Working Outside the Box: Home Based Employees

1. 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

2. 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

3. 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?

4. 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

5. 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

6. 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

7. 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)

8. 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

9. 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

10. 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)

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

12. Claims editing • EPIC workqueues • Insurance follow-up • Refund processing/research • Denials/Appeals Process Case Studies – Patient Accounting Quality • 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 Productivity

13. Citrix • EPIC (Patient Accounting System/EMR) • QuadaxXpeditor (Clearinghouse) • Horizon Patient Folder (Imaging) • Organizational IntraNet • Department Website • Department Sharepoint Technology Case Studies – Patient Accounting • Quality • Productivity • Technology skills • Communication skills • Self discipline Employee Selection

14. Productivity Reporting – EPIC WQs

15. Productivity Reporting – EPIC WQs

16. Productivity Reporting – Acct. Activities Home-Based

17. Management Issues

18. Management Issues

19. Management Issues

20. 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

21. 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.

22. 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

23. 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.

24. Program Benefits • Employee retention • Cost savings for space • Productivity increases • Flexibility to meet needs of organization and needs of employee

25. 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…”

26. 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”

27. 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”

28. 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

29. 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

30. 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

31. Pre-registration Unit Savings

32. 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

33. 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

34. 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

35. 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

36. Important to remember: All must be prepared to return to pre-flexibility arrangements if the situation requires

37. Parting Thoughts… • Going Green byKate 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

38. 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