"Fear of the unknown” makes some patient access leaders hesitant to allow staff to work from home, says Darlene Powell, CHAA, CHAM, patient access manager at Bronson Methodist Hospital and Bronson Lakeview Hospital in Kalamazoo, MI. Here are some common concerns about telecommuting for patient access areas:

  • Managers want to maintain the same level of customer service as is expected onsite.

“This was one of my initial discomforts regarding allowing employees to work from home,” says Desember Brucker, patient financial services manager at Oregon Health & Science University Hospital (OHSU) in Portland.

To address this concern, managers require telecommuting employees to undergo an initial inspection of their work space, with privacy a main concern. Care providers are required for children under 12 during work hours, paid for by the employee. “We have a continued right to inspect the work area at times throughout the year,” adds Brucker.

At Geisinger Health System in Danville, PA, patient access supervisors conduct home visits with their remote staff to ensure compliance with these requirements of the remote workforce policy:

— The designated work area must be separate from the active living area of the home.

“The workspace should be comfortable, conducive to concentration, and allow for mental and physical separation from family during work hours,” says Mark S. Rodi, MHA, CHAM, associate vice president of revenue management and access.

— Appropriate arrangements should be made as necessary to provide caregiving to family members.

— There must be proper lighting.

— There must be a fire alarm and smoke detector in the room designated as the work area.

— There must be a proper electrical source.

— There must be an approved ergonomic workstation.

Powell ensures that the employee’s work area is private and can be locked to protect confidentiality of patient information.

“I haven’t identified any issues with regard to the home visits,” says Powell. “The staff actually like to show off their office areas and welcome me to stop by anytime.”

  • Managers are concerned about employees staying up to date on policies and procedures.

“Over time, we have not found this to be as large of a concern as initially feared,” Brucker says. Telecommuters attend staff meetings and training sessions in person. They also receive continual updates through email and instant messaging.

  • Trouble-shooting computer issues is more challenging for at-home workers.

A reliable, fast Internet connection is a must, says Brucker. “This is one issue that we came across early on in our telecommuting project,” she says. One employee who lived on the outskirts of the city found that the speed wasn’t as fast as the carrier had said it would be. She eventually switched carriers and has not experienced any problems since.

At times, OHSU’s hospital technicians must travel to the employee’s home to assist with computer problems. “Our technicians can access employee computers that are on campus, but they do not have the ability to access computers off of campus, unfortunately,” says Brucker.

Too-slow Internet connections occasionally hinder productivity of at-home workers at Children’s Hospital of Atlanta. “Staff may experience technical issues at home that are not supported by your IS [Information Systems] department,” says Tammy Jones, manager of hospital authorization and patient access.

  • Telecommuting is not possible for all patient access staff.

Not all employees are able to take advantage of a more relaxed dress code, time and cost savings with no commute, and less fuel and lunch expenses. “While identifying roles who are capable of working remotely, it may decrease the morale of others who are not considered,” acknowledges Jones.

  • There is a need to ensure remote workers adhere to patient privacy regulations.

“Remote and on-site staff only have access to the last four digits of a social security number in our systems,” says Rodi. “Remote staff do not collect payments over the phone.”

Bronson’s telecommuting patient access employees aren’t taking payments over the phone. “But we hope to start taking credit card payments for self-pay patients and any copays and deductibles when applicable,” says Powell. Each year, employees sign a confidentiality agreement and an employer agreement regarding breaching patient information, including social security numbers obtained by at-home employees.

“I have never experienced any issues with regard to this from my at-home staff,” says Powell. “They have many years vested with the hospital and are stellar employees and understand the importance of protecting patient information.” During site visits, Powell verifies that at-home employees’ offices and file cabinets can be locked. “This space also has to be away from a main living area. Both my staff have a specific room dedicated in their basements,” she says.

  • Employees who work from home sometimes feel less connected to the department.

Lack of “face time” with their supervisor and peers can affect relationships. Rodi says, “This is one of the biggest challenges associated with a remote workforce.”

The patient access leadership team communicates with teleworkers via the phone, email, and instant messages, but also in person. “Regular scheduled face-to-face meetings with supervisors is important. Attendance in departmental meetings are required,” says Rodi. “This allows everyone to connect on a personal level.”

When communicating with at-home workers, Powell uses the phone when a lengthy conversation is needed, email if she’s conveying messages going out to the entire team, and instant messages if a quick response is needed. She also conducts occasional home visits. “I observe them on calls to see how their routine flows,” adds Powell.