Adding an employee to any business takes some serious consideration.

Regardless of whether you are replacing someone who left the company or you are adding an entirely new position, adding an employee is a serious commitment. At the point that you are ready to make an offer to a candidate, you have already invested labor and resources.

In healthcare, most employees (excluding Mid-level Providers and Technologists) do not generate revenue. Sometimes they are hired to accommodate increased patient volume as with the addition of a new physician, but they often are hired because it takes more administrative manpower to garner the same or less reimbursement from payers. In particular, there are more phone calls inbound and outbound, more pre-authorizations, more denials, more audits and more hoops to jump through to document, justify and confirm payment.

Before you add a position that will not generate more revenue, that is, one that is not related to more customers/patients needing more services for which they will pay, ask yourself these three questions.

#1 Is there enough for a full-time person to do?

I must admit, I have been guilty of “rounding up” a position to make it full-time. It’s not that I didn’t have enough work for a full-time position, but I let one specific part-time need bloom into one full-time person. In most workplaces, especially in in healthcare, there is always more work than can be done in one day, however, just because there is always work to do does not mean a practice can afford an additional full-time person.

#2 Will the new person come on board with the requisite skills or will they have to be trained?

There is always a push-pull between hiring someone with lots of experience (more money) and hiring someone with less experience but who can be trained in the duties needed (less money.) The more experienced person will probably hire in at more than you allocated for the position, but the less-experienced person will take time to ramp up and will not be immediately productive.

#3  Will you have to allocate workspace and outfit the new employee with a desk, chair, phone and computer?

When the decision is made to add an employee, do you list the hard and soft costs of adding an employee to the practice? Just like you construct a pro forma to consider adding a new provider or a new ancillary service, you should construct a pro forma to truly understand the cost to the practice of adding an employee. List what you spend to recruit, salary, all benefits including paid time off, anything the practice pays based on the number of employees such as unemployment, perks such as parties and gifts, bonuses,uniforms, parking, dues, memberships, licenses, continuing education (whether guaranteed or not), plus desk, chair, phone, computer and workspace.

If you don’t have the work for another FT person, if you’re not sure if you can afford an experienced person, and if your investment will be significant, it’s time to do some creative thinking about getting what your business needs without adding an additional employee.

Some Other Options for Your Workforce

Remote Employee

Get what you need by hiring someone to work from their home. Obviously only some jobs can be done remotely, but there are more possibilities than you might think. Most Practice Management and Electronic Medical Record (PM/EMR) software have built-in communications so staff can email or instant message each other instead of walking through the clinic to have a conversation. You should be using this functionality even if all your employees are onsite. Develop a Remote Employee Policy that spells out the expectations of a remote employee and clearly discusses security and privacy as it relates to the home office of a healthcare employee. Remote employees can be part-time or full-time. They can also be remote four days a week and come onsite one day a week to give another employee an opportunity to work from home one day a week.

Contract Help

Don’t want to hire an employee? How about paying someone on a contract basis? Make sure you are following the guidelines for employees vs contractors and that the contractor understands the terms of the work. Make sure you have a contract, or at least a written agreement that you’ve both signed, as well as a Business Associates Agreement, required of all healthcare contractors who have access to PHI (Protected Health Information.)

Student Help

Do you have your full-time employees doing a lot of work that could be offloaded to someone with a different skill set? Think about hiring a part-time high school or college student to scan and index records, enter pre-registration data, scan non-medical record paperwork to be stored in the cloud, correct simple claims issues, etc. Spend some time observing employees or have them write down every little job they are doing so you can assess what they may be doing that you could transition to someone else.

Volunteer Help

Most people think that volunteers are only appropriate for hospitals. Think again. There are many, many people trying to break into the healthcare field that would love to volunteer some of their time at your facility. There are also people who have retired from healthcare who would love to spend a few hours a week staying involved in their former career. I’ve written before about using retired people for greeters in the reception area, or for teaching others how to use your patient portal or the Personal Health Record (PHR) you offer your patients.

Outsourced Help

You might be surprised that companies now offer more services than you could previously get. What about phone pre-registration, nurse triage, appointment scheduling, collection calls, appointment reminders, credentialing, phone answering 24/7, medical record scanning & indexing, release of information (ROI), no-show follow-up, recall follow-up or remote scribing of the office visit.

Recruit from All 50 States

Don’t forget that you are no longer restricted to hiring from your local area. Whether you are talking about an employee, a contractor, or a company, as long as you both agree on the terms, it doesn’t matter where they are working, it only matters how well they are meeting your company’s needs.