The Atlanta-based group practice’s performance improvement program increased productivity while maintaining staff morale.
One year ago, leaders at Emory Clinic aimed to improve their revenue cycle metrics by implementing a performance improvement program that used game-based principles.
“We wanted to increase performance standards such as productivity and quality of work without having a negative impact on staff morale,” says Adam Gobin, director of revenue management at the Atlanta-based medical group practice with more than 1,600 providers. “We thought we could do that by employing a gamification methodology.”
Gamification applies the typical elements of game playing, such as competition and rewards, to business and training applications, according to Gobin, who leads a 179-person staff. It also involves providing frequent feedback to individuals on their performance in a challenging but nonthreatening way. “By adding gamification, we knew we could make the program more fun and get employees engaged in improving their performance,” he says.
Planning the Implementation
Getting access to individual employee’s performance data was an important first step. “Although we had performance metrics, we had difficulty pulling user-level data from our former billing system,” says Melissa Crozier, manager of analytics and process improvement. “When we switched to a new billing system that gave us access to user-level data, we could hold individuals accountable for their performance.”
Another critical step was marketing the performance improvement program internally. Six months before their go-live date, Gobin and Crozier convened representatives from marketing and human resources (HR) to create internal buy-in for the program. “We made sure we included them in every step of the planning and vision-development process,” Gobin says.
In their internal communications, leaders highlighted the value of the new performance improvement program to accounts receivable (A/R) staff. Prior to adding gamification, most feedback to staff was given on a monthly basis. “We emphasized the value of having an easy-to-follow, individualized progress report that each employee could use to gauge their performance on a weekly basis,” Gobin says. “The weekly progress reports would create daily goals and tasks for staff. And receiving regular feedback would help staff avoid surprises at the mid-year or end-of-year performance review.”
In June 2015, leaders at Emory Clinic launched their new performance improvement program. To make sure employees were comfortable with the program, leaders waited three months before holding A/R staff accountable to the new metrics.
How It Works
One of the key principles of gamification is to reward good performance. As part of the new program at Emory Clinic, A/R staff can win up to four different badges each month when they reach certain targets. The badges are as follows.
Exceeds expectation. To earn this, the employee must have a total score of 100 percent and be nominated by their supervisor. (Performance scores are calculated using analytics.)
Top producer. The employee must have a productivity score of 100 percent and high productivity metrics. The top three employees of each team receive this badge.
Top quality. The employee must have a quality score of 100 percent. The top three employees of each team receive this badge.
Top revenue producer. This is awarded to the team employee with the highest dollars collected that month.
Emory Clinic’s revenue cycle department is divided into five teams. Leaders assign different daily productivity goals per team based on level of difficulty. For example, Emory Clinic’s coding team and precertification team have a lower ratio of tasks/hour than the administrative denials team. For example, the administrative denials teams operate at five tasks per hour while the coding precertification teams operate at three tasks per hour. “Those tasks take a little longer and require a bit more expertise to address,” Crozier says.
Each month, employees that earn badges receive recognition and certificates during team huddles. Some badges also help employees earn points that they can redeem for prizes like cameras and restaurant gift cards as part of the health system’s broader incentive program.
See related tool: Emory Clinic’s Revenue Cycle Department Performance Dashboard
“It is important to give employees a tangible report on their performance,” Crozier says. Within three days, supervisors have an opportunity to meet with low performers to go over the scorecard. Training specialists also get involved with staff to provide coaching or offer a performance improvement plan as needed. “The training specialists will monitor the staff’s workflow or do an analysis on some of their user data to identify trends,” Crozier says. “Often, they uncover a faster or better way for employees to complete a task.”
Realizing the Results
Just three months after leaders implemented the new performance improvement program, A/R staff increased their productivity by 7.9 percent. They also trimmed six days from net days in A/R and increased net payments by 6.2 percent.
In April 2016, the A/R department’s productivity was at 99.56 percent, an 8.6 percent increase from September 2015. Total performance across all teams was at 99 percent, a 5.2 percent increase. The precertification team, in particular, saw their total performance rise from approximately 80 percent to 98 percent.
“Adding the gamification has not only increased productivity and the quality of work, but it also has increased morale because staff are getting feedback on a regular basis,” Gobin says. “There are less complaints because staff know what to expect.”
Emory Clinic’s Improved Denial Turnaround Times
For organizations that want to enhance their A/R team’s performance with gamification, Gobin and Crozier suggest the following advice.
Engage HR early on. “Before rolling out the program, we spent a lot of time with our HR specialists making sure the program complied with our HR policies and also to make sure the program helped the employee,” Crozier says. “We didn’t want to create a program that just identified low performers.”
Establish a governance team. Early on in the development process, Gobin established a governance team that included physicians and administrators. “We wanted some high-level leaders as part of the team, so that when they sent congratulatory and thank-you cards to staff for good performance, it would mean something,” Gobin says.
Audit supervisors to make sure their work is consistent. Emory Clinic’s quality metric is based on an average of audits conducted by supervisors. Each team supervisor is required to complete at least five audits on each team member, based on a standard audit template, as part of the month-end performance assessments. A supervisor of quality monitors the supervisors’ audits to make sure they audit their teams in the same ways.
Invest in training for supervisors. Prior to taking the program live, team supervisors attended a coaching class through the HR department. Although the course was helpful, supervisors could have benefitted from more practical coaching simulations, Gobin says. “Looking back, we did not spend enough time teaching supervisors how to have specific conversations about performance with staff in various case scenarios,” he says.
Seek input from staff. “Soliciting feedback helps create a program that employees can feel confident about,” Crozier says. “We want to not only identify areas of improvement for staff, but also to find ways to make the system and workflows work better for them.”
This article is based in part on a presentation at HIMSS16 in Las Vegas in March.
Laura Ramos Hegwer is a freelance writer and editor based in Lake Bluff, Ill., and a member of HFMA’s First Illinois Chapter.
Interviewed for this article: Adam Gobin is director of revenue cycle management, Emory Clinic, Atlanta.
Melissa Crozier is manager of analytics and process improvement, Emory Clinic.