None of the patient access employees at Brewer, ME-based Northern Light Health’s 10 hospitals had ever worked from home. Many are now, but exactly how it happened varied depending on the facility.

“In making the decision of whether to send staff home, we tried to honor employee preferences as much as possible,” says Revenue Cycle Director Jennifer Cox. Some hospitals found ways to keep registrars on site safely by relocating them to other spaces that became open because other hospital departments had been sent home. For certain registrars who already worked in offices or cubicles with dividers, no change was needed.

The state’s executive order limiting gatherings to fewer than 10 people also factored into decision-making. A few departments had only four registrars, while others had dozens. “We have spaced people out to increase the distance between colleagues in their work spaces,” Cox reports. Other changes:

For financial counselors. Some remain on site to help assist patients, but many now work from home. “This is a very big change,” Cox notes.

Typically, financial counselors meet with patients in the hospital, review applications in person, and help them understand their bills in face-to-face conversations. “They are now off site and doing their best to walk through the information over the phone,” Cox says.

For schedulers. All are working from home. “You can truly schedule from anywhere,” Cox says.

Scheduling remains paper-based at certain facilities, which complicated things to an extent. One hospital solved this by directing three schedulers to work from home and one scheduler going in two days a week. The on-site scheduler faxes documents to outside providers sending patients to the hospital, and handles payments submitted by mail.

For other patient access employees. This group can either work in another building or from home.

Some said right away that they were not comfortable working on site. Others really felt a need to be physically present in a time of crisis. “We did our best to make it the staff member’s choice as much as possible,” Cox explains.

Every hospital still needed a small core group of registrars to greet arriving patients and family. Volumes are much smaller with elective services canceled. “But we still have patients coming to the hospital. We still need to check people in,” Cox observes.

A few people still come to the hospital asking to pay bills. “We are asking them to pay online or by phone,” Cox explains. “But they show up because they know the front end people and want to see them.”

At press time, patient access employees had been working at home for six weeks. It could continue indefinitely for at least some of them. Regarding the shift to at-home work, says Cox, “it’s impossible to believe that there wouldn’t be a massive change for healthcare.”

Still, the patient access role always has involved highly personal, face-to-face encounters. From a morale perspective, says Cox, “there is a huge benefit to having staff on site to being a part of the organization.”

With patients instructed to register, pay, and schedule remotely, it is unclear how it will affect satisfaction over the long term. It is giving our patients a very different experience,” Cox says.

Meanwhile, detailed productivity metrics are in place for at-home workers. “What you do on site is not necessarily what you need to do at home,” Cox acknowledge.

For example, experienced staff normally educate new hires on how to register patients. Now, that training is handled via Skype. In certain cases, experienced employees set up individual times to go over challenging topics with new hires. “But it doesn’t really work as well as when you catch that person right as they are asking for help,” Cox says.

Staff have shifted to performing any tasks that can help secure revenue. Following up on unpaid claims is a prime example. “There is plenty of work to do,” Cox notes. “Every hospital should be utilizing this time to do clean up.”