Remote vs. Onsite Staffing: The Great Debate

Should mid-revenue professionals (coding, CDI, case management/utilization review) return to the hospital to resume their work onsite, now that the COVID-19 pandemic is lifting? Or, is remote work here to stay?

You did not think there would be a pat answer, did you?

Remote work is now a reality throughout the mid-revenue cycle, particularly in CDI and coding. But case managers, and clinical social workers, have gone remote in many instances too.

The reality is that if you don’t offer remote work, you will be at a tremendous competitive disadvantage when hiring or retaining employees, compared to employees that offer at-home work. You shouldn’t be afraid of managing remote teams any longer.

Times change, and technology has changed the game. Zoom, barely in our lexicon 4-5 years ago, is today so ubiquitous that “hopping on a Zoom call” is as common and commonly understood as picking up a phone. We share screens at the push of a button, engage face-to-face (digitally) with colleagues working hundreds of miles away, and make incredible connections, all while working from home.

Everyone wants to work remotely these days, and it can be a huge help with team satisfaction and employee retention. And, according to some studies, remote mid-revenue cycle professionals are more productive.

For example, 41% of CDI professionals responding to a 2017 ACDIS CDI Week Industry Overview Survey indicated their chart review productivity was better than on-site staff, as opposed to 4% that said it was worse (31% said they were the same). In addition, 23% of respondents indicated their query rate was better than on-site staff, as opposed to 3% that said their query rate was worse than on-site.

But, if you operate entirely remotely, you also risk suffering some disadvantages, minor and profound.

Some individuals want to come into the office. They enjoy the separation of home and office life. Entering the doors of the hospital allows them to put on a work hat, which they leave on a hook at the end of the day.

If your chief clients (aka, physicians) never see you, you are in danger of losing relevance and connection. Leaders should have an onsite presence. For example, let’s say you want to launch an ambulatory CDI program in your clinics. What is more effective: A zoom call you have to schedule, or an unplanned 3-minute hallway conversation with a skeptical busy doc?

A coding and CDI educator should meet physicians where they are. So too should staff. There is incredible value in unplanned conversation with a wound care nurse, or a quality improvement professional over a difficult sepsis case. With occasional onsite work, CDI staff, or coders that query, can create an impact that ripples throughout the organization.

The Association of Clinical Documentation Integrity Specialists issued a position paper that covers many sides of this multifaceted issue. “The pros and cons of remote CDI: Evaluate before you implement” was written in 2018 in a pre-pandemic world but still contains some of the most useful advice you will find on this topic, including obstacles you might not have thought of, including:

• Privacy and security: Employees must have access to a dedicated workspace that satisfies the privacy requirements of working with protected health information (PHI).
• Equipment and logistical concerns: In some hospitals, electronic tools or shared drives may only be available to employees on the physical network. Facilities must identify what equipment will be required for employers and consider what will be provided by the organization versus the employee.
• Hidden costs: Remote programs can reduce the costs associated with physical footprint, helping to alleviate the lack of space plaguing many hospitals. However, these cost savings may be erased through travel expenses if programs require remote workers to periodically appear on-site for training, education, team building, or other department activities.

The decision of remote vs. onsite work is not a binary, black and white decision, but a balancing act.

“I think hospitals can portably make a CDI department work remotely—but I don’t know if there is enough data out there to support 100% remote,” says Mike Behringer, senior vice president for strategic partnerships for Norwood. “There may be people that prefer to work onsite. And there has to be some people onsite to beat the drum of positive physician engagement. There  has to be at least a couple onsite to be the torchbearers to make sure the query process continues to flourish, based on having those relationships with physicians. It’s notoriously difficult to do if you’re remote and [physicians] don’t know if you’re querying for the right reasons.” 

A New Landscape of Hiring, Staff Retention

The real game-changer of remote work is access to a wider talent tool. Managers can now recruit top CDI, coding, and even case management and clinical social workers from all over the country.

But, it also makes your teams more vulnerable to offers from competitors. And, if you’re a manager who insists on onsite staff, you will have to offer additional compensation or more attractive benefits to offset the convenience and desirability of remote work. And possibly relocation fees and the like.

“The big benefit is expanding your talent pool and getting the best of the best,” says Behringer, of remote work. “You get to pick and choose your exact skills and open it up to an entire audience, not just 30 or 40 miles away. The downside is, you might be paying $30 hour for your onsite, and competing against $40-50 hour from a hospital 50 miles away that uses remote staff.”

If you’re a manager and insist on bringing your staff back onsite, make sure you’re doing it for the right reasons, with a game plan. Good communication is critical.

“If you’re bringing people onsite, they need to know there’s a logical, good reason for it,” says Devon Santoro, Senior Recruiter for Norwood. “Time with physicians, morale boost, a good environment, these are good reasons. But many hospitals have done away with so much office space, people aren’t super happy with being put the on floor with a laptop at a nurses’ station. The bottom line, it comes down to sound decision-making—knowing what you’re doing.”

Going Remote Means Being Flexible

Working remotely is incredibly desirable. Who doesn’t want to be able to eat lunch with your kids, or feed the dog and water the plants during your short breaks? Who doesn’t want to work shoeless, playing your favorite music in the background? Does anyone miss the hour commute each way into the office?

But remote work also requires discipline, and flexibility.

The value case managers, utilization review professionals, and clinical social workers bring has led to a surge in remote work opportunities. Post-discharge followup—medication adherence, checking in with family members on changing wound dressings, etc.–is a critical component in patient care and reducing readmissions and associated penalties. Today these tasks can be performed effectively using Zoom and other modern technologies.

Remote work pays well, too. But it isn’t for everyone. Norwood Vice President of Case Management John Kiwanuka says the ability to adapt to new professional habitats is the most important skill for those seeking work in an interim travel or remote setting.

“The ability to adapt to the culture of a hospital is such an amazing trait to have. It is one that requires patience and humility,” he says. “When we ask an aspiring contractor, ‘why do you want to travel,’ and the response is ‘to make the money,’ that’s acceptable, but at times, money can be confused with power. The most important piece to effective recruitment in travel nursing is transparency. We must be able to have the conversation with them, that they are not going in (to a hospital) as a bull in a china shop. They are guests in the hospital. You must be willing to learn and embrace a new culture, a new environment.”

Something to think about if you’re working on a temporary, remote contract basis.

Working remotely is a skill, different than operating under the thumb of a manager. Santoro has many clients who require at least three years of onsite work before they will allow CDI staff to transition to the home office. That’s because the additional freedom requires the discipline to structure your day.

“You still need that hands-on experience and a demonstrated ability to do remote work. Some managers still feel like you should consider remote special, something you’ve earned, vs. a given,” she says. “Putting your time in is crucial for success for people working remotely. It’s not a strength of everyone to sit at home and be able to effectively structure your day.”

Santoro says many CDI leaders consider remote work a privilege that is earned, not a given to be expected. And so contract professionals, especially early in their careers, will need to factor that into their expectations.

Conclusion

Today’s workspaces are fluid, and hybrid. The majority of staff will work remotely, but specialized roles (director, educator) will need onsite presence, at least a few days a week. Remote staff will likely need to come on site for occasional joint education or team-building exercises. New staff will likely need onsite orientation and training.

This hybrid approach requires flexibility on all levels, from leadership to staff. Implementing an effective strategy won’t be easy. Check out the ACDIS paper referenced below for sample remote work policies.

Consider finding a partner to help you navigate this brave new world. Norwood is one possible option who can serve as a resource to fill vacancies when staff leave, or to add temporary coding/CDI/case management staff when volumes peak.

“We’re meant to be a safety net, you walk the high wire and that’s your act. We’re here just in case,” Behringer says. “We’re not here to replace your HR dept, just here to make sure we’re meeting your ROI, and you are getting revenue collected in a timely fashion. If you’re willing to train someone, but you need a top performer in the meantime, we lend you one.”

About the Author

Brian Murphy is the founder and former director of the Association of Clinical Documentation Integrity Specialists (2007-2022). In his current role as Branding Director of Norwood he enhances and elevates careers of mid-revenue cycle healthcare professionals.

References

ACDIS, Position Paper, “The pros and cons of remote CDI: Evaluate before you implement.” Accessed at: https://acdis.org/resources/pros-and-cons-remote-cdi-evaluate-you-implement

ACDIS, 2017 CDI Week Industry Overview Survey. Accessed at: https://acdis.org/cdi-week/2017-cdi-week-industry-overview-survey