WORKING OUTSIDE THE BOX:
HOME BASED EMPLOYEES
Northeast Ohio HFMA /Western Reserve AAHAM
Patient Financial Services Program
Adding Value to the Revenue Cycle
February 21, 2013
Akron, OH
Leah Klinke, Director, Patient Financial Services
Dianna Cesa, Manager, Patient Financial Services
Agenda
• Learning from others – examples from the private
sector
• Identifying the potential within your revenue cycle
• Case studies – process, technology,
implementation; challenges and proven
resolutions
• What employees are saying
• Costs and ROI
• Summary
Quick Questions!
• Have you implemented a home-based worker
program?
• Have you implemented and later eliminated a
home-based worker program? Why?
• If you were to start a home-based worker
program, what would be your first area? Why?
Learning from Others
• What functions can be handled from home?
• Any function involving a sufficient volume of work, supported by
virtual technology, that does not require face to face interaction
• The Best Buy “ROWE”
• “results only work environment”
• Alpine Access
• 7,500 employees
• Call center operations for Office Depot, ExpressJet, J. Crew,
Internal Revenue Service
• Sun Microsystems, Inc.
• “Open Work” resulted in 34% productivity gains
Learning from Others
• KPMG LLP
• Flextime including compressed work weeks, especially during
summer months
• PNC Financial Services Group
• Approximately 12,500 employees using some form of flexible work
arrangement
• Fuentek, NC multi-million company
• Virtual Company
• No Bricks and Mortar
• All employees required to work from home
• Builds great loyalty from employees
Home-based Workers
• New generation of employees do better in this type of
•
•
•
•
•
•
•
environment; flexibility
New manager mind-set: emphasis on approaching work
with adaptability and creativity
Focus on productivity vs. work time
Flex time vs. semi-flex time schedules
Key is technology
Family Adjustments
Weather
Trust is Critical
WVUH – Who We Are
• Teaching hospital with level 1 trauma
• Magnet Certified
• 531 beds
• >500 physicians in closed faculty practice
• $1.4 billion gross revenue (hospital only)
• WVU Healthcare (WVU Hospitals & University Health
Assosicates)
Revenue Cycle Opportunities
Pre-Service
Processing
.
.
• Scheduling and Pre-Service
• Scheduling calls
• Medical necessity screening
• Post scanning/electronic receipt of orders-accuracy and
completeness review
• Pre-registration calls
• Insurance verification processing and resolution
• Managed care authorization resolution
• Financial liability, patient financial education and
account resolution
Revenue Cycle Opportunities
Pre-Service
Processing
Time of Service
Processing
• Time of Service
• Unresolved time of service accounts from work queues
• Transcription
• Coding
• Deficiency analysis and tracking
• Cancer registry
• Release of information processing
• Scrubber account failures resolution
Revenue Cycle Opportunities
Pre-Service
Processing
Time of Service
Processing
Post Service
Processing
• Post Service
• Billing
• Follow-Up – Insurance
• Follow-Up – Self Pay
• Bad Debt processing
• Charity applications (if not resolved at pre/time of
service)
Other Opportunities
Pre-Service
Processing
Time of Service
Processing
• Accounting
• Payroll
• Accounting (Decision Support)
• AP Staff
• Reimbursement
• Management
• ???? – What’s on your mind?
Post Service
Processing
Case Studies – Patient Accounting
Process
Quality
Productivity
•
•
•
•
•
Claims editing
EPIC workqueues
Insurance follow-up
Refund processing/research
Denials/Appeals
• Meet threshold set for follow-up criteria
• “Print Status” Workqueue
• Monitoring reports on adjustment codes
•
•
•
•
•
Age of backlogs
EPIC account activities
Monitoring workqueues (in and out)
Productivity reporting
Coming Soon: Time stamping report
Case Studies – Patient Accounting
Technology
Employee
Selection
• Citrix
• EPIC (Patient Accounting System/EMR)
• Quadax Xpeditor (Clearinghouse)
• Horizon Patient Folder (Imaging)
• Organizational IntraNet
• Department Website
• Department Sharepoint
•
•
•
•
•
Quality
Productivity
Technology skills
Communication skills
Self discipline
Productivity Reporting – EPIC WQs
Productivity Reporting – EPIC WQs
Productivity Reporting – Acct. Activities
Home-Based
Management Issues
Challenge
Resolution
Communication
•
•
•
•
•
Ongoing communication
Secure instant messaging
Department website/Sharepoint
Use of internal phone system
Virtual meetings
IT Issues
•
•
•
•
Planning/communication with IT
Internal resources within department
Personal responsibility for resolution on employee
Office workstations kept available during outages
Work schedules: flex
vs. partial vs. none
• Semi-flex Mon-Fri
• Approval required for Saturday/Sunday
Training
• Major system change-in-house training
• Minor changes-individual basis
• CBLs
Management Issues
Challenge
Resolution
Confidentiality
• Private area within home
• Only staff use hospital provided equipment
• No wireless networks allowed
Privilege vs.
entitlement
•
•
•
•
Space
• Private space/workstation required in work areas
Geographic locations
• Keep HR in loop on out-of-state workers
System down time
• Manager involvement to direct work locations
• Bringing staff in to facility for day (days) as needed
Child-care; parent
care
• Explicit in home-base contract – zero tolerance
• Address in policy
Break seniority mold
Privilege of home base is based on performance
Zero tolerance for disciplinary incidents
Trial period (2 way)
Management Issues
Challenge
Resolution
Work assignments for
special projects
• Management discipline to review all options before
assigning work
Maintaining team
environment
•
•
•
•
Managing by results
• Set and communicate clear goals, set and maintain
deadlines, measuring results vs. expectations
Regular contact to maintain high morale
Consider using IM
Monthly staff meetings
Reward/celebrations done in conjunction with staff
meetings so all can participate
Work from Home Policy Highlights
• Work from Home is a privilege, not an automatic
benefit
• Can discontinue program entirely or individually
• Will start with a 6 week trial period
• Patient confidentiality is of utmost importance
• Home office in a private location free of interruptions
• Installed equipment for work use only
• No use of non-hospital equipment not allowed
• Hospital security policies will be followed
Work from Home Policy Highlights
• This program involves some cost be borne by the
employee
• Minor supplies including pens, etc.
• Workstation (desk, etc.)
• Hospital approves appropriateness of workstation
• Employee responsible for phone line/internet
charges, firewall, surge protector & cables.
Work from Home Policy Highlights
• Hospital will maintain hospital-issued equipment
• No unauthorized software
• Hospital can inspect at any time
• Damage due to irresponsible use will be employee’s
responsibility
• Internet downtime is employee’s responsibility
• Downtime > 30 min requires making up lost time or take
PDO
• Must notify manager within 15 minutes of outage
• Must report to the office if > half of shift remains
• Employee must comply with all Hospital & PFS
policies on leave and work hours
Work from Home Policy Highlights
• Employee will attend all meetings
• Staff meetings, performance evaluations, etc.
• Mileage will not be compensated.
• Employees are required to clock in and out online
• Printing of PHI should be avoided. Any printed
PHI will be destroyed using a paper shredder
• Employee required to meet Quality & Productivity
standards – may result in disciplinary action
• Any employee under disciplinary action will not
be allowed to work from home.
Program Benefits
• Employee retention
• Cost savings for space
• Productivity increases
• Flexibility to meet needs of organization and
needs of employee
What employees are saying … positives
• “the privilege of being able to do so, especially with
•
•
•
•
today’s gas prices, not having to drive to work each day
and the ease of getting ready for work not having to worry
about office attire…”
“is the fact that I can work at home at a job I love and still
be able to have the flexibility that I need to help raise my
children”
“convenience”
“less days missed due to FMLA issues…”
“the fact that, although the productivity is monitored, there
is no one looking over your shoulder all day long to make
sure that things are complete…”
What employees are saying … challenges
• “electric going off; internet going down”
• “technical problems that arise on occasion…working
•
•
•
•
through Citrix is different than in house, but able to
resolve problems as they have come up.”
“constant worry about meeting productivity so I can stay at
home”
“flexibility is a blessing and a curse”
“managing my time”
“co-worker interaction”
What employees are saying…improvements
• “I don’t know of anything I would do different.”
• “No changes”
• “Would like to see it where the coders could set our own
schedule as long as we got our 8 hours in each day…”
• “Nothing really…I feel that the process works, the
computer system functions properly and the work gets
done”
Start-Up Costs
• Workstation and software – hospital
• High speed internet – employee
• Home office space and desk – employee
• Telephone set-up – hospital
• Home visit to validate space, etc. – hospital
Return on Investment
• Hospital perspective
• Minimum 10% productivity increase
• Employee retention (replacement cost estimated at 1.5 time annual
salary)
• Decrease in FMLA usage (90+%)
• Reduced space costs ($7,500 per seat at hospital)
• Elimination of shift differential
• Availability to work overtime as needed
• Reduction of pressure on parking lots
• Long term FTE savings as productivity improvements reduce need
to add staff to offset volume growth
Return on Investment
• Employee perspective
• Savings in commuting costs
• Savings in clothing costs
• Savings in food costs
• Elimination of commuting stress, especially in bad
weather
Pre-registration Unit Savings
Expense Item
Per Unit Price
Total Price
Lease
$16 - $24 per sqft
$
200,000
Utilities
$2.50 per sqft
$
25,000
Housekeeping
$1.50 per sqft
$
15,000
Copier Lease
$3500 per
$
3,500
$
243,500
Expense for 10,000 SqFt Building
Total
Expense to Send 30 Employees Home
Headsets
$75 each
$
2,250
Software Licenses
$250 each
$
7,500
Paper Shredder
$75 each
$
2,250
Total
$
12,000
Total Savings
$
231,500
Implementation Check List
• Process – define the work flow(s) involved in writing for
•
•
•
•
•
each activity
Clearly define how quality will be measured and what
constitutes acceptable performance
Establish productivity standards and create measurement
tools before sending staff home
Create a technology list and check off each application
needed to complete the assigned work
Complete home visit
Select employees based on quality and productivity, not
seniority
Retention Committee
Flexible Work Options Pilot
• Three departments selected with management employees
• Must support hospital goals
• Assignment must be appropriate
• Equipment, systems, materials must be available
• The individual's work style and history must support the
demands of the arrangement
• Special arrangements for communication and
accountability must be established
• Flexibility must be mutually beneficial to WVUH and the
employee. Thus the flex work option should meet both
business and employee needs
Flexible Work Options Pilot
Outcomes
• Management self evaluation of process positive
• Employee evaluation of process positive
• Focused time to work on specific projects, email, reports,
staffing, etc…
• Keep WVUH current with emerging trends in a
competitive market
• Toolkit developed
Summary
• Do not rush to move to home-based workers – do
your homework first
• Policies and procedures
• Human Resources involvement
• IT involvement
• Training on remote access functionality
• Monitor productivity and quality and routinely
report results to employees
• Look for additional opportunities once your first
efforts are proven to be successful
Important to remember:
All must be prepared to return to pre-flexibility
arrangements if the situation requires
Parting Thoughts…
• Going Green by Kate Lister
• Only 3% of work force telecommutes, but estimated
40% could
• Nation would save 453 million barrels of oil
• Take 15 million cars off the road
• Businesses would save $194 billion in real estate,
electric, absenteeism, turnover
• Employees would save $2,500 to $11,000 annually
• Communities would save $3 billion in highway
maintenance
• 150,000 people/year would be saved from traffic related
injury or death
Contact Information
Leah Klinke, Director – Patient Financial Services
West Virginia University Hospitals
klinkel@wvuhealthcare.com
Dianna Cesa, Manager Patient Financial Services
West Virginia University Hospitals
cesad@wvuhealthcare.com