In the recent “Keeping up with COVID-19” webinar on Robotic Process Automation (RPA), nThrive expert Andrew Woughter discussed how hospitals and healthcare organizations can automate business processes to recover stronger from the COVID-19 Coronavirus pandemic. “Social distancing and the shift to remote staff are forcing healthcare industry leaders to rethink how work gets done,” explained Woughter, who is senior vice president of nThrive Product Strategy. “Now is the time to recognize these changes and reinvent processes, leveraging RPA to operate more efficiently now and in the future.”
Bridging the staffing gap at your healthcare organization
Woughter reflected on “how COVID has changed our world,” acknowledging that it has forced healthcare organizations become nimble in response to new challenges. He cited four factors resulting from COVID-19 that are driving the need to re-think operations and re-examine long-held assumptions:
- Human-resource-intense processes have had to be reevaluated to enable social distancing
- Staff have been reassigned to other tasks, and may be working reduced hours or even be furloughed or laid off
- When work returns to normal, volumes will likely challenge staff who have not been performing their normal tasks
- Requirements for new tasks will need to be addressed
“Many healthcare workers are in new roles and this is likely going to change how they work long-term,” he explained. Staff will need to be redeployed or reintroduced, many staff members may be able to continue to work remotely and collective intelligence will be at risk as remote scenarios challenge knowledge sharing.
“As America opens back up, the next hurdle will likely be re-inventing workflows and adding automation to help staff both compensate for change and keep up with pent-up demand for elective medical care.”
Leverage RPA with nThrive to do more with less
Post-COVID-19, Woughter suggested that healthcare specialists will need to work smarter to keep up with demand while ensuring high levels of patient satisfaction by shifting low-value-added tasks to software “bots” to replicate repetitive work. “Instead of a person logging into software to get work done, RPA can do it. For instance, a bot can enter a username and password, access an account, trigger application programming interfaces and operate directly on the objects within the system to parse information.”
While there are many choices, common bot applications include:
- Payor request for medical records
- Denials management lock boxes to address and/or route correspondence
- Handling eligibility processes
- Submitting notifications on admissions
- Adding claims attachments
- Executing medical billing edits
- Translating Medicare codes to standard codes
- Automating authorization submission and tracking
Efficiency improvements from RPA are dramatic, as bots can do in a matter seconds what takes minutes for a human specialist. Lightening this load for staff frees them to work on more complex, human decision-making requirements.
“While RPA is addressing basic cleanup items such as eligibility mistakes or rejections, specialists can be talking to patients about their itemized statements, something most people still want human interaction on.”
Getting started with RPA
“COVID-19 has already disrupted how we work, requiring us to put the pieces back together,” explained Woughter. “There is no better time than now to embark on a digital transformation journey with RPA to free up cost and allow for re-allocation of cash for critical initiatives.”
He strongly urged healthcare leaders against “taking a bad process and just doing it faster,” instead recommending three key steps to drive improvement:
- Rebuild – Many processes must be re-built in response to the new normal
- Optimize – RPA can break the constraints that previously shaped processes we originally designed
- Automate – Best known practices can be automated for revenue cycle teams to improve performance and ensure ongoing productivity improvements
Once a thorough assessment has been made to identify process and tasks for improvements, deploying pilot bots is a good way to test their effectiveness.
Pairing artificial intelligence with RPA
For those that want to take RPA to the next level, Woughter explained that it possible to build in custom artificial intelligence layers to extract data and act on it. For instance, RPA can be used as a powerful health information technology solution to capture data from insurance cards and match it with the correct payor plan code selection, a common source of human error. “This the same technology that enables Facebook or Google to recognize you using facial recognition AI. It simply overlays on top of insurance cards to map the insurance card information directly to the right payor code. In addition to defining machine learning rules that are specific, this is more sophisticated technology that solves some of the root cause problems we discover in our RPA engagements,” he said.
Deciding to build or buy
Ultimately the decision to build or buy depends on how much a hospital or healthcare organization can invest. Medical organizations that decide to build their own bots will need to commit in-house resources both to create and maintain the technology. Woughter emphasized that partnering with an expert revenue cycle management resource like nThrive can be much more efficient, especially if the vendor truly understands healthcare revenue cycle processes and is committed to RPA for the long term.
“Look for a partner that creates bots using a ‘smart architecture’ based on shared knowledge that is maintained across multiple users,” he emphasized. “Should something go awry, issues can be addressed rapidly to minimize downtime.”
Evaluating the risks
When implementing RPA, Woughter noted three risks healthcare leaders should not lose sight of, including:
- Change management – are you prepared to create a plan and manage changes in how you allocate work and deploy human resources?
- RPA Architecture – can you invest a robust solution versus deploying low-code solutions that require high maintenance?
- RPA Governance – Are you committed to prioritizing RPA initiatives to ensure you get the most out implementations without overwhelming your resources?
Reaping the rewards
Ultimately, for medical organizations that embark on an RPA implementation, the average labor savings can be dramatic. For instance, one large, 50+ hospital that deployed bots for adjustment claims (XX7 type bill), eligibility denials and root cause (XX7 claims), eliminated between two and four FTEs per application, resulting in ROIs of as much as 583 percent! Smaller facilities can also greatly benefit, often eliminating two or more FTEs.