How Nebraska Medicine Avoided Furloughs During COVID-19

At a time when healthcare organizations had to make the tough decision to furlough staff, Nebraska Medicine was quickly adapting its existing workforce to effectively respond to a global health crisis.

“Our thought was we have not had to furlough anybody yet and we really don't want to,” Kristi Atkinson, budget and cost accounting manager at Nebraska Medicine, recently said in an interview with RevCycleIntelligence. “We were looking at what could we do differently, who could we shift around to preserve as much as we can, knowing that this is our new normal. This is not a short-term challenge.”

The outbreak of COVID-19 has been the greatest public health crisis most US healthcare providers have seen in their lifetimes. A lack of supplies, providers, and other resources have made it difficult for providers to adapt their operations to a pandemic. Meanwhile, most organizations are struggling to make ends meet as entire service lines have had to be shut down and shelter-at-home orders prevent patients from seeking in-person care.

Emergency coronavirus relief funds from the federal government, payment parity for virtual care, and other new policies created in response to COVID-19 have helped the healthcare system from breaking. But the pandemic has exposed significant cracks in its foundation, particularly the section holding up the provider workforce.

“Before COVID hit, we, like many other organizations, had labor challenges,” Atkinson explained. “We already had a nursing shortage. We had other specialty provider shortages, like respiratory therapists. So, the moment [COVID-19] hit, it hit us harder in that we knew we already didn't have a surplus of ICU nurses and we were already short respiratory therapists.”

With patients desperately in need of care, Nebraska Medicine knew it had to work with what they already had to survive the crisis.

“Immediately, we stood up an inpatient and outpatient float pool for staff, and the primary task for our leadership was to see who's in the pool and where do we need to put them,” Atkinson said. “That's when we started using data to look where productivity was high and where productivity was super low.”

Fortunately, Nebraska Medicine had already started the process of aggregating and analyzing data on its more than 8,000 employees, including 1,000 doctors.

Last year, the health system started to explore productivity data using its financial planning, analytics, and performance platform from Strata Decision Technology. Using the information, Atkinson and her team have been able to identify workforce trends over the course of a year and reduce unnecessary labor costs, such excessive overtime costs that had nothing to do with the RN shortage, for example.

Now, that data was supporting the health system’s COVID-19 response efforts.

“It was kind of perfect timing because now that we really need to use this data for a different reason than we thought, people are comfortable with it and they understand it,” Atkinson stated.

Having trusted labor data supported new flex pools needed to handle surges at the health system’s hospitals, Atkinson stressed.

Floating and flexing were already common practice among the health system’s nurses, but Atkinson and her team were now tasked with implementing a similar labor management practice across the entire system. On top of that, her team had to determine where staff were needed most, even if it was not part of their established roles.

The data helped to identify areas within the system where productivity was low due to COVID-19, as well as areas where productivity was unexpectedly spiking, like access services.

Despite essentially locking down facilities and limiting visitors, access services staff were reporting more overtime than before the pandemic hit. What would not have been intuitive before, though, had a story because of access to labor and productivity data.

“Those access services people really had to do way more than they normally do,” Atkinson explained. “They had to make sure that the people who were checking in were really supposed to be here. So, that's where we were able to do some floating.”

In addition to sending providers to support COVID-19 treatment, Nebraska Medicine was also able to leverage some outpatient surgical nurses who did not have surgeries and already had extensive patient management experience to help access services with the additional work.

The health system was also able to use staff with lower-than-normal workloads to address challenges unique to COVID-19. For example, procuring and repurposing personal protective equipment (PPE).

“We have a sterile processing center that processes all of our surgical equipment, sterilizes it in a central location, and delivers it back to all the locations,” Atkinson said. “With our electives having gone down, we didn't want to send them home, so now we have some of those people driving around the city, picking up PPE that can be reprocessed and sterilized.”

Other staff are also being redeployed to sew masks, make disinfectant wipes, and even print 3D nasal swabs for COVID-19 testing. And just as importantly, Nebraska Medicine is tracking these tasks through new pay codes in the payroll system.

“We realize we may not be reimbursed by some of the federal funds for everything, but we want to make sure that we're doing a good job tracking it,” Atkinson said. “We think is important because we may be able to do something differently from an accounting perspective going forward.”

Many aspects of the healthcare system will be different in a post-pandemic world. The operational and financial challenges created by COVID-19 will have lasting effects on revenue, volumes, and how providers deliver care in general. Nebraska Medicine’s budget and accounting team is bracing for some of those changes.

For some time, the health system has considered moving to a rolling forecast budget, which allows organizations to be nimbler and adapt financial goals and plans regularly versus once a year. The non-traditional budgeting practice can help organizations meet new business demands and challenges, like a pandemic.

Rolling forecasts allow organizations to identify and adjust to market changes, improve timely allocation of resources, execute a forward-looking view of organizational performance, and even reduce staff. With this in mind, more healthcare organizations are moving to rolling forecasts, at least as a complement to traditional budgeting, according to a recent report from consulting firm Kaufman Hall.

But the transition can be tough for larger organizations like Nebraska Medicine, which typically plan months and years in advance. The pandemic, however, is changing how leaders at the health system think.

“Using the rolling forecast and looking at trend data is the way we're going to be going a little bit more as we do an operating budget,” Atkinson stated. “It's going to be a little different. We're going to be more flexible.”

Flexibility is key in the current landscape. COVID-19 has made it difficult for healthcare organizations to predict what their providers will need to handle, like a second wave of the virus. With the help of labor data and analytics, providers like Nebraska Medicine are able to adapt quickly.

For more coronavirus updates, visit our resource page, updated twice daily by Xtelligent Healthcare Media.