From Response to New Normal: Moving Forward in a Pandemic

Healthcare operational leaders recognize that the ongoing pandemic will have a long-term impact on everything, from social behavior to financial outlook and payment habits, to institutional policies and procedures. While these impacts continue to evolve, leaders charting a new normal are currently working to:

  • Prepare Staff for a Changing Work Environment
  • Rapidly Evolve Patient-Facing Processes in a Safe, Efficient Manner
  • Address Patient Hesitancy Proactively
  • Rethink Revenue Management

Prepare Staff for a Changing Work Environment
Where Organizations Are Increasing Remote Work Due to COVID-19 (By Revenue Cycle Department)
Source: Healthcare Business Insights, Part of Clarivate (2020)
*Support staff is defined as revenue cycle trainers, analytics team members, etc.
N=42 health systems, representing 180 hospitals

Embrace Remote Work — It’s Here to Stay
For many organizations, the ability to work from home has long been seen as a privilege or a reward. Concerns surrounding connectivity, equipment, and engagement held leaders back from expanding this option. That is, until operational leaders no longer had a choice. Due to COVID-19, some organizations had to send 50% or more of their staff home—and within a matter of days.

Several decision-makers have remarked to HBI that, as staff were sent home, previous concerns were more easily addressed than expected, staff rose to the challenge, and efficiencies have resulted. To ensure this, leaders have:

  • Maintained culture and camaraderie through virtual coffee breaks or games.
  • Conducted regular check-ins with staff—both individually and by team as often as weekly.
  • Rotated staff still working from the office.
  • Limited occupancy in common areas, such as break rooms and cafeterias.
  • Evaluated staff preference and comfort on an ongoing basis with respect to continuing to work from home or coming back to the office.
  • Used this period as an opportunity to rethink and rebuild processes, workflows, and staff structures.

Moving forward, many industries will first see staff alternate days from which they work from home and the office. But as leases run out and health systems continue to look to do more with less, we may see wider and more permanent adoption of at-home workforces. The combined benefits of preserving staff members’ health, increasing productivity, and reducing facility costs are too important and significant to ignore.

A June 2020 PwC survey[1] revealed that workers see the value in working from home and 83% wish to continue doing so one or more days a week.

The same survey shared that 55% of employers expect work-from-home arrangements to continue well after the concern of COVID-19.

For Those On-Site, Safety Needs to Be Seen to Be Felt

In order to make employees safe and feel comfortable working on-site, healthcare leaders will have a long list of logistics to work out—from temperature checks and workspace distancing to disinfectant schedules and proper airflow. In addition, organizations will want to consider how to:

  • Procure appropriate PPE for patient and staff volumes, whether internationally, through donation or nonprofit organizations, new partnerships, social media campaigns, or reuse.
  • Define and communicate decontamination policies; at present, vaporous hydrogen peroxide is among the disinfectant methods hospitals are using for reusable PPE, and barcodes or ID numbers will ensure equipment is reissued to the correct staff member.
  • Plan for staff shortages should a resurgence occur and understand what roles will fill in for others and at what stage (e.g., if registrars are down 20%, tapping in pro re nata staff, then financial counselors at a 50% shortage).
For Those On-Site, Safety Needs to Be Seen to Be Felt

Leaders will also want to retrain staff on the elements of safety that each individual will be responsible for, such as proper hand hygiene. This should include instruction regarding:

  • Each instance in which hands need to be washed.
  • When to use gloves and how to dispose of them.
  • Further CDC and WHO guidance.

Ensure staff also receive training and support in working from home effectively, including but not limited to:

  • How to manage time and limit distractions.
  • How to manage staff remotely.
  • How to maintain compliance with internal or regulatory policies, such as HIPAA.

Staff interactions with patients have also taken on a different tone. Clinical and financial discussions may require quelling fears, addressing misinformation or uncertainty, and will require greater empathy and compassion. To reequip staff, HBI recommends:

01
Surveying staff on their key concerns or needs prior to training.

02
Unifying the message to ensure everyone operates from the same directives, tools, and policies.

03
Going beyond scripting and showing what soft skills and empathy look like in practice.

04
Practicing common scenarios staff are experiencing and providing an ongoing forum to share communication challenges or changes.

05
Reinforcing customer service by equipping staff with resolution paradigms and equipping patients with the information needed to make the right choice or arrangement for them.

06
Ensuring staff are well versed in the financial arrangements available; all staff should see themselves as both caregivers and advocates.

Rapidly Evolve Patient-Facing Processes in a Safe, Efficient Manner
Organizations That Adjusted Patient Access Functions Due to COVID-19
Source: Healthcare Business Insights, Part of Clarivate (2020)

Patients Need Updated Accessibility

Pre-Arrival

Given the need to bring back previously deferred services while also obtaining more patient information sooner and remotely, pre-service staff members may be facing higher workloads and expectations than before. At some hospitals, these staff members are being asked to:

  • Screen patients for symptoms commonly associated with COVID-19 at the point of scheduling.
  • Conduct confirmation calls 1-2 days prior to service to screen patients again for symptoms.
  • Transition services to telehealth as deemed appropriate.
  • Instruct patients how to access virtual care, how to safely arrive for services, and of new safety precautions.
  • Obtain verbal consent during preregistration or scheduling.
  • Financially clear patients, provide estimates, and hold an initial financial discussion with the patient.

Organizations may find that online or mobile pre-registration is needed now more than ever to help a potentially decreased group of staff adequately keep up to rebounding volumes. These applications may also include a self-screening field for patients to indicate whether they are experiencing COVID-19 symptoms.

Arrival

Not every clinical service is feasible from a remote standpoint; thus, healthcare facilities are challenged with how to limit person-to-person contact among patients who may have COVID-19, be susceptible to it, or have other compromising or chronic conditions. This is why organizations have been:

  • Rearranging waiting rooms to ensure patients remain six feet apart.
  • Assigning a cleaning schedule in which various staff take on shifts to disinfect high-touch items.
  • Placing sneeze guards or plexiglass at check-in desks or anywhere where nonclinical staff interact with patients.
  • Offering low- or no-contact arrival where patients wait in their car until called or texted; geolocation can even be used to notify the facility as the patient arrives in the parking lot.
  • Enacting mobile or over-the-phone registration.
  • Or, developing a virtual registration process through Zoom or other videoconferencing solutions.
  • Treating potential COVID-19 patients in designated areas, separate from other conditions.

But Will Telehealth Remain Accessible?
According to FairHealth[3], the volume of telehealth claim lines grew more than 8,300% from April 2019 to April 2020. Healthcare organizations have gone so far as to redesign scheduling templates to indicate when and which services will be done virtually for each physician. As such, physicians and patients have seen the value in maintaining a virtual care option from a cost-savings, efficiency, revenue, and accessibility perspective. But do payers see the same value? The jury is still out on whether insurers will continue to extend reimbursement for this service modality beyond the pandemic.

In an April 2020 Sermo poll4

Address Patient Hesitancy Proactively
First, Make Safety Apparent
In July, HBI’s social intelligence team identified some of the main patient personas with respect to their sentiments about returning to their doctor’s office or a hospital for care, including:
Patient Persona Sentiment
The Loyal The first feels happy about previous experiences at the hospital and appreciative of healthcare workers.
The Visitor-Sensitive The second is nervous about going to the hospital alone and wants to know if their companions will be permitted.
The Concerned The third patient persona is concerned about safety measures and bed availability.
The Skeptic This includes patients who don’t understand why they have to wear masks, wait in their car, get a COVID test at an inconvenient location, or other changes.
The Dissatisfied Patients may have issues with being rescheduled, not being able to get a hold of anyone who can answer their questions, or other situations that could have been resolved by a better customer service response.
The Safety Fan Finally, patients who have seen the precautions taken and they specifically mention how pleased they are with safety measures.

The main theme we see throughout all of these patient personas is the importance of letting patients see safety in action. This is the key to comforting nerves, persuading the uncertain, enforcing compliance, and ensuring patients leave with and share their positive experience.

  • Develop marketing resources, social media posts, website updates, and signs on the safety measures taken—and make them highly visual.
  • Proactive outreach will be needed to call or text patients and talk through new precautions and what to expect.
  • Have clinicians speak up over their concern for patients delaying necessary care and have them validate the safety measures in place.
  • Match on-site actions with what is promised—let patients see cleaning and hand hygiene in person.
  • Consistency is key to confidence—ensure all affiliated facilities are following the same precautions and policies.

Then, Maintain Financial Discussions and Expand Payment Options

Patients are not only concerned with their physical health but also their financial health. They are more likely to be affected financially from the pandemic than clinically. And yet, many leaders HBI has spoken to noted that upfront collections, and therefore financial discussions, have all but ceased. Being compassionate necessitates being transparent and also knowing when a patient may require a more flexible or creative arrangement. Revenue cycle leaders are reconsidering:

  • Payment plans: including but not limited to extending repayment periods, lowering minimum monthly payments, and offering 30–90 day deferrals for existing plans or new arrangements.
  • Prompt-pay discounts: increasing these by 15%–30%, escalating the discount applied based on how soon the patient pays or the size of their balance, extending eligibility for a limited time post-discharge, or applying a lower discount for partial payments.
  • Self-pay discounts: increasing these by 15%–35% or applying an out-of-pocket maximum for patients based on service setting.
  • Financial assistance programs: updating applications to allow the patient to indicate they have been financially affected by COVID-19 and raising baseline eligibility to 300%–400% of the federal poverty level.
  • Crowdfunding: designating programs where patients can elect to raise donations for their medical bills even if already eligible or enrolled in the options explored above.

Rethink Revenue Management

First, Find New Ways to Conserve Costs

Contributing to these losses were the cancellation of nearly all elective services (representing a grave reduction in revenue), preparation for the potential wave of highly acute patients (representing increased expenditures), and the exacerbation of held bills and delayed reimbursement and government assistance. The following shares how supply chain and revenue cycle leaders are working together and with suppliers and vendors to circumvent these financial headwinds.

  • Order in the lowest unit of measure for nonessential supplies.
  • Conduct a gap analysis of supply procurement compared to supply utilization to reduce spend.
  • Provide physicians with pricing information on devices to help them achieve more cost-effective preferences.
  • Consider alternative routes or networks for supply procurement such as LinkedIn.
  • Evaluate vendor contracts across the organization to renegotiate prices or consolidate duplicative services.
  • Request partial or delayed payments on vendor invoices.
  • Renegotiate terms with payers, specifically looking at pre-authorization, timely filing, or other requirements.
  • Automate workflows through existing systems or vendors and encourage patients to utilize self-service.
Effects of COVID-19 on Revenue Cycle KPIs

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Then, Ready Your Organization for Revenue Optimization

While federal programs have offered support to come to the aid of healthcare providers— such as the Provider Relief Fund, FEMA Public Assistance Funds, and Accelerated Medicare Payments—it is not a guarantee that organizations will make a full financial recovery. Across departments, providers are looking to optimize cash on hand where possible, such as by:

  • Offering a one-time resolution discount to patients with overdue, aging balances.
  • Revisiting leases or selling real estate no longer being utilized as a result of new remote work capabilities.
  • Taking advantage of accelerated payments or loan programs offered by any contracted payers.
  • Emphasizing and marketing primary care—both its ongoing importance and its safety precautions.
  • Evaluating patient referrals to understand why or for which services patients are being referred outside of the health system.
  • Conducting more home health and/or telehealth visits to counteract increased time between on-site appointments.

Our mission is to provide healthcare insights that change lives by helping providers optimize performance, understand their markets, and engage and retain employees. This is as important as it’s ever been as leaders chart a new normal.

To discuss the ways in which HBI can help you and your organization, contact our experts today at contact@hbinsights.com.