Working Outside the Box: Home Based Employees

WORKING OUTSIDE THE BOX: HOME BASED EMPLOYEES

Northeast Ohio HFMA /Western Reserve AAHAMPatient Financial Services Program Adding Value to the Revenue CycleFebruary 21, 2013Akron, 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

• 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

• 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

• 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

• Accounting• Payroll• Accounting (Decision Support)• AP Staff• Reimbursement• Management• ???? – What’s on your mind?

Case Studies – Patient Accounting

Case Studies – Patient Accounting

Productivity Reporting – EPIC WQs

Productivity Reporting – EPIC WQs

Productivity Reporting – Acct. Activities

Home-Based

Management IssuesChallenge 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 IssuesChallenge Resolution

Confidentiality • Private area within home• Only staff use hospital provided equipment• No wireless networks allowed

Privilege vs. entitlement

• Break seniority mold• Privilege of home base is based on performance• Zero tolerance for disciplinary incidents• Trial period (2 way)

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

Management IssuesChallenge Resolution

Work assignments for special projects

• Management discipline to review all options before assigning work

Maintaining team environment

• Regular contact to maintain high morale• Consider using IM• Monthly staff meetings• Reward/celebrations done in conjunction with staff

meetings so all can participate

Managing by results • Set and communicate clear goals, set and maintain deadlines, measuring results vs. expectations

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 SavingsExpense Item Per Unit Price Total PriceExpense for 10,000 SqFt Building

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

Total $ 243,500

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 CommitteeFlexible 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 PilotOutcomes• 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