Well over a year into the pandemic, all indicators show that virtual workforce is becoming a permanent fixture in revenue cycle management. To surface key learnings and best practices in virtual revenue cycle management, The Chartis Group conducted a series of interviews with top-performing revenue cycle leaders who have successfully implemented a virtual workforce strategy. All interviewees indicated that anywhere from 60 to 100 percent of their revenue cycle workforce is working in either a fully virtual or a hybrid model, underscoring that virtual workforce management is enduring. Organizations not actively and purposefully pursuing a virtual workforce strategy may find themselves significantly disadvantaged in the future.
1/3 of healthcare providers plan to restructure and increase permanent work-from-home capabilities post-pandemic.1
While leaders are surely adapting as they see what works, determining the appropriate strategies to address four major areas of change appears to contribute to the success of a modern-day virtual workforce. Executing tailored strategies in light of each of these four areas of change will position healthcare organizations well to reach or exceed their financial, operational, and cultural goals — and sustain an effective virtual revenue cycle workforce:
Key Components of a Top-Performing Revenue Cycle Virtual Workforce
1. Performance Standards Should Hold Strong, but Leaders May Need to Rethink How They Support Employees to Achieve Them.
The initial priority for the virtual workforce was expediency. Leaders were forced to thrust employees into a work-from-home environment — in some cases in less than one week — with little regard to its impact on performance. Once the initial frenzy subsided, performance reemerged as a top priority. Top-performing leaders are concluding that the performance standards should be equal to or greater than before.
Ensure you have automated performance monitoring tools across your revenue cycle and monitor the same metrics:
Most revenue cycle job descriptions remained the same in the new environment. If only the environment changed, then the performance metric should remain unchanged as well. Some interviewees argued that staff should be more productive, given changes such as the elimination of a commute. For those roles that did see responsibility changes, gauge the degree to which duties were modified and adjust the metric accordingly. The key: adjusting as you would have if employees were still in the office environment.
One revenue cycle executive from the Mid-Atlantic region stated, “I asked myself, how did I gauge performance before? The standard is the standard.”
Compare performance trends over the appropriate timeframe:
As with any major disruption, adjusting to a new environment requires time and strategic management. Having the capability to use volume-based performance metrics tied to staffing management is essential. Managers of top-performing revenue cycles maintain visibility and transparency into critical volume-calibrated metrics applicable to departmental functions trended over time. This goes beyond the metric itself (e.g., outpatient coders held to a standard number of charts per hour) to include more frequent trending of the right metrics (i.e., daily or weekly). If performance fails to meet expectations, drill down to find root causes, adjust, and continue monitoring. Top performers found that more frequent metric tracking and greater transparency with their teams was a key to resolving aberrant performance.
Identify and support underperforming individuals:
Managers must identify both highly productive and underperforming staff at the individual level. Once underperformance is identified, changes must be made that account for new benefits and challenges in the virtual workforce environment. Our respondents identified a myriad of underperformance root causes — some of them new and unique to the virtual environment, including limited space, ergonomic hardware, communication, and childcare. Once these root causes are identified, managers must become creative in supporting employees to address them and in turn raise the level of performance.
One interviewee’s organization urged colleagues to “resist the temptation to lower performance standards” and understand that performance can potentially improve, given today’s technology and good old-fashioned strategic management.
Measuring productivity and individual work quality and promoting transparency will ensure staff are held accountable to expected performance levels.
2. Meeting More Complex Technology Needs Can Make or Break the Virtual Workforce.
Most organizations when first thrust into a virtual workforce environment focused on desktop technology. In other words, if the technology was on the employee’s desk at the office, get it to them in their home. Top performers, on the other hand, found that expanding beyond desktop technology empowers staff far beyond these basic items and makes a tremendous difference in performance improvement.
Enhance and automate work queuing:
Clearly, work queues are not new to savvy revenue cycle managers. Nevertheless, many found that in a virtual work environment, work queues required significant manual intervention, which placed a greater burden on managers and staff alike. Top performers employ automation to regularly triage and prioritize work. Once trends are identified, work assignments are automated and prioritized based on business needs and analytics through modern work queue technology and/or robotic process automation (RPA).
The technology should allow management to be nimble with worker capacity, reassignments, coverage, and allocation of special projects. Note that automation does not eliminate the need for human intervention. In accordance with leading practice, 80-90 percent of work queues should be completely automated and push alerts to management when standards are not met.
Read “Launching a Revenue Cycle Automation Strategy” for more detailed considerations around development of a revenue cycle automation strategy.
Upgrade scanning and paperless capabilities:
Most of our interviewees shared that scanning was more critical to their transition than originally expected. In fact, some job functions must remain office-based, given the healthcare industry’s continued reliance on paper to communicate. The reality is that many work processes are still driven by paper correspondence (remittance advices, denial letters, clinical charts, super bills, etc.). Organizations must analyze the volume of this correspondence, quantify its value, and staff in-person resources accordingly. High-capacity scanners, sophisticated indexing, and automated distribution technologies are critical to optimizing performance in a virtual workforce environment. Organizations that free themselves from the burden of shuffling paper to and from different locations realize a next level of efficiency and more virtually enabled operations.
One CFO of a large health system in the Southwest stated, “Scanning is a bigger deal than you think…” In fact, this organization dedicated 25 in-person resources to scanning to enable their virtual workforce.
Improve employee access:
Another common theme our interviewees shared was the wide variation in speed to access data as a result of bandwidth accessibility in the home. While some organizations require staff to obtain their own high-speed connections, high-performing organizations provide a standardized work-at-home "technology kit" that is deployed to all virtual workers. Be sure to perform a security, cost, and benefit analysis to select the right and most cost-effective approach for your revenue cycle.
Select the right communication technology:
Robust communication is a must for many reasons, including employee-management, Q&A, work directives, culture, and comradery. Workers previously were able to pop into a manager’s office, attend a team meeting, peak into the next cubicle to ask a quick question, or simply take a short mental break. Most organizations reported having some sort of platform that provides video conferencing, email, instant messaging, document sharing, or other virtual communication aids. However, many found significant problems using existing platforms in their new virtual environment, including redundancy, lack of integration of platforms, and difficult-to-use interfaces. While several communications and “teaming” technologies exist in the market, each organization must find the right technology to meet their own needs. These technologies are the basic enablers of your culture, communication, and connectivity — and they can dictate work satisfaction or dissatisfaction.
In addition to determining the right communication and collaboration technologies, it is important for each team to define appropriate and best use of each technology available. For instance, when should a team member reach out to their manager with a question via instant message versus via text or via call? How should the team use video conferencing to maintain connectivity? Defining not only how each channel should be used but also which channels are appropriate during business hours and off hours can streamline myriad communications technologies and workflows and minimize frustration.
The technologies described above are proven to provide significant leverage to staff in their work-at-home environments. That said, technology is only one factor in the performance improvement equation. Without appropriately considering these next two factors, organizations will struggle to meet performance standards, whether back in the office or in a virtual environment.
3. The Candidate Pool Has Expanded for More High-Quality Applicants, but Talent Acquisition and Management Has Become More Complex.
Though most job duties have remained unchanged with the shift to virtual, attracting and managing top talent changed significantly. No longer are revenue cycles restricted by vicinity. And while this is certainly an upside of moving to a virtual workforce, organizations need new talent strategies to be successful.
Leverage work from home as a benefit:
More revenue cycle specialists now expect roles to incorporate some degree of a work-from-home benefit. Be sure to clearly outline what your complete package entails to gain a competitive edge. Some packages include flexible work hours, in-office expectations, technology packages (laptop, printer, Wi-Fi, etc.), transportation (to and from work on office days), and other such components. Some organizations are posting positions with no specific work hours at all, only productivity expectations. For example, an inpatient coder job description may simply specify productivity and accuracy expectations.
Expand geographic footprint for recruiting:
Many healthcare organizations are posting revenue cycle positions as 100 percent remote. This allows revenue cycle leaders to expand their search for new talent to areas beyond their local boundaries — even outside of their states. One organization in the Southwest has been recruiting virtual workers into their revenue cycle for more than a decade. The ability to recruit highly (or higher) skilled employees is in effect upskilling revenue cycle departments and providing a tangible advantage over competitors. This is especially true for highly specialized workers who are in short supply, such as facility coders, professional fee coders, and clinical documentation specialists.
You must be in lockstep with your Human Resources Department to deploy a successful virtual workforce team. New realities, such as having workers from multiple states with varying employment laws, add complexity. Remember, employees are subject to labor and tax laws from the state in which they work. These laws may differ significantly from the state in which your operation resides.
Retrain managers to function in the virtual environment:
Building a high-performing team has always required leaders to inspire employees to bring their best self to work. A virtual workforce requires a whole new paradigm. Leaders of virtual teams must focus on learning a set of enhanced management skills related to inclusivity, empathy, and engagement — essentially, emotional intelligence and communication best practices. Encourage leaders to engage in formal staff engagement and issue resolution training. Our interviewees cited using various technologies, such as: webinars, hyperlinked Q&As, recorded online trainings, online knowledge bases, and other self-guided tools.
A revenue cycle executive from the Mid-Atlantic advised, “…get leadership used to it. Challenge them to get over thinking that remote work management is harder or unusually special. It’s just different. The new environment can be an opportunity to stretch your team as well — especially those that show leadership promise!”
4. Building the Right Culture Is Essential, Yet It Can Be the Most Challenging Element to Translate into the Virtual Environment.
The leaders we interviewed unanimously agreed that the virtual environment brought forth new hurdles to establishing their desired culture and at the same time agreed that meeting this challenge is critical to retaining employees, attracting new talent, and driving efficiency and top-tier results.
Every one of our interviewees cited maintaining or building culture as a challenge in maintaining a virtual workforce:
- "We experienced a loss of identity and connectivity."
- "Perhaps our biggest challenge has been maintaining culture and figuring out the right mix."
- "People felt at disconnected and at times excluded."
- "How do we model our culture for the newer employee?"
Define your desired culture:
Most organizations have already defined key attributes of their culture they wish their staff to represent (e.g., core values; desired work ethics; and commitments to patients, customers, staff, and community). They may wish to further refine these attributes and cultural elements in light of the move to the virtual environment as well. The next step is translating behaviors and values into the virtual environment. These factors must be communicated in creative ways to stimulate cultural growth, such as computer wallpaper, screensavers, video conferences, and desk placards. Our respondents reported the most creative and impactful ideas came from soliciting feedback from staff.
Answer These Critical Questions:
- How do we want to collaborate and build relationships?
- How do we celebrate team and individual accomplishments?
- How do we utilize work-from-home time? In-office time?
- What measures are required to maintain this flexibility?
- How much flexibility should the team have in determining where, when, and how they work?
- How do we cultivate growth through professional development, mentorship, employee onboarding, and other opportunities?
- How do we discuss challenges or opportunities for improvement?
Ensure your leadership and managers model your desired culture:
Beyond helpful tools that can serve as reminders, it’s critical that managers and leaders model the desired behavior and culture for their teams, regularly reinforcing them both in team and 1:1 settings.
Set ground rules that reinforce your desired culture:
Smart organizations hardwire tactics into day-to-day operations that encourage the culture they desire. For example, one organization in the South established ground rules to help staff feel more comfortable and included in their virtual environment. Some ground rules include cameras on during video meetings, beginning meetings with staff recognition/accolades, and providing social time within the virtual environment.
Leverage in-person time to strengthen your desired culture:
Consider incorporating social elements into in-person business events. Invite the entire team or stagger attendance strategically, allowing people to come together and keep the human connection, while still honoring any continued social distancing policies. Given how rare in-person meetings will be in a virtual workforce environment, optimizing the human connection will provide a much-needed positive boost to culture. Leverage in-person time for key moments that leave a lasting impression, such as onboarding new team members (during which you can immerse them in the desired team culture, modeling and training in the skills and behaviors required for success). Mentorship opportunities and employee performance reviews can also be especially meaningful times to interact in person.
One Southeastern hospital has decreased their footprint, opening up space for clinical additions. Cubes in their new space are for “hoteling,” allowing for maximum flexibility.
Are You Embracing the Opportunities?
Revenue cycle leaders should embrace the disruption caused by moving to a remote work environment. While there are many benefits to this new workforce model, there is also more complexity. If these new requirements are neglected, it could negatively impact the workforce, operational efficiency, and — ultimately — performance.
Smart organizations are retooling their operations, rethinking their approach to workforce management, and leveraging the next set of tactics to improve work performance, enhance the culture of their teams, and become more competitive in their market. Organizations should be intentional about how accountability, technology, management skills, and culture are leveraged to build upon their current foundation. All must blend strategically to ensure the staff performs at peak levels in this new environment. These actions will result in better outcomes across the organization — both operationally and financially. With virtual work teams here to stay, it is essential that leaders think differently about how a top-performing revenue cycle team is built and supported.
At Chartis, we bring unrivaled, objective, and forward-thinking approaches to transforming the revenue cycle. Contact us if you would like support assessing or improving your revenue cycle’s virtual workforce performance in order to meet the next set of challenges.
Key Benefits of an Effective Virtual Workforce:
- LOWER EMPLOYEE TURNOVER
- INCREASED PRODUCTIVITY
- INCREASED JOB SATISFACTION
- BROADER RECRUITING GEOGRAPHY
- GREATER COST AND REAL ESTATE SAVINGS
 1 HFMA Pulse Survey, conducted between May and June of 2020; Sept. 9, 2020; https://apnews.com/press-release/pr-newswire/37203fb469321c8607f3e74f6df6c7f1
© 2022 The Chartis Group, LLC. All rights reserved. This content draws on the research and experience of Chartis consultants and other sources. It is for general information purposes only and should not be used as a substitute for consultation with professional advisors.