Few patient access departments had successful remote work programs in place before COVID-19. Since the pandemic began, facilities have made some major adjustments. The following is a review of how the field is faring with these unusual arrangements:

Departments that already employed some people working at home transitioned a little easier. At St. Luke’s Hospital in Chesterfield, MO, 10 patient access employees already were working remotely on a limited basis. “This made the conversion to full-time remote work relatively simple,” says Laura Holt, senior director of network revenue cycle management.

Well-established processes for supervision and productivity monitoring made for a relatively smooth transition. The first step was to ensure proper connectivity and security for each employee working remotely. “The internet services department provided assistance to roll out the necessary hardware and access,” Holt reports.

Just before the pandemic hit, patient access leaders at Tufts Medical Center in Boston were gearing up to implement a remote work program. “We had just presented our plans to roll out a flex-work policy for our patient access team members,” reports Kaylin Fogarty, director of patient access.

The plan was to allow strongly performing employees to apply for flexible hours or work-from-home capability. “As soon as COVID started to ramp up, we began transitioning everyone off site,” Fogarty says. The department’s planning came in handy now that all patient access staff (about 80 full-time employees) are working at home.

A few employees still are needed on site. One of Tufts Medical Center’s financial counselors is on site every day. “They address any urgent financial concerns for our inpatients to avoid any barriers with discharge,” Fogarty explains.

Issues with technology caused headaches initially, but those problems have since been resolved. At Tufts Medical Center, the biggest challenge was quickly setting up everyone on the registration system. Most registrars worked on desktop computers onsite, and only a few had been issued hospital-owned laptops. “They had to get their personal computers configured,” Fogarty adds.

At Winston-Salem, NC-based Novant Health, “we had laptops that needed to be reprogrammed, and laptops running with outdated software that needed to be upgraded,” says Jennifer Love, assistant director of scheduling and previsit services. Some team members lacked laptops and needed loaners on short notice. “There were also issues related to our phone system that we had to quickly resolve,” Love says.

Staff also needed access to high-speed internet and the department’s videoconference application. “We also had to develop procedures to print and mail documents in a secure manner,” Love adds.

Setting early standards for productivity prevented problems. Tufts Medical Center’s remote workers knew their productivity would be monitored closely. Frequent check-ins via Zoom, with ad-hoc meetings as needed, help with morale. “It gives them a chance to see and connect with their coworkers who they normally sit in the same office with every day,” Fogarty says.

The department really has not experienced issues with productivity. “The team realizes that the success of our ability to work remotely post-pandemic depends on how well we do during this time,” Fogarty notes. With work queues monitored throughout the day, Novant Health has seen “little to no” issues with quality and productivity, Love says. “But their volume of work has taken a huge hit,” she adds. “This has been addressed with scheduling changes.”

St. Luke’s Hospital’s revenue cycle team is monitored for productivity (through volume dashboards) and quality (through supervisor audits). “Staff who were already working remotely understood that this benefit could be compromised if their productivity or quality suffered as a result of their home working arrangement,” Holt says.

The same stringent standards apply wherever the job is performed. “For the most part, staff have shown a higher level of productivity in their work-from-home environments,” Holt adds.

Not all registrars like working from home. “Working from home is an extreme satisfier for some, and not so much for others,” Love observes.

Some staff initially were thrilled to work from home, but changed their minds after they found it hard to complete tasks. “Some who pushed to work from home now find it much less attractive than working on site,” Love says.

Staff are performing different functions, and working different hours, than they did on site. Just a few on-site registrars see patients for scheduled tests at St. Luke’s Hospital. “All registrars are now working four 10-hour days, which reduced the number of people in the work area,” Holt explains.

All other registrars are handling different jobs than normal. “They were redeployed within the revenue cycle department to assist with other project work, mostly related to back-end functions,” Holt says.

The remaining 25 patient access staff who are not in registration positions are working at home now. They are scheduling, obtaining authorizations, verifying insurance, and collecting copays. Some staff took on entirely new roles. “For others, this involved minimal training to help out with special projects,” Holt notes.

Overall, patient access leaders have become more comfortable with remote work arrangements. “It’s been a good test for us to see how things would go with a remote work policy for our team,” Fogarty offers.

This could work both for the people who love working at home, and the ones who miss coming to work every day. “Ideally, I would like to get to a place where we could offer remote work to those who are interested in it on a part-time basis to start,” Fogarty says.

If some jobs are performed 100% remotely, it could help recruitment. The department could hire highly qualified people from outside the immediate geographic area. “With the appropriate technology, policies, and good communication, full-time remote positions for patient access are a strong possibility,” Fogarty says.