How Revenue Cycles Can Adjust to a New Normal

Northwell Health revenue cycle executives discuss with HealthLeaders two elements of what's next as they move into a new normal: Welcoming patients back and recouping revenue, and evaluating long-term remote-work options.

On June 8, New York City became eligible to resume elective surgeries and ambulatory care, but that doesn’t mean that things at systems like Northwell Health will snap back to normal immediately.

"To be frank there is still some reluctance. There's a percentage of patients with concern at the this point in time in coming back in on elective procedures," Rich Miller, Northwell Health's EVP and chief business strategy officer, told HealthLeaders in late May, as other parts of New York State were beginning to resume elective surgeries and ambulatory care.

Miller and Gerard Brogan, MD, Northwell Health's SVP and chief revenue officer, spoke with HealthLeaders for a two-part story about the lessons it's learned from being in the epicenter of the COVID-19 pandemic.

In part one, they discussed three specific elements of their revenue cycle work during the COVID-19 crisis—queries, redeploying revenue cycle employees with clinical credentials, and field hospital registration—to help revenue cycle leaders prepare for additional COVID-19 surges and other emergencies.

Now, in part two, they discuss two elements of what's next as they move into a new normal: Welcoming patients back while recouping revenue and evaluating long-term remote-work options.

Welcoming patients back and recouping revenue

"It's been a very, very difficult time," Miller says. "We've had some pretty significant revenue losses."

Even though Northwell Health had a large volume of COVID cases, overall they experienced a "significant decline to our normal volume levels, and at the same time we've had significant increases in expenses because of labor costs, as well as supplies, PPE, capital costs related to things like ventilators."

Although they've had some uptake in patients coming back, it's been slow. Now, they're focusing on triaging canceled patients in terms of clinical priority.

In fact, they now have a separate committee that vets each surgery so that the patients are appropriately prioritized based on the risk of any delay to their clinical condition.

"It's been a whole other workflow to make sure we get the right patients in at the right time," Brogan says.

They're also identifying in which of their sites they'll resume surgeries; implementing new and better infection control measures in their facilities; and clearly communicating those safety protocols to patients.

"We've always gone through great lengths to make sure our physical environment was safe and our staff was safe. This takes it to another level for sure, but it's always been part of our responsibility," Brogan says. "'We are messaging that even more clearly to patients."

Reevaluating in-person work

Like so many revenue cycles, Northwell Health transitioned most of its employees to remote work, including its call center staff, financial counselors, and most of its back-end employees. Coders and CDI staff were already largely working from home.

Other staff, like registrars, HIM, and medical records employees, had to stay onsite because of the "nature of the work," Miller says.

However, in deciding who could work from home, they encountered an unexpected wrinkle: cash collections. According to Miller, "we still had cash drops, people picking up cash, processing cash, the armored truck coming, and it made us think about what's our model going forward in terms of just collecting physical cash versus going to some other model versus credit or some other type of payment option."

Although Miller calls their decision making in the area "still a work in progress," they have decided that "we don’t want to have cash being collected if we can avoid it," and are exploring "a number of alternative payment models."

"That's part of our conversation," he says. "We're still evaluating just where we're going to land with that."

Northwell Health also re-evaluating who needs to come into the office at all going forward. Already, they've decided to have their employees continue to work from home until the end of August "at a minimum," Miller says.

But now they're also looking at longer-term remote work possibilities. Miller says the technology tools they use to monitor productivity have showed that employees are not only just as productive at home, in some cases they're actually more productive.

"The level of accounts…that they're handling and completing in a timely fashion has slightly increased during this period," he says.

Alexandra Wilson Pecci is an editor for HealthLeaders.