Accounts worked each week increased from 52,000 to 70,500 after moving to a virtual work environment.

The benefits of work-from-home strategies are well documented, with studies showing marked improvements in employee productivity, job satisfaction, and work-life balance. Studies show that 80 percent of employees who telework consider it a benefit, and more than 30 percent are more productive in their roles. In addition, organizations experience an estimated $10,000 savings in real estate costs per employee when staff move to a home setting, according to Global Workplace Analytics.

More and more healthcare organizations are now following the work-from-home trend for eligible revenue cycle roles such as scheduling, pre-registration, insurance verification, and billing and collections. Health systems considering these programs need effective ways to manage security, compliance, and collaboration for remote workforces. This requires a secure, paperless environment and a virtual approach to employee training, quality assurance, and engagement.

The Virtual Movement at Texas Health Resources

Texas Health Resources (THR) in north central Texas moved its central business office (CBO) to a virtual environment in 2013 and now has more than 300 staff members working from home. As a result of the program, the CBO reduced employee turnover from 9 percent to below 4 percent and boosted Press Ganey employee satisfaction scores to the 99th percentile nationwide. Productivity improved, increasing from 52,000 accounts worked each week to 70,500 after moving to a virtual environment. THR is also saving $760,000 annually by eliminating the need for CBO office space.

Total Number of Accounts Worked Pre- and Post-Virtual Environment

Texas Health Resources Total Number of Accounts Worked Pre- and Post-Virtual Worker Program (2)

Based on outcomes in the CBO, THR began to evaluate the work-from-home model for its Patient Access Intake Center (PAIC) which conducts the health system’s insurance verification, precertification, pre-registration, financial clearance, and price estimation activities. This unit performs all pre-service functions for THR’s 14 hospitals, ensuring that activities are complete when patients arrive for service. Of THR’s patients, 96 percent are pre-registered, and 98 percent have had insurance verification performed prior to arrival.

Because the functions performed in the PAIC are critical to the patient experience, the unit must be staffed full-time, even in inclement weather and crisis situations. When the PAIC initially opened, the building was located across the street from a hotel, giving key personnel a place to stay to ensure that pre-service functions could continue even in these conditions. In 2014, however, the PAIC moved to a new location that did not have any nearby hotels. This heightened the need to rethink the department’s staffing plan for crisis situations and consider a work-from-home option.

Initially, supervisors had mixed reactions to offering a work-from-home option. Many liked seeing productivity in action and were concerned that employee performance might suffer without direct supervision. To test the program, the department conducted a pilot giving eligible insurance verification employees the option to work from home two days a week, then increasing to three. The same option was later extended to employees in pre-registration.

The Home Office Environment

Revenue cycle leaders evaluated functions performed by each PAIC department (i.e., insurance verification, pre-certification, pre-registration, and financial clearance) to determine technology needs and feasibility of conducting activities in a remote setting. Important considerations were whether associates were patient-facing, how many applications they used, and how often they were on the phone either making or receiving calls. Various departments were consulted on working arrangements and technology.

See related sidebarHealth System Develops Productivity and Quality Standards for Remote Employees

Human resources. Strategic Revenue Services, which encompasses all THR revenue cycle functions including finance, the CBO, patient access, and PAIC, worked with human resources to establish telework agreements, policies, and procedures. A worksite agreement outlines home office requirements for employee safety and security. Employees send pictures of their home offices, which are added to their file along with signed agreements. An unannounced supervisor site visit is also required to confirm that pictures accurately depict employees’ work spaces.

Information technology. Before pursuing the telework option, THR’s IT team confirmed that its telecom infrastructure could support work-from-home environments. THR made an effort to ensure that home offices mirrored THR’s on-site location. The department moved from desktops to laptops, which are VPN-activated so they function remotely as they do in the office.

Technology used on site―such as dual monitors, voice recording, image capture, and electronic faxing―is available to each employee working from home. Internet speed tests are performed every quarter to ensure that employees have the minimum speed necessary to run required software and internet programs. THR also has policies that specify associates’ responsibilities to use required tools (i.e., phone and fax equipment, online documentation software) to ensure that all activity is logged in the system for productivity, quality, and security measures; and that associates are trained to use the tools at home.

THR’s technology platform provides seamless experiences for hospital entities and patients. Remote employees use IP phones connected through routers and internet cables to deliver high call quality. A predictive dialer automatically calls scheduled patients and assigns them to employees based on availability. Predictive dialing typically increases agent utilization from 40 to 57 minutes per hour, reducing idle time from 33 to 5 percent (Samuelson, D.A., “ Predictive Dialing for Outbound Telephone Call Centers,” Interfaces, Vol. 29, Issue 5, September-October, 1999, pp. 66-81). In addition, phone calls are automatically recorded and indexed to patient accounts through a PC connection.

The integration of voice records with data such as faxes, images, and electronic documents has given THR a more complete view of patient health information exchanged across the continuum of care. Patient access associates record all phone calls with payers, physicians, and patients. Recordings are indexed to patient accounts and searchable for reference in denials management, patient collections, quality assurance, and other efforts. The same technology platform is used to send and receive faxes electronically, as well as capture images of online activity and electronic documents. Indexing all of these activities to the patient account gives THR a chronological view of all revenue cycle communication surrounding the patient.

The process has allowed the system to maintain existing goals for data accuracy and collections, while improving patient satisfaction.

During a three-year period, THR increased its Press Ganey registration scores from the 40th percentile to the 86th percentile―and increased point-of-service collections by $7 million during the same period. The system also overturned $2.5 million in denials in a single year by referencing recorded conversations with health plan representatives that confirmed patient authorization.

Security. To facilitate compliance and protection of patient health information, THR made a blanket rule that remote employees cannot print or fax at home. The system’s technology platform facilitates electronic faxing as well as image capture so that associates can capture and exchange information―faxes, medical records, websites, forms, etc.―in a completely paperless environment. Because on-site employees use the same platform, all employees access the same information and have a unified view of revenue cycle data pertaining to the patient.

An Evolving Program

As its work-from-home program has evolved, THR has identified new strategies for engaging remote employees and managing a virtual workforce.

Recognize different work styles. An important perspective was recognizing different types of employees―some who perform better at home and some who thrive in the office setting. Keeping a finger on the pulse of performance has helped leaders identify opportunities at the individual and team levels, making necessary adjustments and updating system leadership on progress.

Develop virtual job shadowing options. A challenge for the PAIC’s training and job shadowing programs is that many of the department’s highest performers are now working from home. As a result, it can be difficult to find seasoned employees for new hires to shadow. To address this, the department has transitioned to virtual job shadowing. Remote employees share their screens with new employees, who watch the entire patient registration process on-screen while listening via phone and ask questions using a chat tool.

Seasoned staff conduct virtual mentoring with new employees by listening to recordings and reviewing scorecards online. THR also holds quarterly call labs, during which the department reviews a phone call from each employee and listens to what the patient is hearing. This is particularly important for home settings where there could be issues such as static, barking dogs, or dropped calls.

Foster remote staff engagement. The PAIC holds staff events, huddles, and rounding online so that all employees can participate together. Skype features such as instant messaging, screen and file sharing, video conferencing, and polling are used for virtual staff meetings, morale-building activities, workshops, and weekly huddles. The tool also gives employees a way to quickly reach supervisors and peers throughout the day without needing to call.

Impact of the Virtual Move

As employees have moved to remote settings, THR is seeing improvements in employee satisfaction, as well as a reduction in unscheduled absences. Because registration and insurance verification staff have higher turnover rates than other departments, any effort to improve retention in these areas benefits the health system. This is especially true because losing a valued employee is estimated to cost an employer anywhere from $10,000 to $30,000 according to Global Workplace Analytics.

The PAIC has also seen improvements in productivity, tracked closely to ensure it stays in line with on-site teams. Not only are remote employees more productive in their work, but they also save time and costs associated with a daily commute. Global Workplace Analytics estimates that employees who work from home just half the time can gain back the equivalent of up to 3 weeks’ worth of free time per year and save between $2,000 and $7,000 in transportation and work-related costs.

Another benefit of the program has been freeing up office space for the health system’s continued expansion. Leaders say the department would not have had space to add more staff if it did not have some employees working from home.

There are numerous benefits to implementing a virtual framework in the revenue cycle, as demonstrated through THR’s outcomes. A well-planned approach that considers supporting technology, productivity/quality standards and management strategies for a remote workforce will ensure a seamless experience for stakeholders while promoting security, compliance, and collaboration among teams.

Patti Consolver is senior director, patient access, Texas Health Resources, Arlington, Texas, and is a member of HFMA’s Lone Star Chapter.

Publication Date: Monday, July 17, 2017