In addition to the CEO’s high-profile, weekly two-hour meeting with, on average, as many as 175 new hires and transferring employees at the 70,000-employee health system, the organization is focused on nontraditional ways to make connections with employees. Moscola believes one of the reasons people stay in an organization is the relationships they develop there. “So to the extent that we can create comradery, we do that, as well,” he says.
Other efforts to improve retention included adding ways for Northwell employees to advance their careers. An example was the launch of a school for nurses and physician assistants in partnership with Hofstra University that includes a track for nurse practitioners.
The efforts were credited with reducing the organization’s turnover rate to 9% and allowing average tenure to reach 9.5 years.
Czajka says the retention challenge is a common clinical-labor cost driver for hospitals.
“They haven’t figured out the secret sauce to keeping nurses and lab workers and pharmacists and ancillary staff,” Czajka says. “So they lose people and end up having to engage premium labor.”
The response of not-for-profit Northwell to the costly contract-worker challenge was for its human resources department to launch a for-profit temp worker and travel nurse agency, called FlexStaff. That entity has allowed the health system to cut its temporary staff costs by focusing on converting temps to permanent employees and avoiding agency service charges. Through also eliminating premium travel agency payments, the subsidiary overall was credited with saving Northwell $38 million over four years, Moscola says.
Automated revenue cycle savings
Scott Johnson, FHFMA, MBA, executive vice president and CFO of St. Luke’s Health Corp., a two-hospital health system based in St. Louis has found automation can provide labor savings within the revenue cycle function.
“It’s a great way for us to consider automating some processes that are fairly redundant and high volume in the revenue cycle,” Johnson said about efforts related to prior-authorization compliance and payment denial research. “There’s all kinds of busywork being done by people that is tedious, and it became clear that to some extent those are basic rule-based functions you could automate with an RPA [robotic process automation] tool.”
One RPA system St. Luke’s has added replaced staff manually logging into the health plans’ websites to confirm that each claim was adjudicated properly.
“Instead, you have a computer do that, constantly pinging the payer database for an immediate answer,” Johnson said.
Johnson says many hospitals already own IT systems that include RPA-type assistance for repetitive tasks but don’t realize it. For instance, a module was available within the health system’s HR payroll system to allow managers to automate tedious tasks of posting job notices, reviewing basic qualifications of applicants and moving the application through the various approvals required from staff on multiple levels.
“Sometimes you just need to get inside your own systems and say ‘OK, is this system capable of performing more for us and have we explored that first?’” Johnson says.
Kelley Blair, a senior vice president for Change Healthcare in Chicago, says other labor savings in revenue cycle operations that hospitals have achieved in recent years have come from:
- Increasing use of work-from-home administrative positions
- Leveraging global talent
- Shifting revenue cycle staff replaced by AI to the task of auditing the AI’s claim work
The shift to overseas financial office contractors, which can cut labor costs in half, has moved beyond accounts receivable management, Blair says, and healthcare organizations are increasingly willing to look at patient interaction functions, such as business office call centers and patient scheduling.
Blair said such outsourcing is difficult for hospitals because such moves raise concerns the community-based organizations are taking jobs out of the community. Overseas contracting also can detract from hospitals’ ability to ensure patients have an excellent experience that will strengthen their loyalty to the health system, which is hugely important in the era of consumerism. However, health plans have long adopted this strategy, and physician groups are increasingly doing so too.
Additional labor savings can be provided by increased use of analytics to change workflows in the revenue cycle. That can allow hospitals to switch from labor-intensive monthly reporting or root-cause analysis in response to health plan payment denials to real-time tracking of claims. Use of analytics allows hospitals to identify all pending transactions similar to rejected claims and to address them all simultaneously to prevent denials, Blair says.
Focusing on a stealth cost
Gerard Brogan Jr., MD, senior vice president and chief revenue officer of Northwell Health, says he has found high turnover is a revenue cycle labor “stealth cost,” as new hires take time to find, train and get up to the speed of existing employees. In response, the health system has implemented leadership training and career development to minimize turnover and to encourage employees who want new jobs to move within the organization instead of leaving.
Among the available labor-savings initiatives, Brogan warns hospital leaders to use caution when bringing in external contractors to implement process changes. “There is an assumption as to the efficiency and effectiveness of that process change, and it may not be monitored as closely as it needs to be,” Brogan says. “And it may not actually have resulted in any improved outcomes, versus what could have been done internally.”