At the end of last year, I was asked by HIT Consultant to predict healthcare trends to watch for in 2020. My biggest prediction was the impact of the new CMS rules around price transparency, specifically the opportunity some organizations would take to go above and beyond the requirements and provide personal price estimation.
Today that topic seems almost inconsequential. I think we can safely say, from the middle of this unprecedented pandemic, that I and every other healthcare executive that made 2020 predictions were way off.
There’s no doubt that 2020’s biggest trend is a completely upended healthcare industry. Strategic initiatives have been sidelined as health systems are all hands on deck. Healthcare teams are working tirelessly to test potential COVID-19 patients and care for the potential onslaught of patients who have a highly contagious disease with no specific treatment. Suddenly, the overriding concern is keeping patients and staff safe from contagion through social distancing and personal protective equipment (PPE) while maximizing ventilator inventory. Meanwhile, many clinicians are wholly underutilized as elective procedures are postponed and fearful patients are avoiding all but the most urgent care issues. Cash is critical for health systems right now, yet nearly every provider’s cash flow and bottom line have gone sideways.
Obviously, COVID-19 won’t just impact 2020. Its grasp has reached all aspects of care delivery and society in general – and will affect us for years to come. In future posts, I’ll expand on the longer-term impact of healthcare’s responses to COVID-19, including how:
And, just as Jimmy Fallon’s monologues are interrupted by his young daughters, the evening news features anchors in Zoom boxes, and the NFL draft is conducted from Roger Goodell’s basement, many of us are intimately learning this new acronym: WFH (work from home).
Healthcare has significant traditional barriers to a work-from-home approach. It's inherently the most people-focused industry of all, at least from a patient-to-clinician standpoint. Yet in a typical health system, most employees are non-clinical, such as IT staff, recordkeeping, food services, security and building operations. This also applies to the many revenue cycle staff, who form the financial backbone of a typical healthcare provider – the front office staff such as registrars, schedulers, and financial counselors; middle-office specialists who work on medical coding, revenue integrity and clinical documentation; and back-office managers of contracts, claims, billing and denials.
Quite suddenly in March, the industry’s imperative was to get as many of these employees telecommuting as possible. Hospitals obviously can’t shut down during a pandemic, and they also can’t follow the Centers for Disease Control and Prevention’s guidelines which suggest limiting gatherings of people to 10 or fewer. But they can get non-clinical staff out of the care setting, which lowers everyone’s risk and frees up critical PPE for the clinical staff. According to a survey of providers in late March, 70 percent had implemented telecommuting policies with 50 percent mandating WFH wherever possible.
Some clinical staff are now working from home through telehealth functionality, streamlined from a reimbursement and technology perspective by CMS. Similarly, for most of the revenue cycle, the business processes, workflow technology, networking, and security are mature enough to support WFH. In many health systems, most of these functions are already handled offsite, either domestically or overseas, at lower cost centers of excellence. The immediate effort to get these employees productive at home became one of hardware, networking, and security, not a change of business processes.
Patient-facing roles such as registration and financial counseling, however, were more challenging to move off-site, with many providers establishing social distancing configurations such as plexiglass safe rooms for these staff.
R1 manages revenue cycle operations for our clients, which include 750+ hospitals and 27,000 physicians across the country. We have approximately 6,000 associates who work with patients in the front office of the healthcare system every day and about 13,000 at centers of excellence across the U.S. and India. As the crisis hit, we were faced with the twin needs of keeping our people safe and ensuring our clients were financially prepared for this pandemic.
Getting associates at our domestic centers of excellence to work from home was relatively easy as we already had established a level of WFH versus in-office work. For the front-office registration functions, we were able to move many of our associates home – providing an even safer model than plexiglass safe rooms – by changing business processes through telephony and online functionality and extending the hospitals’ security networks.
However, we had never even postulated the idea of our India team working from home given the significant regulatory, infrastructure, economic and cultural barriers. In short, those operations are built entirely around regulated and secure office park environments. Additional concerns were that many associates do not have Internet bandwidth at home to perform their work functions. Plus, oversight and training processes assume working in the same building with their supervisors. We initially investigated alternative approaches, but we quickly realized there was no other option due to the potential universal reach of the pandemic. The risk to business continuity for us and by extension our customers was too great.
We began the Herculean tasks of procuring laptops, WiFi dongles, security provisioning and hardware delivery to thousands of employees. Keep in mind, India’s lockdown was far more rigid than shelter-in-place, as citizens were not allowed to even step foot outside their homes – making delivery of equipment almost impossible. But within 10 days and just ahead of the government’s lockdown order on March 25, we had 85% of our associates up and running at home, a truly remarkable accomplishment. Fast forward to today, and 95% of our India associates are working from home – and we have even begun hiring and growing our India-based work at home operations.
After getting our domestic and offshore associates home safe, R1’s next step has been learning how to effectively manage and improve our operations. We can no longer rely on supervisors assessing and optimizing productivity by observation and face-to-face consults. Instead we accelerated already planned real-time performance measurement tools such as dashboards that supervisors could use to identify and resolve issues.
We’ve built tremendous rigor around our training and onboarding processes to support remote staff, including self-service, detailed documentation and video-based learning. And we’ve put a great focus on maintaining a positive work culture and personal connections across our teams through conferencing, blogging and team collaborations. We’ve also received a great deal of positive feedback from associates who have a better quality of life and can spend more time with family because they no longer have to commute.
The effort that R1 and the healthcare industry has undergone to transition associates to WFH is surely a trend that will live on once we are past this pandemic. The advantages of telecommuting – employee satisfaction, efficiency and costs (real estate in particular) – are well-documented. When the pandemic passes, we’ll be able to leverage our new learnings and efforts to reassess the best balance between office and WFH. For example, we’ll be better equipped to staff roles in rural regions where labor is less expensive. We are already finding opportunities to flex resources that are no longer tied to a physical desk. For example, some front-office roles were only 50% utilized, their remaining time occupied by unrelated functions. By working remotely, a single registrar now can work multiple (virtual) desks.
We had to react to this crisis incredibly fast and suddenly operate 100% remotely for many functions – without the benefit of a long and well-planned roll-out. Healthcare roles that never were considered for WFH, such as front-desk registration and offshore operations, are almost overnight doing exactly that.
While WFH s a trend that COVID-19 forced upon healthcare, it will live on – helping drive additional efficiencies and quality of life once we are finally able to return to our restaurants, movie theaters and traffic jams.