Hospital registration has suddenly moved from face-to-face encounters that happen right when the patient presents, to a work queue-based task handled remotely.

“We have created a process that we refer to internally as ‘slim reg.’ It has reduced our patient-facing registration time to one-fourth of the regular process,” says Daniel J. Plavsic, MBA, CRCRC, executive director of time of service for system patient access at Indiana University (IU) Health in Indianapolis.

Most, although not all, of IU Health’s registrars now work at home. This has allowed the department to continue operations despite school closings and self-quarantines of asymptomatic employees exposed to the virus. On site, registrars gather just enough information from patients to identify them. “This immediately lands on a worklist for our newly remote team members to complete the registration,” Plavsic says.

Off site, staff use previous registration information in the electronic medical record and insurance coverage given by the patient to confirm the insurance is active. Sometimes, additional data or signed documents are needed. If so, the registrar calls the patient in their room to learn the information and/or obtain verbal consent. “Each day, we find additional ways to optimize our process,” Plavsic reports.

Overall, the “slim reg” process has been successful. The department is seeing solid performance metrics with it. For staff, “slim reg” opened up some much-needed unscheduled personal time — and could do so again in the future. “We believe this model can be sustained and optimized, long after the COVID-19 crisis,” Plavsic says.

Allowing some registrars to work at home had long been considered at Nemours/Alfred I. duPont Hospital for Children in Wilmington, DE. It sounded appealing in some ways, but problematic in others, and the switch never actually happened. “My biggest concern was the associate engagement. I was fearful of the team disengaging and losing that team atmosphere,” says Stacy Hutchison-Neale, CRCR, CHAA, manager of the physician referral/authorization department.

Most staff were not too keen on working at home, either. “They wanted the human interaction,” Hutchison-Neale says.

When COVID-19 hit, no one had a choice in the matter. Almost overnight, everyone was working remotely. “All of the team is working from home, including management,” Hutchison-Neale reports.

For the first time, staff were performing their jobs without their familiar cubicles, computer screens, and colleagues. It was not an easy transition, but one thing helped tremendously: flexibility. “We offered flex shift options to ensure associates’ needs are met,” Hutchison-Neale says.

For some employees, tending to kids who are at home from school was their biggest concern. Others wanted to shore up their finances and work longer hours. Staff were asked to choose to work shifts of four, eight, or 10 hours. After a short adjustment period, most registrars have been very productive. “I find that I am very focused during the time working from home and pushing out the same number, if not more, claims than I would in the office,” says authorization specialist Jessica Ridley.

The first issue was the need to respond to dozens of voicemail messages left by families wanting to know how the situation would affect their scheduled services. All employees’ regular responsibilities also are in full gear. “We are business as usual,” Hutchison-Neale says. “We check in multiple times a day to ensure that we are all on the same page.”

To keep things running smoothly, the department is running registration productivity reports and monitoring for large gaps in time. “All breaks are scheduled to ensure that we have full coverage throughout the day,” Hutchison-Neale explains.

At home, staff are obtaining authorizations and referrals just as they normally would. The timing is what has changed. “The teams are now advised to work as far out as they can,” Hutchison-Neale says. “We have told them to get out as far as possible.”

Staff always tried to work ahead as far in advance of scheduled services as they could. The volume of work always held them back. “Usually, the furthest they could manage was about 30 days out for surgeries, and 15 to 18 days for office visits,” Hutchison-Neale notes.

That changed because of all the rescheduled and canceled procedures. If a surgery is rescheduled six months or even one year out, and the insurance company allows it to be authorized, staff do so. Working ahead in this way is going to help the department going forward. “This is the silver lining in a bad situation,” Hutchison-Neale observes.

At one point, all the canceled surgeries and procedures are going to happen. Securing all the authorizations well in advance is going to be helpful. Those claims will be paid without issues, freeing up staff to secure authorizations for emergent surgeries and procedures. When the crisis is finally over, explains Hutchison-Neale, “we can be very focused on the last-minute add-on requests.”