Presented by:

Julie Champayne, RHIA - Trinity Health Revenue Excellence

The Remote Worker - Tips and Guidance

for Successful Implementation

Florida HFMA – Spring Conference

Vinoy Renaissance – St. Petersburg, Florida

May 21, 2019

• How to evaluate the readiness of a “Remote" program for your site.

• Share how we planned for the technology, process and a secure environment for a “Remote" program.

• Discuss how we communicated and enhanced employee engagement with the program for retention and recruitment.

• Share the key performance metrics on productivity and other revenue cycle processes that improved after program implementation.

• Share our successes, barriers and speed bumps in the implementation.

Our Time Together

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3©2019 Trinity Health

Trinity Health’s 22-state

diversified system today

*Owned, managed or in JOAs or JVs.

Hospitals* in 22 states94

Employed Physicians & Clinicians7.8K

Attributed Lives1.5M

Affiliated Physicians28K

Community Benefit Ministry$1.1B

In Revenue$18.3B

23Clinically Integrated Networks

Continuing Care Locations10917 PACE Center

Locations

Colleagues133K

Muskegon

Grand Rapids

West Michigan – Mercy Health Where are we?

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The Patient Access Leadership team implemented a remote "At Home" program

which increased the Colleague satisfaction/engagement and assisted in

retention of our best talent.

This program enabled the Colleagues to perform a number of patient access

function including pre-registration, insurance verification, authorization/referral

follow up, POS collections and contacting patients to financially clear them for

services.

Sharing Our Story

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A number of things sparked the idea of a remote program.

• At our Muskegon location we were running out of space in the office.

• In Grand Rapids we were relocating to a new building and this

program allowed us to reduce the construction costs.

• With input from the Colleagues they wanted some options to work

from home.

- In West Michigan the winters get very snowy, cold and

travel is many times a hazard.

- Working from home saved time, gas expense, travel

worries and ensured peace of mind.

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Ideas and Justification

West Michigan Winter

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8©2017 Trinity Health

Michigan Spring Time

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SW Florida Sunset

Less Traffic Reduces Traffic Congestion, prevents

accidents and saves

the roadways deteriorating infrastructure.

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I-75 Traffic

• Enhanced Colleague satisfaction, which promotes retention and

recruitment

• Reduction in unscheduled absences

• Improved efficiency and productivity

• Decreased overhead costs and non-productive time

• Increased flexibility in scheduling and load balancing which makes it

easier to manage

Many Benefits of Remote Colleagues

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Other Remote Revenue Cycle Areas

Currently within the Revenue Cycle operations we have other

processes and departments that have elected to offer remote

programs these include:

• Medical transcription

• Coding/HIM

• Charge capture verification

• Data Analytics

• Revenue Cycle Consultants

With these programs already operational we leveraged existing contracts, policies,

procedures and technical network infrastructure to duplicate our processes.

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• Information Technology

• Project Management

• Consulting

• Management

• Education

• Customer Service

• Marketing

• Teaching

• Sales

• Healthcare – Case Management,

Physician Advisors, etc.

Other Industries using Remote Colleagues

13©2017 Trinity Health

Gallup

Gallup’s State of the American Workplace report states that only one-third of employees are actively engaged at work. The rest are either disengaged or actively disengaged, which leaves them susceptible to poor performance and switching jobs when something better comes along. To keep employees pumped up, company leaders must understand what employees want and how to sustain their interest. For starters, work-life balance, flexible schedules, and flexible work locations are among the top benefits that determine whether an employee will stay or go.

Key Findings:

• 53% of employees pointed to work-life balance as being very important when choosing a job

• 51% of employees said they would leave their employer if another company offered them flextime.

• 35% of employees indicated they would change jobs if another employer let them work wherever they wanted full-time.

• Final Word: To reduce employee attrition, employers should consider flexible work arrangements – regarding both time and location – to afford employees more work-life balance and improve overall job satisfaction. Telecommuting and flexible scheduling aren’t the only way to win employees’ hearts, but they’re certainly a step in the right direction.

Stats – Gallop Poll

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Prior to developing a formal work plan, a “Level of

Interest Survey” was conducted with our current

colleagues.

This survey also identified segments of work that

were appropriate to performed remotely and those

tasks which simply were not feasible.

Polling For Interest

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• Point of service/pre-service collections

• Pricing estimates

• Financial assistance screening

• Monitoring for quality and accuracy

• Scheduling simple procedures

• Data Analytics

• Demographic verification.

Patient Access and other Revenue Cycle Functions

• Pre-registration with calls to patients

• Authorization verification and retrieval

• Insurance verification using real time eligibility and websites

• Auto fax (paperless) for payer authorization requests to providers

• Virtual meetings/huddles

• Lab registration completion

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Colleague Performance Monitoring

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Participation and Engagement

Feedback – Report Cards and Evaluations

Metrics – Productivity and Quality

Communication

Things To Consider Before You Start

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Security and HIPAA –

Home visit and no paper

Colleague Engagement

Budget

Eligibility –check with

your HR and Legal

Department

Performance Criteria

Consistency

Plan and Strategy – All Colleagues

Technical Configuration

Recommendations –resurvey

Colleague Eligibility Requirements – Signed Agreement

The Remote/Telecommuting program by Patient Access Colleagues consists of the following structure and guidelines detailed in the signed agreement:

• Budgeted position and status

• Current work performance standards

• Status of Human Resource policy violations

• Computer competency and demonstration

• Connectivity that is part of the standard service for the residential area

• Physical Environment assessment completed

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• A colleague with corrective/

disciplinary action is not eligible to

telecommute. (We will consider after

6 months to a year according to

policy with no additional corrective

action)

• Performance Metrics must be met

• Communication skills and the ability

to work independently and

completion of the assigned work

• Computer proficiency/competency

• Colleagues must be in a budgeted

position for one year prior to going

home to work

• The Colleague’s performance

evaluation must be at meets

expectations or above

• Ability to work independently

• Completion of all assigned online

education

• Must meet and maintain average

registration quality score

Eligibility Specifics

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• Colleague’s ability to provide necessary connectivity through

recognized, IT approved dealer/vendor; and telephone connectivity with

necessary reporting functionality

• Colleague must provide phone stats timely each month

• Ability to meet and maintain productivity and quality standards

• Ability to meet necessary physical environment requirements for work

environment/location & safety, HIPAA security, confidentiality and

privacy

• Colleague must be willing to come on-site to work at least 1-day per

month and attend training, education, meetings, evaluations, and/or

other business purposes

Other Eligibility Requirements

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Remote

Program Plan

Eligibility

Communication

Staff Scheduling

Downtimeand Support

Monitoring

Workenvironmentand Safety

Equipment, Software &

Network

Work Plan Categories

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• Signed Agreement and Compliance with the policies

• Cable/DSL company set up and testing

• Delivery of technical equipment

• After hours, weekend and lunch - call forwarding

• Conduct at home security/HIPAA inspection

• Review time tracking and logs with staff

• Review workflow and assignment of work with all associates

• Reports – Separate workflow reports

Work Plan Highlights

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• Conduct quality/productivity monitoring monthly with feedback for all associates

• Clocking agreement and staff given number

• Scripting for phones and caller ID

• Downtime processes

• Authorization Grid and other

reference material access

• Real-time communication:

Questions and Transmittals

• Access to phone and account

productivity records

• Scheduled daily huddles, monthly

team meetings with agendas

Work Plan Highlights – Continued.

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The Telecommuting (working remotely at home) program for Revenue

Cycle Colleagues consists of the following structure and guidelines:

1. Physical environment requirements

2. Equipment and software usage

3. Connectivity/system access

4. Hours of work

Policy Details

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Work Environment/Location & Safety

• An inspection and/or photograph of the remote work environment will

be made prior to the approval to work remotely, and periodically

thereafter.

• With regard to the work environment, associates must

meet/provide/adhere to the following:

- If requested, a photograph of the designated work area

- A designated, dedicated work area completely separate from family living areas,

high traffic areas, and areas likely accessible to visitors

- A safe location for all equipment to prevent against damage, theft, vandalism or

unauthorized access/use (including a fire extinguisher within reach)

- Necessary electrical/cable/phone access, including grounded electrical outlets

- Proper location of cables and cords to prevent tripping

- Proper lighting

- Noise controlled area (NO barking dogs)

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• Ergonomically equipped workstation (i.e., desk and chair)

• Someone other than the associate must provide appropriate

dependent care during scheduled work hours

• Associates working remotely who have an injury they believe to be

work related are to immediately report to Leadership and complete an

incident/injury report

- Any injury occurring outside the defined workspace and outside telecommuting hours

shall not be considered work-related

• Any geographical change of work location or address must be

reported to Patient Access Leadership prior to the change

Other Home Office Tips

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Technical Requirements

• Proper technical infrastructure

• Phone requirements/Caller ID

• Cable and Internet Connections

• Monitoring and reporting of outbound calls

• Equipment works

• Network Connections and testing

• Applications access and functional

The “Must Haves” To Set Up the Technology

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- We provided the personal computer, standard keyboard, monitor(s),

telephone (no Cell Phones) and necessary software and instructions.

• Initial testing of equipment will be done prior to deployment

• We maintain ownership of equipment and software for remote use

• This equipment and software is for the sole purpose is for work and other

contracted business entities

- Use of this equipment/software for any other purpose will be considered a

violation of employment rules, which may result in corrective action up to

and including termination of employment. Equipment and software will be

maintained and serviced by IS.

Equipment

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Software and Internet Access

• We are not responsible for operating costs, home maintenance, or any other

incidental cost (e.g., utilities and home improvements) related to the use of the

associate’s remote location.

• The employee is responsible for provisioning a telephone land line and high-

speed Internet access and the installation costs and monthly fees. If for any

reason the colleague is unable to work from home we are not be responsible

costs incurred or otherwise.

• It is the expectation that timely utility payments are maintained so as not to

incur disruption in service and/or inability to work remotely/telecommute. If

access to the service is affected due to non-payment the colleague, is

expected to report to their supervisor.

• Upon termination of participation in a remote work program, the colleague will

return all equipment and software within 5 days.

• The Associate is prohibited from installing additional hardware, software or

peripheral equipment.

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We maintain the right to establish security and confidentiality policies

and conditions for the use of its equipment.

• All electronic information must be protected from unauthorized disclosure

or damage.

• No PHI is to be saved or printed on the colleague’s premises for any

reason.

• Colleagues will be held to the Hospital/Region’s confidentiality and security

policies, subject to disciplinary action outlined in these policies, and must

complete the annual confidentiality agreement.

Security & Confidentiality – NO Paper

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How did we communicate for work assignment?

As we have both hospital and remote teams we had to strategically

target a plan to ensure these two groups did not pre-register the same

patient population.

There are also "add-on" patients for same day/next day procedures that

require a more integral use of real-time connectivity to hospital

departments.

Technology in a paperless work environment did assist to be your

advocate in an at-home setting.

Processes-Workflow-Communication

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How did we keep everyone up to date ?

Communication is essential to the success of the remote program and will be accomplished via telephone and/or e-mail between Patient Access Leadership and the colleague.

- Use of “Instant Messaging”/Jabber if your company allows this

- The colleague is required to review and respond to their e-mail periodically throughout their shift

- The colleague must be available by telephone throughout their scheduled work time

- Colleague is discouraged from accessing Trinity Health e-mail during non-work hours

- Prior to a change in geographical address, notification must be made to Patient Access Leadership and HR

Communication with the Team

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Remote Huddles/Meetings

How Do Our Remote Colleagues Stay Department Connected?

• We schedule Huddles to the entire department’s calendar –using video

cameras

• The meetings include Web-Ex and Conference Number

• Use of White Board or Photos of Huddle Boards

• Hospital based workers meet together and join the conference call

• Huddle is performed with all colleagues as a full team

• Remote colleagues submit topics to Manager or Team Lead

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- Remote/home-based colleagues will be subject to, and

compensated under, the same policies and procedures as other

colleagues

- Travel time and mileage expenses will not be

compensated/reimbursed when the remote/home-based colleague

is scheduled to work at the RHM or attend meetings

- Clock in process included a special phone number or system

Compensation and benefits

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- The colleague is required to complete their scheduled shift

- Colleagues are required to report hours worked via the Hospital/Region’s time and attendance system or other means approved by Leadership

- Any time spent away from the designated work area (other than regularly scheduled breaks), is considered non-work (uncompensated) time

- Unless pre-approved, no overtime is allowed

- Colleagues may be requested by Leadership to report to the hospital/site for training, education, meetings, evaluations, and other business purposes

Scheduling and Time Off Requests

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• Colleagues will be notified of scheduled system downtimes. If downtime is

less than 30 minutes, the colleague may remain on the clock. As is the

practice on-site, the staff is encouraged to use this advanced scheduled time

for lunch breaks and/or education.

• Up to 30-minutes nonproductive work time caused by an accessibility

failure/unscheduled downtime will be compensated through logged downtime.

The colleague will track dates and times of system downtime.

• The process for requesting and scheduling time off remains the same

regardless of whether the colleague works on-site or remotely.

System Downtime

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- Increase in Point of Service Collections

- Reduce write-offs/Denials for No authorization Recoveries

- Improved Productivity

- Decreased Turnover rate

- Decrease in Accounts Receivable days

- Increased Employee Engagement scores

Key Performance Metrics And Objectives

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“I love working from home and I love what I

do. I feel more productive without all disruptions, gossip and

negativity.”

Survey Comments from Colleagues – Recent Feedback

“In my personal opinion this has

been a positive and morale

booster for our department.”

“Less Stress, quiet,

Easier to focus

Less Distractions

Happier”

“Working in the

comfort of your own

home is a definite

perk that I am grateful

for…”

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Program Evaluation from Colleagues –Barriers

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Don’t feel part of the Team

System Issues

Lack of Networking

Management Trust

Positive Feedback

41©2017 Trinity Health

Less Interruptions

Focused

No Travel – Less Cost

Less Stress

Increased productivity

Work Life Balance

Less exposure

to disease and

infections

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Speed Bumps

• Access and information from internet providers

• Phone call monitoring in/out bound productivity

• Technical access to network and auto faxing

• Access to all applications and testing

• Workflow and reports for daily work

• Communication between staff

• Performance metrics not met

• Quality of work and coaching

• Monitoring consistency

• Team building

• Pilot first

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Questions