Introducing a flexible work environment

A question-and-answer with Casey Crotty, MGMA member, chief executive officer, San Juan IPA, Farmington, N.M., who is testing a flexible work schedule for employees this summer to accommodate a growing team with limited space, enhance work-life benefits and retain employees.

Q: Please describe the flexible work schedule you introduced.
A: This affects staff in the Independent Practice Association (IPA) and Physician Billing Resources (PBA), not the home health unit. With home health, your staff is (or should be) in the field all day seeing patients; not much I can do to help that. Not yet, anyway. We have about 45 employees across all three units. This schedule affects 12 of them. Staff members from the IPA and PBA have the option to work from home under these rules:

• This is an option if the staff person’s workload at the office allows a telework option. For example, if there’s a lot of filing to be done, an expectation that there will be a large volume of faxes related to contracting work or an upcoming audit, the staff person is expected to be in the office. If, on the other hand, everything can be accomplished electronically or by telephone, the staff person can work from home.
• All staff must be in on Mondays so we can talk about issues, events, meetings, schedules, so forth- and to get a pulse on staff — during an 8:30 a.m. staff meeting.
• Two people (one from the IPA and one from PBR) are in the office every day through the week, and those staff members rotate each week. If someone is unable to come in, he or she is required to find a replacement.
• If working from home, staff members must be available to come to the office within 30 minutes of a call or email. If someone is unable to abide by that rule, that time is considered paid time off.
• Everyone must be in business attire when in the office, even if someone is called in at the last minute.
• Everyone’s computers used from home must be cleared by the company’s information technology department and have all security updates.
• Staff must forward office phones to their personal phones to take calls real time. All calls and emails must be returned within one business day.

Q: What prompted you to introduce this new schedule?
A: There are a few reasons: Every summer I try and do something different with people’s hours so they have more time to spend with family, enjoy the weather, so forth. Last year we tried four 10-hour days but that was met with some criticism from our billing clients. This year we’re trying a work-from-home option. Let’s face it: For the most part, billing can be done at all hours of the day. Part is because I keep reading about these innovative companies that have such high employee satisfaction. Some of them have pool tables. Some of them have nice employee relaxation areas. Heck, some have bars! I don’t have the room to do any of that (and I’m not sure that a bar is a great option, though personally, I wouldn’t mind it) so I went with a work-from-home option. Finally, in my own position I can do 90% of my job anywhere in the world.  I can negotiate contracts on the beaches of Belize. I don’t need to be in an office! But I thought if I can allow others that flexibility, then why not try it?

Q: When did you introduce it?
A: Originally I introduced the idea back in February or March to staff and opened it up for discussion.  After deciding on the rules, we decided to implement it the first Monday after Memorial Day weekend. I rarely make sweeping operational decisions without staff input.

Q: How has it affected operations so far?  
A: Operations haven’t changed a bit; in fact, I think I’ve seen an increase in output from my billing staff.  People seem much more relaxed, and I have yet to hear a complaint about not being able to reach another team member, though it’s early yet.

Q: What is the goal of the program?  
A: Ultimately I want an office where we’re known as The Place (capitalized quite on purpose) to work.  I want staff to brag to others about how good they have it here.  This is part of a larger strategy in terms of employee benefits, how I recruit new staff people and organizational growth.

Q:  Is this a test or something that will continue long term?
A: This is in test phase until Labor Day. I might very well make it permanent, though. One of the things we’re struggling with is limited space and high growth; having this sort of schedule also helps me mitigate trying to cram people into a very limited area.

Q: Could this type of schedule be implemented for medical groups or other healthcare organizations that see patients?
A: That’s a tough one. We’re a much different office than a traditional medical office, but I do think there are units within the practice that can work from home. For example, billing can be done anywhere at any time. It’s possible to rotate billing staff to work from home like we do or allow your single biller to work from home one, two or three days a week. You can have a receptionist take calls at home and do scheduling; you really don’t have to have one in the office for that. You can have your prior authorization person work from home. I think the larger groups have more flexibility; as we all know, in smaller groups, people tend to wear many hats so I don’t think it would work quite as well. The big thing is to set up your systems so that the workflow doesn’t change that much. For our office, we moved 90% of our paper to servers. I can access virtually anything I need from my laptop anywhere in the world as can most of our people. HIPAA and confidentiality rules still apply no matter what.

Q:  Do you expect more healthcare organizations to test or adopt this type of schedule in the future?
A:  Looking into my very hazy crystal ball, I think that healthcare is going to go through another revolution in the next three to five years. For those folks who are willing to try new things, I can see some attempts at new office paradigms. Outside of that, though, clinical people generally have to be where the patient is: in the office. There’s some opportunity on the clinical side for employee-sharing and flex-time models, but what we’re doing is more suited to the administrative staff. People told me I was insane when I predicted that accountable care organizations would take off and be a new delivery model, though, so take everything above with a grain of salt!