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Meeting the Challenge of Becoming a Remote Workforce: A Roundtable With Revenue Cycle Leaders

When COVID-19 arrived, revenue cycle leaders across the country had to make a rapid transition to running a completely remote workforce. Swift adaptation was needed to keep teams safe and functioning. No time off for healthcare providers. You name it, and it required reassessment: ensuring staff had access to needed tools, adjusting performance benchmarks, and overall, leading effectively in radically new and urgent circumstances.

A couple of months into this brave new world, we held a webinar to invite a few revenue cycle leaders to share their experiences with the situation, and asked them to share what did and didn’t work for them.

Get ready to gather some new ideas and file away some useful tips: we hope you and your team will benefit from what they’ve shared.

Meet the Revenue Cycle Leaders

First let’s meet the leaders who, like you, have been in the thick of all these changes:

Andrea Clark Rubinowitz, Senior Director of Revenue Integrity, MaineHealth

When shelter-in-place guidelines began, Rubinowitz’s MaineHealth team was 100% onsite. Her team is about five years old, so still growing and maturing in this space.

Terri Rinker, Revenue Cycle Director, Community Hospital, Anderson, IN

Rinker had about 150 staff in their revenue cycle at Anderson hospital, 10% already working from home. Now, 35% are remote with the remainder being patient-access, front-facing personnel who need to be onsite.

Bruce Preston, Director of Revenue Integrity, Grady Health System

Preston’s Grady Health team had a jump on remote working – they made the switch to nearly 100% work-from-home about a year ago, though everyone came into the office for a weekly meeting.

Lisa Longo, Director of Revenue Integrity, UConn Health

Longo has a very small, fairly new team at UConn: ramping up as the pandemic hit, then thrust into yet another new environment with remote work. She says these circumstances are “odd, but going pretty well.”

So how are the workforces staying effective and connected?

Like many of us, they are making heavy use of internet-based conferencing tools. For most, the weekly meetings and regular staff-huddles are still happening — but they take place online using Zoom, Skype Meetings, and Cisco’s WebEx.

"Visuals Help"

Our panelists agreed that the visual connection was as integral for these virtual check-ins as the review of to-do items. Another consideration that was common was the need to adjust schedules: working hours needed to be flexible for some staff who are teaching their children now while schools are closed.

Looking to maintain engagement, other key meet-ups have been scheduled online, too. For the newer teams, training has continued via internet platforms. Some teams have tried a virtual book club (with varying success) and plan other virtual groups according to staff interests, such as a card club and even a hiking club. Others have created presentations to continue sharing photos and other events with coworkers.

Rinker said her team had an entertaining online parade of “Co-Woofers.” And Rubinowitz mentioned that some of their Zoom huddles have been themed — like one inspired by “Tiger King,” with everyone wearing cat apparel and leopard print.

...Whatever it takes to keep spirits up!

What Might Stay?

Remote work is going well, but is it the new normal post-pandemic?

Each of our panelists said the plan is to eventually return to working the same way as before the COVID-19 requirements. For Preston, that means working remotely most of the time, as they have for the past year, but returning to in-office, in-person, weekly meetings. As returns are phased-in, they may stagger attendance at their meetings, possibly over two days, in order to maintain distance and prevent crowding.

Rinker, Rubinowitz, and Longo also look forward to meeting with their colleagues in person, and returning to work onsite. Rinker said her Anderson Hospital team plans to be remote at least until the end of the year, though. Rubinowitz noted MaineHealth also plans to go back to brick-and-mortar — remote work has not been adopted as the new normal, unless it's necessary.

Even when back to onsite work, Longo suggested that UConn may offer remote work as an option. Since it has worked well, it could be a nice offer for those who prefer the office-home balance.

Lessons Learned

The biggest lesson for our panelists? Take ALL the equipment! Many people wished they had taken their dual monitors and everything on their desktop with them. Due to the urgency of the shut down and move to remote working, packing was swift. Some staff members then struggled with an incomplete setup at home.

Preston agreed they “would have been in a world of trouble” had they not already equipped their staff with laptops when they started remote working a year ago.

Rinker further remarked that existing policies don’t always work. Telecommuting policies were in place, but the emergency situation required changes. For example, their policy states office furniture must be provided by the employee. All of a sudden “we have folks working on card-table folding chairs and dining room chairs, and all this furniture sitting in an empty office.” The problem was solved by offering staff a chance to safely go back and get their comfortable office chair, if they wished.

Phone Home

Rinker related one of the most troublesome issues, at first, was staff cell phone use. Reasonably, her team did not want to have conversations with patients using their personal cell phones: a twofold problem of (1) staff personal information being shared and (2) patients not answering calls from unidentified cell phone numbers. A working solution was mapped out by using their systems with Cisco’s Jabber.

Rubinowitz said her team struggled with infrastructure connectivity. They “weren’t ready for the number of individuals who needed to connect live.” Stopgap measures included certain hours slated for staff to work and not get bumped off or disconnected. It took about four weeks to get the necessary bandwidth for everyone to be up and running remotely.

Refining Skills And Processes
During Decreased Work Volume

As many readers know, in revenue integrity, if the volume of encounters goes down, such as elective surgeries, then much of the revenue cycle work also decreases. All of our panelists reported a significant drop in volume of work.

Our roundtable members felt lucky they had not had any furloughs so far. But they have also reassessed the benchmarks for productivity. Most have taken advantage of lesser workloads: more education for staff, and giving more feedback in their auditing skills, including forensic reviews of charge line-items and CPT codes. When there is a gap, after work is done, they offer assistance to the coding department or the PFS department – wherever it makes sense to lend a hand.

Teams have taken on professional billing and rules and regulations, since so much volume went from in-clinic to telehealth visits. And all have made an effort to use “extra” time to stay abreast of any changes and updates from compliance departments. Longo noted that “not only is revenue integrity very new at UConn, Epic is fairly new, and our revenue cycle team is very new, so we have a lot of project work.”

Across the board, our panelists turned low work volumes into opportunities. They’ve been able to boost staff education, move back-burner projects to the forefront, and use their time to prepare for price transparency issues coming down the pike.

Pleasantly Surprised...

Preston is pleasantly surprised at the willingness of staff to be “all-hands on-deck.” When volume started to go down, instead of stretching-out work or ignoring gaps, his team was ready, willing, and able to address different areas with meaningful work.

“What surprised me from our team, is the creativity” says Rubinowitz. Her staff built a revenue integrity Jeopardy game, and everyone signed onto video and played. Now they’re looking at making a revenue integrity Family Feud. She proudly notes this demonstrates her team’s creativity AND expertise in their field.

Longo has been delighted at how well and how quickly everyone has adapted to the work-from-home environment, especially “how nobody is afraid to pick up the phone and carry on conversations on a regular basis.” Instead of walking into someone’s office, “we just make a call and stay in sync.”

That’s the roundup from our panelists. Hopefully you gained some ideas to use now and to have in your back pocket for any future changes to the workforce environment.