At Tampa (FL) General Hospital, “the move to telework has enhanced employee engagement and satisfaction,” says revenue cycle director Stephanie C. Franz, MBA, revenue cycle director for patient access. One at-home registrar put it this way in a recent email: “We have the best support system — not only for patients, but for us as employees.”

The switch to telework was well underway before the COVID-19 pandemic. Financial clearance and scheduling teams started teleworking in 2018, and the call center teams made the switch in 2019. The remaining teams were deployed in early 2020. Currently, 61 patient access staff telework. “If staff do not meet expectations after support and coaching, they know they will return to the office,” Franz says.

Staff agree to respond to all chat inquiries within 60 seconds (except during breaks or lunch), handle an average of 10.5 calls per hour, financially clear an average of six accounts per hour, and collect a certain percentage of dollars preservice. Employees can opt out of telework because of home situations or because they prefer to remain in the office. Only six have chosen to work on site. “Periodically, team members come in for a refresher in the workflow,” Franz says.

Refresher examples include when team members struggle with productivity because of a system upgrade, when payer requirements change, or when team members want to connect in person with leadership. Supervisors also look for calls that are taking longer than expected, and step in to help. “The leader messages the team member to determine what assistance is needed,” Franz says.

Usually, the supervisor takes over to complete the problematic call. “Another very effective way to provide immediate support is when leaders and team members share their computer screens to walk through difficulties together,” Franz adds.

Many patient financial services and patient access staff at Brewer, ME-based Northern Light Health remain remote workers. The department has kept morale strong in several ways:

Colleagues keep in touch on a personal level. Staff always expected pictures if a co-worker had a new baby or a new pet. Working at home has not changed this. “We do one-on-one rounding with staff,” says Jennifer Cox, MBA, revenue cycle director.

After managers review work and productivity, they ask, “How are you doing?” This question opens the door for staff to engage in the kind of personal chitchat that used to be common.

Managers encourage staff to use mental health resources. The organization put into place plenty of resources to help staff struggling with anxiety and depression, including counseling, online tools, and educational sessions. “The message is: We are in this together, and we are going to support you,” Cox says.

Supervisors offer as much flexibility as possible. Many staff had a fairly idealistic vision of what it would be like to work at home. In reality, there are constant distractions. Staff know they can go on “pause” if they need to attend to something personal during their shift. Staff also can use a weekly leave if it becomes necessary.

“Basically, we are asking leaders to be understanding, and to please be flexible with schedules,” Cox says.

Some staff at Texas Health Resources’ centralized Patient Access Intake Center (PAIC) always have worked remotely. The at-home staff handled preregistration, estimates, preservice collections, insurance verification, authorization, and admission notification. The comparatively few staff who continued working on site did so out of choice.

“Employees generally had factors in their home lives that made them favor working in the office,” explains Chris Gronek, senior director of revenue cycle operations.

Some had young children, dependent family members, or lack of workspace. Yet all were sent home when the PAIC closed because of the pandemic. “They had some pretty significant hurdles to overcome in order to keep up with their work and maintain healthy home lives,” Gronek says.

PAIC leaders offered plenty of flexibility. “This was not possible for all roles. But we strived to make accommodations wherever possible,” Gronek says.

Staff can work different hours, work a longer day but with longer breaks, or take more frequent short breaks. “We found this to be particularly appealing to people who did not have regular child care or had a need to be away from their desk throughout the day,” Gronek says.

The department initially struggled to connect with remote workers. “The reality is that even a very well-run video meeting is often a poor analog for face-to-face human interaction,” Gronek admits.

Virtual happy hours, lunch meetups, and pet showcases were met with mixed reactions. In the end, the department found successful online socializing included three components: Small groups (fewer than eight), some preprogrammed content (in the form of simple icebreakers), and a set timeframe (30 to 45 minutes).

“Throwing 20 people on a video conference with no structure is much like doing the same in a meeting,” Gronek says. “It’s not going to be very effective or enjoyable.”