When employees aren't in the office, tracking every action, account, and hour of work becomes more important than ever to run an effective revenue cycle.
Revenue cycle leaders are contemplating the prospect of long-term remote work at many organizations, including Memorial Health System in Marietta, Ohio, where remote work productivity not only hasn't suffered, it's improved.
HealthLeaders spoke with Derek Dudley, senior director of revenue cycle, for episode six of the HealthLeaders Revenue Cycle Podcast. The following transcript of that discussion has been lightly edited.
HealthLeaders: Derek, can you give us a brief background about Memorial Health System's history with remote revenue cycle work? Where were you pre-pandemic, where are you now, and what are your long-term plans?
Derek Dudley: About three years ago, prior leadership here had sent home much of the revenue cycle to work remotely. The challenge was that we never really had a way to measure staff productivity or work effectiveness for our remote staff or even our in-house staff. As you can imagine, that proved to be problematic. When I joined Memorial about a year ago, job one for me was to find a way to manage both our remote and our in-house staff more effectively.
We started with an activity audit of time in the systems. It was a manual process where we pulled activity logs and bounced that against our timekeeping system. What we found was we had some challenges with staff staying active and productive. So, we brought some staff back in-house and we had some coaching conversations aimed at changing behavior.
We also realized we needed a better tool to sustain our performance going forward. We partnered [with the vendor Vispa] and began to design a workflow tool that would serve up the right work to the staff at the right time.
[The tool] would also provide us with real-time insight into the productivity and effectiveness of each team member, so we could really see how they were doing, and what they were doing, and how effective it was.
As soon as we completed the installation and go-live with [the tool], COVID hit, so we knew we had to keep staff at home and isolated to keep them safe. We sent everybody home and began to manage our staff through the system and the detailed analytics that we got from it.
As we've seen some easing in COVID [cases] regionally, some of our staff has opted to return to work in the office. Now, we have a bit of a hybrid workforce. I see this as how we go forward, with the ability to pivot as the demand changes. If we see a secondary spike in COVID, we can again push all staff back home to keep everybody isolated and not really see a drop in our effectiveness.
This ability to see what our staff is doing has helped us expand our reach for quality talent outside the mid-Ohio valley. We can get employees who maybe don't live in this region who can still work for us remotely and that helps us compete for talent.
HL: How has your revenue cycle's performance been during the remote work period compared to pre-pandemic?
Dudley: Like everybody, we saw a decrease in volume. We actually dipped about 30%. The decrease in volume means decrease in charges, which eventually means decreases in revenue. We've seen some really wild swings in our collection rates as we're collecting revenue from prior months and working against low charge months during that March and April time frame.
We've reduced our outstanding AR across all aging buckets by about 25%; we reduced our unbilled numbers by about 20%; we've brought down our days in AR by four days; and our staff effectiveness has increased by about 26% since we went live with [the tool].
We now spend less time working our pending accounts; we're calling to check the status of accounts and [spending] more time selecting the correct resolution for accounts.
HL: Walk us through some of your other strategies that have ensured success.
Dudley: The workload tasking system pushes the next most valuable account to the staff member. It kind of works like an ACD [automatic call distributor] system in a call center except it pushes the highest dollar invoice to our follow-up staff.
We've seen a big increase in quality of account work being done. My teams are communicating better with each other and more effectively, and we can see that in the system notes, for example. They're putting more detailed instructions for follow-up in the system. We're now able to route work within the system instead of using emails to push work around—the challenge with working via email is you lose visibility. There's no way to track it in the system. We've eliminated that, which has also helped our productivity.
We've also stood up [a product] which pulls data … to manage our staff effort at the microscopic level. We're in the midst of a pretty heavy project year. Prior to COVID, we had big plans for this year with a lot of initiatives aimed at improved revenue cycle performance. We've got a documentation improvement initiative going on, vendor management, and invoice reconciliation projects. We have a busy year.
HL: How has data helped your remote workforce efforts in areas like monitoring cashflow, denials, days in AR, and other indicators?
Dudley: We can now track staff effectiveness at the individual or team level, at the account level, by the hour, and by the payer. I can see how long it takes a user to resolve a task, and I can see by hour how much cash they're bringing in. I can see the actions a staff member has taken to resolve accounts. [Then I can] be proactive with that staff member when they're taking or choosing incorrect actions. We can get that microscopic training.
We used to be plagued by extensive use of lengthy and repeat holds on accounts. Users were simply kicking the can down the road instead of resolving or working through those hard accounts, and it would eventually just fall back into somebody's work queue or fall down to the bottom of the AR in aging.
We can now dig into the individual user activities and coach staff on the best possible resolution for each account. As I indicated, our effectiveness in working accounts has increased by about 26% since we began the process. We've conducted user-based trainings on … what we actually have seen in the data. My supervisors now have the tools to manage our staff and improve team performance.
Based on our interactions with our staff and our process changes, we've seen our denials rate drop by a third, and we're now around 4%. We're still seeing improving efforts. We're changing the way we work AR. Staff is no longer able to pick and choose what accounts to work. Right now, our AR greater than 90 is just below 20%. It was in the mid-20s when we started this project, so you can see we're working the full breadth of the AR.
HL: How do you plan to continue or expand the use of data analytics going forward, especially given the prospect of longer-term remote work or hybrid work arrangements?
Dudley: We're in the design stages to push the work-tasking product to our front-end access staff.
We're also utilizing RPA technology to automate some of the staff's rote…tasks, allowing them more time to work on meaningful, productive tasks. We've automating claim statusing and prior authorization and eligibility checks, so we're trying to take the basic stuff off [the worker's] plate.
We will also utilize the analysis details we're seeing with the data mining of our 835s (Health Care Payment and Remittance Advice and Electronic Funds Transfers) and our user experience and develop robust payer scorecards, which will help us with contracting.
HL: What are some best practices that you have seen among your top-performing employees, and how have you been able to replicate those with other team members?
Dudley: It's basic stuff, actually. A great example is just sharing payer phone tactics. We found that based on cycle times, some of our users were able to navigate payer calls much faster than others. We dug into why and found out that they were able to gather more effective phone numbers to call. Simple, but effective, right? It's just working smarter, not necessarily harder.
I also mentioned the quality of the notes in the system improved, largely because the individuals were able to follow the work of other users and see [what] a good note looks like. It's an "all-boats-rise-with-the-tide" approach.
And lastly, we now have the ability to "quarterback" the work and push the work around so that the next most-valuable account is presented to the next available staff member.
Alexandra Wilson Pecci is an editor for HealthLeaders.
Conduct an activity audit to understand staff productivity and identify problem areas.
Utilize workflow tools to ensure high-dollar accounts are prioritized.
Identify strategies employed by the highest-performing staff members and teach them to the rest of the team.