More patient access employees work at home because of expanded roles, limited space in the hospital setting, and staff demand.

  • Staff can retain their jobs despite medical problems or relocation.
  • Meetings, evaluations, and observation take place via Skype.
  • Offloading calls to at-home workers allows onsite registrars to improve patient satisfaction.

In 2010, patient access consisted of four departments and 100 employees at York, PA-based WellSpan Health.

“We grew to 13 departments and 600 employees — and we are still growing,” says Tracey Shetter, CHAM, manager of enterprise patient access, which covers education and call centers.

When WellSpan Health added three new hospitals, patient access responsibilities were centralized.

“Our scope of responsibility expanded far beyond just registration to include departments not known traditionally as patient access,” Shetter says.

Patient access now includes the medical group contact center, the nurse triage call center, the referral center, the insurance specialty center, on-call services, and switchboard services.

The explosive growth of patient access made a work-from-home program a necessity.

“We literally ran out of office space,” Shetter says. “It was more economical to send employees home to work than to obtain more real estate.”

Of the department’s 600 total patient access employees, about 160 now work from home.

“Basically, any position that does not require face-to-face contact with patients can be considered,” Shetter says.

Here are some challenges patient access leaders faced when starting the work-from-home program:

  • Putting the right technology in the hands of at-home workers.

The first step was figuring out all the technology that would make it possible for someone to work from home.

“We were relying on other departments to help this be a success,” Shetter explains.

The IT department ordered equipment and loaded laptops with the necessary software.

“There were times when agents were finished training and were ready to go home, but the equipment wasn’t ready — and we didn’t have any work stations for them in the office,” Shetter recalls.

When this happened, the employees continued training until technology issues were resolved.

  • Monitoring productivity of offsite employees.

Most work-from-home staff are at various call centers, so productivity is monitored easily from phone system reports.

“A workforce management team is responsible for all call center schedules and timecards, which need to be completed timely for payroll and staff,” Shetter says.

In addition, five employees who obtain authorizations and inpatient insurance verification work at home.

“They gauge their productivity by their monthly stats and verifications completed per hour,” Shetter explains.

  • Keeping at-home workers in the communication loop.

“We always keep those at home in the forefront of our minds, so ‘out of sight, out of mind’ never happens,” Shetter says.

Skype for Business is one of the main ways they do this. Managers use the instant message tool if they need to communicate quickly or answer an employee’s questions.

“We use the Skype meeting tool for staff meetings, and the camera Skype for roundings and quarterly evaluations so we can see each other,” Shetter adds.

Many Benefits

Shetter has seen the following benefits from the work-at-home program:

  • Employees use less intermittent leave of absence.
  • There is phone coverage during office power outages.
  • There is continued productivity during bad weather conditions, since at-home agents keep the department running.
  • It is easier to cover the 11 p.m. to 7 a.m. shifts for “on-call services,” an after-hours answering service for some of the health systems’ practices. “It allows the agent to be at home during the night to answer calls, instead of in an office somewhere,” Shetter notes.
  • Employees are highly satisfied.

Some patient access employees jumped at the chance to work at home because of transportation or medical issues. One employee suffered from continual asthma attacks on the job.

“We sent her home to work, which helped her tremendously,” Shetter recalls.

Another employee was exhausted by her commute because of health problems.

“When she didn’t have to worry about travel to the office, her productivity improved, as well as her attitude,” Shetter says.

Another employee switched to an at-home role after her husband’s job required them to move to another state.

“I believe we would have lost these employees if they hadn’t been provided this option,” Shetter offers.

When the program was first announced, there was no shortage of takers.

“Some employees just love working in their pajamas and not having to go out in the cold weather,” Shetter says.

However, not everyone enjoys working at home.

“For some, it’s lonely and isolating,” Shetter explains. When the department needed more at-home workers, none volunteered, so patient access specifically hired people to work from home.

Occasionally, employees ask to work from home, even though they’re in an onsite role.

“Those duties are evaluated to determine if, in fact, it is a role that can be performed at home adequately,” Shetter says.

30% Work at Home

Yvonne Chase, MBA, CHAM, manager of the revenue cycle at Mayo Clinic in Phoenix, hired staff who conduct preregistration and precertification from locations all over the United States.

“We also have coders, billing, and account receivable staff, as well as our patient account services areas, that work from home,” Chase says.

Currently, 30% of Mayo Clinic’s patient access staff work from home, including some who’ve moved but still stayed in their jobs.

“This has allowed us to retain good employees and not to have to rehire and retrain,” Chase says. “That’s a considerable savings for the organization.”

However, patient access managers must stay on top of productivity.

“Our biggest challenge is ensuring everyone is on the phones and working the precertification queues, as well as retaining their efficiencies numbers,” Chase says.

Productivity is measured by managing phone queues for volume and accuracy.

“Calls are recorded and used to develop our customer services metrics,” Chase says. “Some areas use work queues where we can measure volumes per each staff member.”

This shows how many calls were made to patients and insurance companies for preregistration and precertification.

Open space was an important consideration for the department.

“If we can accommodate non-clinical staff at home, it allows more space for key clinical areas,” Chase explains.

She’s found her staff are more efficient at home.

“We have found that productive time improved by 10% to 20%,” Chase adds. “All in all, the benefits far outweigh the challenges.”

New Roles, More Telecommuting

Jeff Brossard-Sims, CHAM, says patient access departments offering work-at-home roles is a growing trend, but progress has been slow.

“Patient access has always been the forward-facing staff members. And as with nearly every trend in industry, healthcare tends to be a little behind the curve,” says Brossard-Sims, former vice president of patient access at Beverly Hills, CA-based American Health Connection, which conducts preregistration, scheduling, and insurance verification for hospital clients.

“The trend for the last several years is moving as much of the pre-work as possible prior to the date of service,” Brossard-Sims says.

Faced with shorter timeframes, patient access increasingly performs preregistration and prescheduling in call centers, which are duties that are conducive to work-at-home roles.

Another problem solved by work-at-home roles involves patient satisfaction. Increasing volumes of incoming calls to registrars pose potential problems with productivity and patient satisfaction, Brossard-Sims explains.

A registrar might not be able to answer a call because there is a patient standing in front of him or her who takes priority. Conversely, a registrar might be on the phone conducting preregistration, financially clearing a patient’s account, or obtaining an authorization from a payer. When a patient walks in to be registered, the registrar has to make a decision.

“Does the registrar place the patient on hold, or ask the patient to wait until the call is finished?” Brossard asks. Either way, patients are likely to become dissatisfied.

If at-home workers field the calls, registrars can give their full attention to face-to-face encounters.

“This allows the front-facing registrar to concentrate on patient satisfaction,” Brossard-Sims says.


  • Jeff Brossard-Sims, CHAM. Email: jeffrey.brossard@gmail.com.
  • Yvonne Chase, MBA, CHAM, Manager, Revenue Cycle, Mayo Clinic, Phoenix. Phone: (480) 342-4472. Email: chase.yvonne@mayo.edu.
  • Tracey Shetter, CHAM, Manager of Enterprise Patient Access, Access Education/Access Call Centers, WellSpan Health, York, PA. Phone: (717) 851-5840. Fax: (717) 812-8190. Email: tshetter2@wellspan.org.

Meeting Demand for Flex Scheduling

Robin Speaks, MSHSA, CHAM, director of admitting at Ann & Robert H. Lurie Children’s Hospital of Chicago, received some surprising feedback from a recent employee engagement survey. Patient access leaders considered the survey results informal “listening sessions” in which employees were encouraged to voice concerns.

“Employees were frustrated and concerned about workload, attendance policy, and staffing schedules, among other things,” Speaks notes.

First, Speaks assured them that leaders were taking their concerns seriously. Next, a committee met to address the demand for flexible scheduling.

“In further discussions with team members, we found that ‘flexible scheduling’ had different meanings for different people,” Speaks says.

To some, it meant working from home. Others just wanted to come in an hour or two later, or go home earlier and be allowed to make up the hours so they wouldn’t have to use their personal time. Another group wanted to work four 10-hour shifts with three days off.

“Our first hurdle was to define flexible scheduling. We agreed that it could mean all of the above,” Speaks says.

Not all flexible scheduling options are practical for all patient access areas. For instance, registrars in the ED or convenient care clinic can’t work from home.

“Both areas require face-to-face contact for registration, ID verification, collection, check in, and check out,” Speaks notes.

Admitting staff now have the option to leave early or start later as needed. “We currently have varying degrees of work schedules to align with patient volumes — and at times personal preference, to align with their own or children’s school schedules,” Speaks says.

The business office, which works on insurance verification, eligibility, and precertification, is the best setting for work at home.

“There is excitement among this group,” she says.

Patient access currently works 12-hour shifts, but leaders are considering offering eight- or 10-hour shifts instead. Some staff are unhappy having three days off.

“However, we will remind the team that 12-hour days are long and arduous,” Speaks says. “At times, productivity decreases, responsibilities are neglected, directions get fuzzy, and there is process drift.”

As a result of flex scheduling, the department sees less overtime, better retention, and fewer sick calls.

“When staff work with managers to work out a schedule that meets the needs of the department, the team, and the individual, it is a win-win situation for all,” Speaks adds.


  • Robin Speaks, MSHSA, CHAM, Director, Admitting, Ann & Robert H. Lurie Children’s Hospital of Chicago. Phone: (312) 227-1231. Fax: (312) 227-9710. Email: rspeaks@luriechildrens.org.