By April Langford and Jessica Moresco

UPMC Revenue Cycle's flexible work arrangement program has resulted in a 9 percent productivity increase.

At UPMC, we have a strong commitment to patient satisfaction. We want every person who walks into a UPMC facility to walk out feeling valued and properly cared for. Throughout the UPMC revenue cycle, we apply the same patient-centered strategies to employee satisfaction.

The UPMC Revenue Cycle culture is based on our core values of accountability, integrity, and teamwork. We integrated an employee-centered focus into the UPMC Revenue Cycle culture and found that our employees are better able to support our departmental mission when they know how much we value them.


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To help our employees, we need to be aware of their needs. When employees were asked about the most common struggles they face, they identified the following:

  • Difficulty maintaining a work/life balance
  • Feelings of stress and guilt related to prolonged absence from children, pets, or spouse
  • Economic woes related to fuel prices and overall cost-of-living increase
  • Increased stress due to commuting in inclement weather

The three core values go both ways-from employee to employer and vice versa. We ensure employee accountability through our clearly defined productivity, quality, and outcome measurements and can be accountable to our employees by offering competitive employee perks. Our employees show integrity by adhering to UPMC Revenue Cycle policies and our mission of providing positive interactions with patients. We, in turn, create an employee-focused culture and keep our promise to provide a positive and flexible work environment.

We all support the value of teamwork by honoring our commitments and treating each other with dignity and respect. Our employees honor their commitment to the organization by giving 100 percent during the work day, and we reward them with the opportunity for a better work/life balance.

The UPMC Revenue Cycle has reaped many benefits from instituting a flexible work arrangement program, including increased employee satisfaction and retention, increased operational efficiency related to increased productivity/quality/outcomes, reduced turnover, reduced costs associated with maintaining office space for telecommuters, and increased draw of top talent to our jobs due to opportunity for flexible work arrangements.

The UPMC Revenue Cycle took the following steps to implement a flexible work arrangement program:

  • Obtain corporate/organizational buy-in
  • Define the policy
  • Perform a job fit analysis to determine which employees are eligible
  • Obtain management buy-in
  • Analyze the employee performance review process to ensure performance standards are clearly defined and can be measured while employees are off site

Gain Organizational Buy-In

Before we developed our flexible work arrangement program, we had to gain organizational support from the UPMC corporate human resources department. In preparing for a meeting with that department and top finance leaders to obtain buy-in, we gathered statistics showing increased employee satisfaction and productivity for full-time or part-time telecommuters. Studies show that employers increase retention of telecommuters and employees who telecommute are 9 to 16 percent more productive on average. Our cost/benefit analysis showed that the rental/maintenance cost per UPMC Revenue Cycle employee per cube per year is $8,331.23 and that the cost to set up the phone system for a telecommuter (100 percent at home) is a one-time cost of $375.00. (Telecommuting staff are given a desktop computer and are responsible for all other equipment in their home office.) Comparatively speaking, the cost for a telecommuter is approximately 5 percent of that for an on-site staff member at the UPMC Revenue Cycle.

One critical step taken before meeting with UPMC corporate human resources was to outline performance expectations for the staff. We estimated that we lose 0.75 productive hours per day due to office distractions and unnecessary, non-work related tasks. Because this loss of productivity approximates 9 percent of the eight-hour workday, our expectation was to see a productivity increase of 9 percent or greater.

Define the Policy

To ensure integrity in the application of a flexible work arrangement program, an employer needs a clearly defined policy. In conjunction with our corporate human resources department, we defined the following types of flexible work arrangements:

  • Flex time. Business office employees work 40 hours within a pay period, but with varying start and end times.
  • Work from home (WFH). Exempt staff may work from home one or two days per month. WFH may be used in conjunction with flexible scheduling.
  • Compressed work week. Business office employees work 40 hours within a pay period, but vary length of day worked and may include days off within the period.
  • Full-time/reduced hours. Employees work and are compensated for 72 hours within a pay period and are classified as full-time. The 72 hours may be accomplished with flex scheduling, compressed weeks, telecommuting, and/or a combination of these options.
  • Job sharing. Job sharing divides the hours and responsibilities of one FTE between two employees.
  • Telecommuting. Employees work from their home office. Supervisors will ensure cubical availability for employees whose presence is required on site.

At the UPMC Revenue Cycle, we offer the option for flexible work arrangements as an incentive to our high performers and to help motivate employees to improve. Employees who have been in their current position for at least six months and meet the performance requirements for their area become eligible for flexible work arrangements, provided this option is offered for their area and not counter to business needs.

Eligibility for a flexible work arrangement is based on a current performance review score of good, solid, or strong performer. Candidates must not have any corrective action against them, have exceeded the productivity goal by 25 percent (125 percent of goal), have met or exceeded the quality and outcomes goals for their area, and adhere to the confidentiality standards required by UPMC.

To support our UPMC Revenue Cycle core value of integrity, we must treat those with flexible work arrangements exactly the same as those who work a standard schedule and clearly delineate expectations for all parties. Employees must sign a contract indicating they understand the flexible work guidelines and are committed to adhering to them.

All employees must show integrity by protecting patient confidentiality. Specific guidelines regarding equipment and confidentiality are defined for the telecommuters. To maintain compliance with HIPAA regulations, all telecommuters are required to have a locked file cabinet to store all confidential documents and a paper shredder to properly destroy all confidential documents.

We expect telecommuters to be accountable by ensuring availability by telephone or e-mail during scheduled work hours and returning phone calls from the management team within four hours. All departmental guidelines for calling off work and requesting vacation or paid time off (PTO) must be followed, so telecommuters must notify management before leaving the house during scheduled work time and use PTO or make up missed hours. Occasionally, telecommuters will be required on-site during certain circumstances, such as yearly performance reviews, mandatory training, and staff meetings.

Staff members not telecommuting but taking advantage of other flexible work arrangements, such as a compressed work week, must support the value of teamwork and attend certain scheduled staff meetings, even if they occur on one of their regular nonscheduled days.

Perform a Job Fit Analysis

Flexible work arrangements can be beneficial to all employees, but they do not work for all positions and departments. To determine whether flexible work arrangements can be applied to certain positions within the UPMC Revenue Cycle, we performed a job fit analysis.

We determined that highly automated job functions were well suited for telecommuting. For example, our insurance verification staff work exclusively from a web-based, exception-only work list and use electronic means to verify most insurances, so they were prime candidates for telecommuting. However, system support staff are needed on site to address system issues as they occur, a job function that we did not feel comfortable could be performed 100 percent remotely.

We grouped the positions and determined that some groups were eligible to telecommute (billing, insurance follow-up, and patient access), some were eligible to work from home one or two days per month and utilize flex-time options (systems/analysis and management), and others were not eligible for any of the flexible work arrangement options due to the nature of their function (administrative/clerical and self-pay follow-up). Currently, 67 percent of our employees hold positions that qualify for one of our flexible work arrangement options.

Gain Management Buy-in

When we first introduced the flexible work arrangement program to our management team, it was met with mixed reviews. Although the entire management team was eager to increase employee satisfaction, there was concern regarding monitoring and managing employee performance. People were concerned that if employees were not on site, they would not be effectively managed and their performance would suffer.

As we did with corporate human resources, we presented our case for change to the management team to garner support. As a team, we outlined performance expectations and a monitoring process to ensure that everyone had an opportunity to share their concerns and felt comfortable with the defined guidelines.

View the exhibit.

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Analyze Employee Performance Review

Our final step is to ensure accountability and integrity by monitoring performance for all employees. The following questions should be asked of managers:

  • Do you have productivity, quality, and/or outcome standards?
  • How can performance standards be measured electronically/automatically so they can be monitored when employees are off site?
  • What are the primary tools used to communicate with your staff and provide feedback (for example, e-mail, instant messenger, phone call, or face to face)?
  • How can you continue to provide guidance and performance feedback when employees work off site?
  • Is the employee performance review score directly tied into performance? What changes to the performance review process need to be made to ensure that off-site employees are being evaluated in the same manner as on-site employees?

Several years ago, we instituted productivity monitoring for all employees and recently refined the metrics to ensure appropriateness and consistency across job functions. The three metrics we use to monitor job performance are productivity, quality, and outcomes.

Productivity typically corresponds to accounts worked per day. How we monitor productivity varies by job function, but is most commonly monitored via the electronic work list. For insurance follow-up, productivity is defined as accounts worked, ranging from 30 to 45 per day, depending on the payer. For patient access, productivity is defined as accounts verified per day with a daily goal of 75 or more.

Quality and outcome measurements are more area-specific, and we do not have a clear-cut or overarching metric to monitor them. For example, quality for insurance follow-up is based on timely follow-up on denials and accounts queued by management and rebill accuracy, while it is defined as verification accuracy for insurance verification. Typically, anything that causes a denial would be a mark against the employee's quality score. We define outcome as the desired outcome of optimum productivity and quality, which also vary by department. For example, in insurance follow-up, the outcome is defined as accounts receivable aged greater than 90 days.

View the exhibit.

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Employee performance is monitored continuously to ensure that the staff member is meeting the minimum requirements to remain a part of the flexible work arrangements program. Productivity, quality, and outcome measurements are monitored weekly and must meet or exceed the goal. Employees who fall short of their goal have two weeks to get back on track for productivity and one month for quality and outcome. Failure to comply with the terms of the agreement will result in termination of the arrangement, and the employee must resume working on site.

Reap Benefits

Although patients are typically our main focus when evaluating how to support our mission of providing world-class health care, we cannot lose sight of who actually makes it happen-our employees. The benefits of instituting a flexible work arrangements program for your employees are numerous. The arrangement is much less costly than maintaining an on-site cubicle. In addition, the other flexible work arrangements have lead to increased staff efficiency and productivity and a reduced turnover rate. We have seen a 9 percent productivity increase for patient access employees and a 34 percent productivity increase for insurance follow-up.

Our turnover rate for employees who are not participating in the flexible work arrangement program is 12.5 percent compared with 0 percent for employees who are in the program. Offering flexible work arrangements also enables us to recruit and retain top talent. The number of new staff hired with a four-year degree or higher has risen from 29 percent in 2007 to 49 percent in 2009.


April Langford is vice president, revenue cycle, UPMC, Pittsburgh, and a member of HFMA's Western Pennsylvania Chapter (langforda@upmc.edu). 

Jessica Moresco is a system coordinator, revenue cycle, UPMC, Pittsburgh (morejx@upmc.edu).

Publication Date: Tuesday, February 01, 2011