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    Christian Green
    Christian Green, MA

    Nearly two years ago, the COVID-19 pandemic forced most medical group practices to move to virtual visits and transition some staff to remote work. Although many providers quickly returned to the office, there were some employees and departments — including call centers, billing and coding, information technology, accounting and finance, and human resources — that continued to work from home.

    A Feb. 9, 2022, MGMA Stat poll found that 59% of medical group practices said they shifted workers to permanent and/or hybrid work in 2021, while 41% responded that they had not. The poll had 989 applicable responses.
    For those who answered “yes,” billing/coding, call center, scheduling and administrative positions were most frequently remote/hybrid. Some of the more compelling reasons for moving employees were tied to retention, productivity and space constraints:

    • “COVID drove innovation. All staff are able to work remotely. In non-patient-facing roles, almost all staff have requested a hybrid schedule. Patient-facing staff have the ability to do telehealth visits when we have inclement weather, so we're never really closed.”
    • “Billing office staff, IT staff and other non-direct patient care positions. COVID-19 propelled us into the future and now it's a retention and recruiting essential.”
    • “All billing and prior authorization positions switched to permanent remote. We realized how well it was working and decided not to switch back.”
    • “Coders and transcription went remote. We could not find either that was willing to work on-site full time. We are still finding it difficult to find staff willing to work a hybrid. They want full remote.”
    • “Chart prep, prior authorization and financial counselors. We need to maximize clinic space and found that these folks did not need to be in the office to be productive.”

    For those who responded “no,” 13% are considering shifting workers to permanent remote or hybrid settings later this year. 

    Continued interest in going remote and hybrid

    One year into the pandemic, an April 13, 2021, MGMA Stat poll showed that one in five practices said that more than 25% of their workforce was remote at least half the time.
    As noted in this poll, there are several advantages to work-from-home arrangements, including:

    • Reducing overhead costs
    • Retaining skilled employees and attracting a larger talent pool
    • Improving performance and productivity, which may result in more engaged workforces
    • Providing alternative and sometimes more convenient care options for patients.

    Remote work in healthcare organizations

    According to a September 2021 Gallup survey, healthcare had one of the lowest rates of remote workers in white-collar jobs at 35%; however, a sizable portion of that percentage includes clinicians and other patient-facing positions. Quite often, non-patient-facing staff have been shown to be more productive, experience less stress and burnout, and have higher morale when working remotely.  
    Some organizations such as Cleveland Clinic have actively promoted and supported long-term remote work strategies, with nearly 8,000 administrative caregivers working in formal remote or hybrid models. That said, there are also smaller organizations that have focused on instituting formal and informal hybrid and remote work models. [Read the upcoming April issue of MGMA Connection magazine for more insights from practice administrators who’ve embraced remote and hybrid work.]
    For many practice leaders, tracking productivity is a primary concern for their hybrid and remote employees; however, if remote workers are engaged, there’s a good chance practice culture is the reason.

    Productivity begins with engagement

    When assessing hybrid and remote employees, it’s relatively easy to gauge productivity because there’s no reason for goals to change. For call center staff and billing and coding staff, for example, there are measurable metrics: for the former, efficiency, first-call resolution response time, customer satisfaction rates; for the latter, charts reviewed, claims coded, claims submitted, denials appealed.

    However, in looking beyond metrics, productivity is influenced by engagement, which, in turn, is sustained by culture. But how do you engage staff during a pandemic? For Galyn Damiani, SHSMD, senior director, brain & spine and critical care, Centra Health, Lynchburg, Va., it starts with flexibility, which helps alleviate emotional and mental anxiety, especially when COVID-19 cases are spiking.

    “If we are concerned with protecting and supporting our caregivers and coming up with a sustainable model that makes them feel comfortable, they're going to deliver better care to our patients,” she says.

    The same holds true for non-patient-facing staff. James Padley, MBA, CMPE, chief operating officer, ID Care, Hillsborough, N.J., says that his organization’s staff have been more productive when working remotely.

    ID Care has a 90-day onboarding period during which time new hires are evaluated and trained to determine their suitability for remote work. The practice provides the equipment they need and ensures that they have access to reliable broadband and a dedicated workspace.

    ID Care has approximately 20 employees who are 100% remote and another 40 who are hybrid. According to Padley, a big reason these individuals are more productive in a remote setting is that they have fewer conversations and distractions from other employees in the office.

    For Padley, the remote work option has also been an important means for attracting candidates, given ID Care’s location in one of the less-populated areas of New Jersey. “Recruiting was becoming an issue because people didn't want to commute out to where we were,” says Padley. “So that was already becoming a request … it's now enabled us to recruit much wider, because we can offer remote work for people.”   

    Maintaining practice culture for hybrid/remote employees

    Although most employees have the technology and tools to effectively work outside the office, organizations may find it difficult to replicate practice culture. Building relationships is important, especially for new hires.
    In a 2020 Deloitte study on the future of work and the workplace in healthcare, 59% of respondents said that their ability to develop camaraderie with their colleagues was less effective while working remotely. Respondents voiced concern that in time this could affect productivity, innovation and collaboration.
    This largely depends on the individual, their role and their time with the organization. To help with employee engagement, culturally driven organizations emphasize communication and connectivity, both of which are integral to maintaining a strong culture.
    For example, Damiani notes that her organization has an executive service line council that meets regularly to discuss organizational culture. “Culture is what underlies executing on the strategies that we put in place,” she says. “If we don't have a great culture and great engagement, then we're not going to be able to effectively and efficiently execute on what we need to get done.”
    To meet the needs of their remote employees, practices have instituted monthly in-person staff and team meetings, virtual daily huddles, virtual happy hours and virtual games. But some individuals may yearn for something more gratifying. Damiani shared a great example that illustrates this desire.

    To help providers and staff connect on a more personal level, in a clinic or remotely, Damiani and the department’s medical director introduced a strategic lunch initiative. By bringing together two or more employees who may not have connected beyond their workplace interactions, Centra Health has begun to foster relationships that are meant to further engage staff and providers through connection.

    Damiani recently helped set up a lunch with a physician and a nurse practitioner who had worked together for a decade, but the physician had never learned much about the NP outside of work. The lunches “provide that relational context, that shared language that can help improve the culture and create a level of engagement that might not otherwise exist,” she explained, pointing out how these informal get-togethers can build trust between individuals.
    Our ability at MGMA to provide great resources, education and advocacy depends on a strong feedback loop with healthcare leaders. To be part of this effort, sign up for MGMA Stat and make your voice heard in our weekly polls. Sign up by texting “STAT” to 33550 or visit Polls will be sent to your phone via text message. 
    Additional resources 

    Christian Green

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