me say that again…Patient Access is unique! Trying to assign specific numbers to convince your CFO to hire another full-time-equivalent employee or to argue that your patient access department is excelling in up-front collections can be a daunting task without benchmarking information. How does one truly benchmark a unique process?

A survey conducted by the Arizona NAHAM affiliate (AzHAM) determined that the key indicators for the State of Arizona participating hospitals were a 95 to 98 percent accuracy benchmark, and six registrations

per hour. What?!, you say? The proof of unique circumstances for each patient access department is in the patient mix. Add inpatients along with several ER registrations, and include several of your sleep lab patients into the mix and what do you come up with? Benchmarking statistics that you can use to prove that your departments are working at maximum capacity and efficiency. A varied patient mix, together with excellent customer service, efficient collections, accuracy, and new technologies, will ensure that your benchmarking stands up to any CFO’s scrutiny.

Each week, studies are published about new findings that skew the benchmarking numbers. It ’s important to take your own surveys, not to take study results at face value, and work to figure out what may be swaying the numbers. How was the information obtained? What were the questions? Dig deep into your hospital’s patient mix and make your own goals. Patient Access managers have the skills needed to produce results under all conditions.

What’s in a Number?By Julie Johnson, BSHA, AAHA, CHAM

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I would like to leave you with this recent benchmarking information: In a survey conducted by the law firm Dewey, Cheatum, and Howe, it was found that 99 percent of all statistical information can be manipulated. So, produce your own awesome results and don’t get bogged down with the numbers. After all, our direction is always clear when we follow our principles. l

Julie Johnson is the Director of HIM – Patient Access, and Communications at Mt. Graham Regional Medical Center located in Safford, Arizona, a 59-bed facility. Julie is a past president of NAHAM and the Special Projects Chair. She also serves on the Policy Development and Government Relations Committee.

The accuracy of benchmarks varies as much as their results, and a closer look is often needed to interpret what the results claim.

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Back in 2008, the recession shrunk budgets across the country, but small towns were hit especially hard. I work at a small Midwest hospital of about 300 beds, in a community ravaged by the changing economy. Unfortunately, illness and injuries don’t take time off due to financial hardship, and many patients still need to check in to the hospital for tests and procedures that they truly can’t afford. In our area, wages are lower than the national average, and after the economic downturn, several large employers were forced to close their doors. With patients needing procedures but unable to pay for them, and hospital expenses growing, we were an organization in crisis. Changes had to be made, and fast.

We came up with several quick solutions to reduce spending, including the immediate implementation of a 3 percent wage cut for all employees and a f reeze on personal leave accrual. Even with these measures in place, we continued to feel the financial strain. As a result, committees formed almost overnight to seek out other

cost-cutting options. We needed the cooperation of the entire hospital to help create a solution to ease some of the pressure.

As a part of the admission team, I dealt regularly with patients who had been hit just as hard by the economy as our hospital was. These patients were often unable to pay for the procedures they so desperately needed. My team put our heads together to come up with new policies that would benefit both our patients and our hospital. We discovered that we could make a difference by redefining our role. By putting forth the effort to contact each patient before his or her procedure and verifying their insurance information, we were able to educate them about their co-pay costs before their appointment.

This was a considerable change from our former process. Though we used to work on the accounts daily, we didn’t always call patients to verify their insurance information. Now we are able to lower their out-of-pocket expenses by verifying their insurance information and making sure that the expense of

Pre-Registration Key in Reducing Days in A/R: A Process Redefi ned

By Misti L. Beck

each procedure is covered to the fullest extent possible. We also didn’t inform patients of their out-of-pocket expenses before the procedure. However, the new process ensures that patients are informed of their out-of-pocket expenses before they arrive at the hospital for their procedures, so that they aren’t surprised by the cost and are able to make payment arrangements.

This new solution also greatly reduced if not eliminated the chance that insurance claims could be denied or diverted for incorrect information. As a part of our efforts, we also attempted to collect remaining deductible amounts and estimated co-insurance payments. While this was a difficult transition initially, patients grew to appreciate knowing exactly how much they were expected to pay out of pocket for a procedure. Our team has made great strides to educate the patients about their financial responsibility so that there are no unpleasant surprises.

Thanks to this new system, we noticed a measurable difference in accounts receivable by the first quarter of 2009. By the end of

Faced with a tough economy, a Midwest hospital implemented a pre-registration system that has streamlined processes and increased patient satisfaction.

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the year, it was obvious that these changes were making a serious impact on the number of days claims sat in accounts receivable. By changing our process for the better, we were able to reach our goals. As a result of our success, employee wages and leave accrual were reinstated in late November 2009. Our team and the entire hospital staff heaved a collective sigh of relief—we felt that we were getting back on track, and helping patients affected by the recession pay for their much-needed procedures. The hospital needed each and every employee to make necessary changes to

achieve company goals—but we are proud that our efforts made the pre-registration process essential to the revenue cycle. l

Misti L. Beck lives in the Black Hills of South Dakota. She enjoys spending time with her husband and beautiful little daughter. For the past three years, she has worked for her local hospital as a pre-registration specialist. She volunteers her time to several community organizations and enjoys writing and sharing information that can make a difference in the lives of others.

There is a direct correlation between the number of days in AR and the efforts made to contact patients in advance. Note the 20-day difference in the number of days it took to get paid by insurance/patients from the end of 2008 to the end of 2009.

Percentage of patients contacted and/or insurance verified prior to care.

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Advocacy Update

Health Reform: One Year LaterOn March 23, 2011, The Patient Protection and Affordable Care Act celebrated the first anniversary of its passage. So what has happened since 2010? Many Americans now benefit f rom the Act, including individuals who can no longer be denied coverage due to a pre-existing condition. Prior to the Act, young adults comprised a large portion of the population living without health coverage. Many of these individuals were full-time students or working in part-time or internship positions that did not offer healthcare. Thanks to the Affordable Care Act, young adults can now stay on their parents’ health plans until the age of 26. In addition, many senior citizens facing the “donut hole” coverage gap under Medicare Part D were able to receive a tax rebate that provided relief for the lost coverage.

However, while some Americans are enjoying the benefits of health reform, others are fighting against it. Twenty-eight states have filed lawsuits claiming that the law is unconstitutional because the federal government does not have the power to

mandate that individuals obtain health insurance. The “individual mandate” provision of the Act states that “every U.S. citizen, other than those falling within specified exceptions, maintain a minimum level of health insurance coverage for each month beginning in 2014.”

So far, courts have been divided in upholding or striking the Act. Three District Court judges have ruled that the law is constitutional. Florida has taken the strongest stance against it. In that state, a District Court judge struck down the entire Act as unconstitutional, ruling that the individual mandate provision could not be ruled unconstitutional while the rest of the Act remained valid. Meanwhile, in Congress, the Republican majority in the House of Representatives continues to attempt to chip away at the Act. However, the Democratic majority in the Senate makes these attempts unlikely to succeed for the time being.

The Affordable Care Act is just beginning to be implemented. With many of the larger changes scheduled to go into effect in the

Healthcare Reform UpdateBy Christine Perez

Stay informed of the latest in health reform with NAHAM’s Advocacy Update.

course of the next few years, we will continue to see this mixed landscape where some states readily implement health reform, while others continue to challenge it. Ultimately, it will likely be the Supreme Court and not Congress that has the final say on health reform.

Updates from the NAHAM Government Relations CommitteeThe NAHAM Government Relations Committee has created an agenda for 2011 centered on three focus areas: education, policy and standards, and the HIMSS Work Group. Through each of these focus areas the Committee hopes to increase member awareness of the latest policy issues affecting patient access managers while raising the value of the profession among policymakers and other healthcare organizations.

Education – The Education task force will focus on providing the membership with information through the Access Management Journal, NAHAM News Blog, and the NAHAM website. This group will monitor and report emerging policy issues, ensuring that members stay on top of

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Advocacy Update

the latest issues affecting the profession. This task force will also work with the NAHAM Education Committee to identify webinar opportunities that can provide members with more in-depth knowledge on policies.

Policy and Standards – The Policy and Standards Task Force will focus on making NAHAM an expert resource in the development of policies and standards that help ensure that patients have a positive experience through the continuum of care. Brenda Sauer, chair of the Government Relations Committee, currently represents NAHAM on The Joint Commission’s Hospital Professional and Technical Advisory Committee (TJC PTAC), which provides TJC

staff with feedback on developing standards and National Patient Safety Goals. As healthcare transitions into new delivery models such as the accountable care organization and patient-centered medical home, this task force will continue to monitor the development of TJC and CMS policies and their effect on the role of patient access managers.

HIMSS Work Group - In 2010, NAHAM joined the Patient Identity Integrity Work Group of the Health Information and Management Systems Society (HIMSS). Participation has offered NAHAM the opportunity to collaborate with other organizations leading the effort to pursue a unique patient identifier to ensure the security and quality of patient data. As

part of our efforts on this Work Group, NAHAM has signed a letter circulating Capitol Hill calling for Congress to lift the ban on a study of a patient identifier solution. NAHAM has also assisted in the development of a patient identifier toolkit by providing articles and resources that emphasize best practices used by patient access managers in ensuring quality patient data. The NAHAM Government Relations Committee will identify and create new resources and papers that can support the efforts of the HIMSS Work Group. l

Christine Perez is NAHAM’s Government Relations Coordinator, based in Washington, DC.

E-Learn Manager™ and E-Learn Associate™ are interactive study aids complete with narrated instruction, learning activities, downloadable materials, and online quizzes—all designed to help certification examination candidates and potential candidates assess their readiness to take the Certified Healthcare Access Manager (CHAM) or Certified Healthcare Access Associate (CHAA) examinations. For detailed information, pricing, and to order E-Learn Manager™ and E-Learn Associate™, please visit www.naham.org.

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Member Spotlight

About Cassandra Title: Manager III, Patient Access Services

Hospital Name and Location: Mease Countryside Hospital, Safety Harbor, Florida

Hospital Website: www.MPMHealth.org

About Your Hospital 1. What is new and exciting at your health system? BayCare Health System is now the biggest healthcare provider in the Tampa Bay area, controlling more than a third of all hospital business here. One year ago, we opened the first all-new, full-service hospital in the area in 30 years. And BayCare is still growing, with another hospital soon to break ground in Ruskin. Among BayCare’s major recent projects: the area’s first f ree-standing emergency room in Largo (opened in 2008); a 52,000 square-foot outpatient center in Westchase (2009); and two new buildings at its Morton Plant North Bay Hospital in New Port Richey (2010). Other major projects underway include a 100,000 square-foot emergency center at St. Anthony’s; a 103,500

square-foot addition to Morton Plant; and a neonatal intensive care unit expansion and new breast center at St. Joseph’s Women’s Hospital.

2. What is it like to work for your health system? BayCare is a great place to work. As a team member with Morton Plant Mease Healthcare (one of the three CHAs that make up BayCare Health System), BayCare strives to help team members balance the demands of their work and personal lives. They know that team members lead increasingly hectic lives, and they offer a number of services in hopes of easing some of the burden. The senior leadership team also hosts town hall meetings throughout the year to encourage communication among all team members.

3. What are some of your department or organizational goals this year? We have ten team goals for my department this year:yy Supporting BayCare’s

marketing efforts by increasing email collectionsyy Improving the Sleep and

Rehabilitation Centers’ Key Performance Indicators

Getting to Know Cassandra G. Acoff

NAHAM’s “Member Spotlight” shares professional and personal insights from NAHAM member Cassandra G. Acoff.

yy Beating budget with justifiable variance of 1 to 2 percent below budgetyy Improving overlays from last yearyy Increasing upfront cash

collections by 5 percent above last year’s actual figureyy Obtaining 95 percent

compliance on audits including JCAHO, IMM, Consent, MSP, and HDXyy Reducing costs, maximizing

resources, and reducing denials by centralizing authorizations BayCare-wideyy Improving quality of new

team members by hiring the right people and reducing turnover by 5 percent over last year’s actual figureyy Increasing up-front hospital

inpatient cash collectionsyy Increasing patient satisfaction

average rankings f rom last year

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Member Spotlight

Continued on page 16.

About Your Career:4. What is your business philosophy? I strive to deliver accurate and efficient access to care; to ensure a compassionate and seamless experience for my customers that consistently exceeds their needs and expectations; to view all obstacles as opportunities to strengthen my team and redirect our focus back to our mission, vision, and values; to take a proactive role in finding solutions for improvement; to view “excuses as stepping stones to failure,” and to reject failure as an option; and to always embrace change. Through divine intervention, my team strives to exceed our goals and try to be the best department we can be.

5. What is the best way to keep a competitive edge? The best way to keep a competitive edge is to know your competitors—their strengths, weaknesses, opportunities and threats. You must also provide excellent customer service; hire a team of dedicated and loyal team members that supports the organization’s mission, vision, and values; and always seek continuous improvement based on the customer’s needs.

6. What was your greatest professional accomplishment within the past year?My greatest professional accomplishment within the past year was serving as President for FAHAM (Florida Association of Healthcare Access Management). I had the opportunity to meet and work with several access professionals as well as new

vendors. More than 80 people f rom different hospitals throughout the state attended our quarterly meetings.

7. What goal are you working toward now? I’m working on improving cost efficiencies and discovering the best way to trim the fat without cutting into the lean.

8. What has been your biggest lesson you’ve learned? I’ve found that when working with a team of diverse and talented individuals, it is difficult, if not impossible, to please everyone. If you are fair and consistent in your management approach, you will gain the trust and respect of your team.

9. What is your career advice? To have a successful career, make sure you understand your purpose and what drives your success. Decide early in your career if what you’re doing is your passion. Ensure that your personal priorities and values do not conflict with your job’s expectations. Finally, enjoy what you’re doing and avoid burnout by having fun often.

10. What is the most rewarding aspect of your job? I enjoy providing excellent customer service to a population of sick and injured people that seek our services at a difficult time in their lives. It ’s satisfying to provide them with a positive registration experience and know that the least of their worries is how they will pay their bill.

11. What is your greatest talent on the job? My strengths are team building, process improvement, data analysis, spreadsheets, flowcharts, and policy development.

More About You:12. What are your greatest passions in life? My spirituality, my family, my passion for the arts (especially dance), doing the right thing, helping those in need, and community service.

13. What is your motto to live by? “Excuses are stepping stones to failure, and failure is not an option.”

14. What is your favorite book? My favorite book is Good to Great by James C. Collins.

15. What is your favorite movie? My favorite movie is The Notebook.

16. What is your hobby or pastime? I really enjoy interior decorating.

17. If you could meet anyone, who would it be? I’ve always admired Michael Jackson as one the greatest entertainers that ever lived.

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18. If you could improve one thing about yourself, what would it be?I would try to strike a healthy balance between work and family. Basically, I would slow down, stop, and smell the roses.

About NAHAM:19. What inspired you to join NAHAM? As a new admitting manager, I wanted to join an organization that had a proven track record of developing healthcare access managers through educational opportunities. I also wanted to be a part of a large network of access managers throughout the country who share best practices and learn from each others’ experiences.

20. How did you get into Patient Access Management? I started my career in Decision Support. While there, the V.P. was experiencing some challenges with her admitting department. She asked me to do an assessment of the department and share my findings and recommendations for improvement. She was so impressed with my presentation that she asked me to head the department and implement my recommendations. I’ve been in Patient Access ever since.

21. What do you like best about NAHAM? NAHAM is a great organization of dedicated professionals with a common goal. It offers valuable educational opportunities and is a terrific avenue for finding best practices for cost efficiencies.

22. What is your favorite NAHAM event or experience? The Annual Conference definitely stands out in my mind.

23. What can NAHAM do to better serve its members? NAHAM is a great organization. I hope that they continue to take advantage of technology to reach the masses and share valuable educational information and best practices. They need to continue to fine tune the picture of what the world of access will look like in the future and help Access professionals understand the new healthcare reform law and its impact on our profession. NAHAM should also continue to support the local chapters by providing a database of key performance access indicators of member hospitals. This will help us set standards of practice as well as determine best practices. l

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CHAA Corner

If you mention the name “Gilda Chinnici” to those who have attended a Northeast Regional NAHAM Conference, or to other local members, they will undoubtedly picture the smiling face of my former coworker, mentor, and friend. Last November, Gilda accepted an offer f rom a new employer who I hope has discovered the extreme value of their newest acquisition. Though I worked with Gilda for only four months, she became a very powerful influence in my professional life. While sadly I no longer see her at work on a daily basis, the lessons she taught will stay with me forever.

In May 2010, I was unhappy and unsatisfied at my workplace. I spent several months seeking a new and more challenging adventure. Finally, I came across a job listing from a substance abuse provider that I encountered almost daily. I quickly called colleagues who I knew worked there and asked them what it was like to work for Gilda Chinnici, the hiring manager for the position. Not one of them had a bad thing to say about her. I remember thinking, “This is someone I would definitely like

to work for!” and I quickly submitted my resume. I told my contacts in the office that I was applying for the position and asked them to put in a good word for me. Within a week, I received a call to schedule an interview.

Recalling suggestions by many interview preparation books to learn about your prospective employer prior to the interview, I searched for Gilda on the Internet. Immediately, I found several links. The first link I opened was the spring 2006 NAHAM Connections newsletter. To my surprise, the opening letter f rom the outgoing NAHAM president was written by none other than Gilda Chinnici.

When I sat down in Gilda’s office for my interview, the first thing I noticed was her Certified Healthcare Access Manager (CHAM) certificate proudly displayed on one wall, accompanied by several NAHAM posters f rom prior years’ Access Weeks. Attached to the posters were ribbon-laden identification badges f rom several NAHAM conferences. Aside from some family pictures on her desk, the

A Mentor’s InfluenceBy Kelley A. Brogden, MPH

posters were the only other decorations in her office. Gilda was clearly proud of her NAHAM membership, which spoke volumes to me. She told me she had been a member for over twenty years.

During my interview, Gilda and I discussed her employer’s mission and what the position entailed. This interview was one of the most relaxed I had ever experienced. I felt as if I were sitting back with a familiar colleague, just talking shop. I left the interview feeling positive about the position, yet disappointed that there were still several candidates who needed to be interviewed. Two weeks later, I received the call I had been waiting for. Gilda offered me the job, which I readily accepted.

Continued on page 18.

A NAHAM member looks back at the strong impact a mentor and friend has had on her development as an access management professional.

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CHAA Corner

From my first day of employment in July 2010, I knew there was something extraordinary about Gilda. She was extremely passionate about her work and dedicated to the populations our employer serves. The clientele we serve can often be belligerent, demanding, and rude. In contrast, however, they can also be very sorrowful, remorseful, and just plain desperate. When I consulted with Gilda about how to manage a specific situation, she told me to always make the decision by asking myself, “First, is it good for the patient? Then, is it good for the hospital?” This was her mantra.

During the four months I worked for Gilda, she unknowingly became my mentor. I absorbed each business practice and management technique that she taught me. In early November, I proudly told her that I had become a NAHAM member and decided to pursue my Certified Healthcare Access Associate (CHAA) certification.

To say that I was devastated at the announcement of her resignation a few weeks later is an understatement. A well-known name in the healthcare access field, Gilda’s NAHAM affiliation, contributions, and accomplishments attracted a recruiter’s attention. As a testament to her dedication, she told us at her resignation that it had taken her over five months to finally accept the job offer that had been made to her in May.

While my work experience with her spanned only a few months, that time was the most influential period of my career thus far. At her farewell luncheon, I was sure to get a photo of us together, which will be my continued inspiration in her physical absence. We promised to meet up again in the future and to see each other at the 2011 Northeast Regional NAHAM Conference. As the luncheon ended and I returned to my office, she left me with these parting words: “Just remember, you will never go wrong in your decision-making if you ask yourself ‘Is it good for the patient and is it good for the hospital?’”— healthcare delivery wisdom to live by, for sure. l

Kelley A. Brogden, MPH, has worked in healthcare for more than 20 years. Since graduating from Holy Family University with a bachelor’s degree in psychology, her experiences have included direct care, utilization management, performance improvement, crisis response center assessment and management, and non-profit managed care organization operations. Kelley received her Masters in Public Health (MPH) from Drexel University in Philadelphia, PA, and is currently the Clinical Supervisor for the Behavioral Access Center at Girard Medical Center, a part of North Philadelphia Health System. She enjoys spending time with her daughter and Navy veteran husband and looks forward to increased involvement with NAHAM committees and publications while preparing for her CHAA.

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Book Review

On days when your work is mundane, your customers unhappy, and your co-workers grumbling, you can feel miserable. On these days, allow your imagination to transport you to an even rougher scene: a smelly fish market, crustaceans packed in ice and reeking of sea salt, the stench of fish permeating the air, and rough-looking fishmongers hoisting the day’s catch onto splintery counters. Now imagine these men smiling and laughing, bursting with energy, and crowds flocking to the market just to see them.

While it seems unlikely, this perfectly describes Seattle’s Pike Place Fish Market, where fishmongers actually enjoy their work and bring that positivity to their customers. In the book Fish! A Remarkable Way to Boost Morale and Improve Results, authors Stephen C. Lundlin, Harry Paul, and John Christensen use this example to show how your attitude shapes your work life.

The authors introduce us to Mary Jane, a recently widowed woman who has been transferred

Fish! A Remarkable Way to Boost Morale and Improve Results

to a “toxic energy dump” of a department, complete with disgruntled co-workers, unhappy customers, and a boss who is notoriously difficult to work with. One particularly grueling day, she escapes for lunch to the Pike Place Fish Market, where she is surprised to see joyful fishmongers joking with customers and laughing amongst themselves.

There she meets Lonnie, a fishmonger who confesses that Pike Place Fish Market wasn’t always this way. Fishmongering is not a glamorous vocation—the work is rough, boring, and long, exacerbated by the added annoyance of smelling fish all day. Sans the fishy aroma, Mary Jane relates to this kind of environment. Lonnie tells her that the market was so bad that it was threatened with bankruptcy. Faced with losing their jobs, the fishmongers came together and changed their attitude about work. They proclaimed that they were “world famous” and decided to bring spirit and energy to their jobs. The authors of Fish! challenge readers to bring this same spirit to their jobs.

With this goal, the authors introduce four key concepts that can help energize any workplace environment: Play; Make Their Day; Be There; and Choose Your Attitude.

This final concept is the core lesson: everyone chooses what attitude they bring to work. Everyone is accountable for whether they choose to allow their emotions to hang a shadow over their day or brush off the negative energy and embrace a positive attitude.

If these four simple concepts can transform a smelly fish market full of unhappy fishmongers into a now world-famous tourist attraction, imagine what they can do for your organization! Check out Fish! and experience the valuable lessons of the Pike Place Fish Market for yourself. l

Holly Beck is NAHAM’s Marketing and Communications Associate, based in Washington, DC.

By Holly Beck

Fish! is sure to inspire positive change in any workplace.

National Association ofHealthcare Access Management

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