ProMedica Leader Shares Rapid Work-at-Home Migration Response

Patrick McDermott, interim VP of revenue cycle for ProMedica, discusses how his revenue cycle team quickly worked to enable employees to work safely at home in response to COVID-19 and how to manage the workforce in this new environment.  

When ProMedica activated its systemwide incident command center in response to the COVID-19 crisis, Patrick McDermott, interim vice president of revenue cycle, sprang into action with his own team, too.

"My team of directors and I wanted to set up an incident command center just for revenue cycle," he tells HealthLeaders. "It's necessary to … get all the right experts in the room, not necessarily by title or by role, but by expertise."

While a hospital incident command center helps prepare for and respond to emergencies at an organizational level, ProMedica's revenue cycle command center focused on managing the revenue cycle's response to the crisis.

Its first order of business was employee safety, and to achieve that, they had to get as many team members as possible working from home.

Before the crisis, about 25% of ProMedica's revenue cycle employees worked from home, and most of those worked in the middle revenue cycle. However, within just a couple of weeks, McDermott and his 11 directors moved 95% of ProMedica's revenue cycle to home offices.

Once everyone was working remotely, the command center could focus fully on maintaining smooth revenue cycle operations. That started with establishing daily telephone meetings with directors to discuss everything from managing staff to what they're learning about registering, coding, and billing COVID-19 cases.

HealthLeaders asked McDermott to take us inside ProMedica's revenue cycle rapid COVID-19 response, from getting employees set up to work remotely, to keeping daily revenue cycle operations running smoothly. The conversation has been lightly edited for clarity.

HealthLeaders: You said you had about 25% of your revenue cycle team at home prior to the COVID-19 crisis. How many of those people are at home now?

Patrick McDermott: There are staff that are on-site and need to be on-site, and that's the registration staff. We've got about 250 registration staff at the 13 hospitals. We already had many people working at home; the biggest team was the coding team.

So, what we're talking about is the remaining 500 people. By [Wednesday, March 25] 95% of those people were working at home. This rapid migration is phenomenal and absolutely blows me away.

The reason it blows me away is because at my previous revenue cycle we very deliberately and thoughtfully spent about a year migrating people to their homes from a shared services building.

That process of approvals and equipment requisition and putting in the proper protocols around productivity and quality … deliberately took about a year to get that done right, and we were close to 90% work at home by August 2019.

To do this in two weeks at ProMedica is just a miracle.

HL: How were you able to take what you learned at a previous job and apply it so quickly in two weeks? And do you feel like there are stones left unturned from those two weeks? Things yet to do?

McDermott: To get this moving very quickly, three groups had to work together with terrific teamwork, and those [were] human resources, the IT team, and the revenue cycle operators. We operated in a highly collaborative environment, and in my nine months [at ProMedica], I have never witnessed such great collaboration between HR, IT, and rev cycle.

We really focused on the mission, and that was how we get our employees home so that they're safe and they're not going to be exposed to this very contagious COVID-19 virus.

So, No. 1 [was] having a clear, compelling mission that went beyond saving money. It was really about keeping employees safe. That was a big difference between a standard work-at-home migration [at my previous job], where our motivation was to save money associated with building leases and create a work-at-home environment that would retain staff and be a recruitment tool.

At ProMedica, this motivation to get people home so they can shelter in place and still be productive and support the healthcare operations was such a compelling mission that the collaboration was terrific

You asked the question, are there still stones unturned? The answer is absolutely. When you do a work-at-home migration, you have to move into standard work. We have SOP [standard operating procedure] in the office, but the SOP needed to change and be refined when you have a large work-at-home workforce.

The things on the checklist that you need to address in terms of changing and redefining include productivity standards, quality management, dress code, and [determining] how we meet and gather during the day to create a sense of community and have a positive culture.

[In addition, we had to figure out] how do we cascade information from management down to the line staff, and then from line staff back to management.

There is a system, not unlike a football offence or basketball game plan, that you need to develop deliberately and implement in a large work-at-home program. To do this rapidly is a much bigger challenge than when you have the luxury of time.

HL: Tell us a bit more about the when and where of the daily director meetings.

McDermott: We're doing our daily meetings at noon each day. That should be the first order of business: always start your day as a leader with your staff, make sure they’re set for success, make sure they’ve got all the equipment and training that they need, [and] they don’t have any barriers.

In the morning, the management team—these 11 directors—[are] doing research on how you register an account, how you code an account, how do you bill an account [related to COVID-19].

When we gather up at noon, No. 1 on the agenda is safety: Are all of the staff safe? What's the safety message? There are reminders about washing our hands. We have a doctor on our team that gives the basic informational update on the virus and what he's learning about it.

No. 2, we literally go around the [virtual] table and each person is encouraged to talk for about 15–30 seconds and report what's happening in their operations; what is the current disruption? How are they handling that disruption? What do they need to be successful from IT, from HR? What do they need from me, their VP?

Thirdly, we go into what information we have from CMS, Medicaid, and the [commercial] payers around COVID-19 billing. What kinds of disruptions do the payers have as they're moving people to work at home? Are their offices open? Are they answering the phones? We keep that agenda pretty standard so that we're efficient with each other's time.

HL: Now that so many employees are operating remotely, what are some useful tools you can recommend to other leaders about keeping the revenue cycle running smoothly?

McDermott: The first thing is very basic but can be a powerful tool and can be implemented within days, and that is a daily huddle. Daily huddles are inspired by the LEAN concept of performance improvement, and it is empowering for line staff.

Starting the day with a daily huddle when you have a work-at-home situation [is important] because you cannot just walk down the aisle and stay hello to the staff. You can't just walk in and wish everybody a good morning—there's not a water cooler to trade information at.

Information flow becomes much more critical and different during a work-at-home situation, and one of the No. 1 ways you can create a high- communication culture is by implementing the daily huddle. The daily huddle means that, at every level, the supervisor is having a 15–30 minute huddle with their staff.

It is best if it's supported by [a video conferencing service like] Webex or Zoom Video or Microsoft Teams, where you can actually see everybody. When you can see people's faces, people have greater attention, they feel more accountable, and it is much more personable. Those things really matter in a virtual working environment. So, the daily huddle is a powerful tool that can be implemented very quickly and can have significant results across the culture.

Another way is ramping up your measurement and monitoring capabilities. We need to measure to improve in the revenue cycle, and in a work-at-home environment, cascading key performance indicators and operating metrics down to the line staff becomes more important than ever.

Some people believe that the key performance indicators and operating metrics are only for senior management. I don’t adopt that view.

I think key performance indicators and operating metrics are much like what we see on a scoreboard when we enter into a sports arena … everybody who enters there wants to be able to follow the game and see if we're winning or losing, how the members of the team are contributing to the offense and the defense.

And this is a great engagement tool, cascading key performance indicators and operating metrics down to the staff and keeping them engaged in the game of the revenue cycle.