Monitoring Spire’s COVID-19 Traveling Nurse ReimbursemenTs
MONITORING SPIRE’S COVID-19 TRAVELING NURSE REIMBURSEMENTS
CLIENT
Spire is a purpose-driven Certified Public Accountant (CPA) firm based in Hawaii, serving clients in state and local government, healthcare, technology, nonprofits, retail, and more. Their team solves multi-dimensional problems holistically for their clients, not only in accounting and audits, but also in areas like IT, management consulting, litigation support, and strategy, treating these as connected facets of organizational health.
During the COVID-19 pandemic, Spire was contracted by Hawaii’s Emergency Management Agency (HiEMA) and the Hawaii State Department of Health to test and verify invoices for staffing services provided to 19 Hawaii hospitals with traveling nurses over a total period of nearly six months. Spire approached our team at Terranox to develop a rigorous system to support this complex work. The project also required adapting the system to rapidly changing conditions and requirements.
CHALLENGES
Spire was tasked with testing and verifying invoices for reimbursement over two separate COVID-19 waves, Delta and Omicron. The traveling nurses were first paid by a third-party vendor contracting the nurses. After Spire’s testing and verification of the vendor’s documentation, the vendor was paid through a cost allocation between the state of Hawaii and from the participating hospitals who shared the cost of staffing. The task of ensuring that critical state and hospital funds were spent on accurate bills was complicated by the extremely high volume of data and dynamically shifting requirements.
Spire estimated that for the 25 weeks that Hawaii hospital staffing was augmented by traveling nurses, for both the Delta and Omicron surges of the COVID-19 pandemic, a single nurse could have close to 150 lines of associated invoice data. Several hundred traveling nurses were involved in the staffing effort.
Spire Partner Lucas Sayin explained, “We were there as the oversight and monitoring that the money was going to be spent in accordance with the rules that had been laid out. It was an unprecedented time and a lot was happening, but at the same time, it was imperative to everybody involved—especially the state personnel leading the project—that the funds were expended appropriately and there were the right supporting documents.”
SYSTEMS NEEDS INCLUDED:
- Swift management of a very high volume of data: tens of thousands of rows of time-entry-level detail
- Precise, trustworthy calculations
- Creation of exception cases based on a complex series of rules, for review
- Reporting on data from different angles
- Configurability to changing formulas and allocations
“We knew the mechanics had to be in place for us to get to that much volume,” Spire Director Lisa Victor said. “And the ramp up was very tight. We must have had, what, a week and a half?”
Spire needed a reliable, precise system capable of managing heavy volumes and automatically flagging discrepancies for the team to look into. And they needed a technology partner with the ability to quickly tailor that system to changing needs.
OUR SOLUTION
Terranox rapidly architected and implemented a user-friendly, highly configurable custom system on the Salesforce platform to support Spire’s emergency response project. Our team at Terranox continued to adapt validation rules, reporting, and other elements of the system as allocations and other needs changed. Some major features include:
- Custom data model: Enables the automated import of invoice data files, to be preserved and processed
- Rate tracking: Associates each hospital, clinician, and job class with their respective rates
- Data validation: Verifies and calculates each charge for accuracy based on numerous conditions and rules
- Flagging/case creation: Detects errors in such categories as hours, dates, and charges and creates a case for the Spire team to document the process
- Privacy: Anonymizes hospitals and clinicians for reporting to agencies like HiEMA and FEMA by holding each name in a separate, hideable field on the record
- Invoice approval process: Spire team researched cases, made notes, and promoted cases to approved status, which would lock records to preserve data integrity once team completed their validation
- Audit trail: Records a trail of data “touched” and changes made, including when, where, how, and who
- Reporting: Generates reports to help processing and overall project reporting such as spend by hospital, spend by month, number of clinicians by job class, open cases, and new invoices
Sayin noted, “Our system was there to recalculate every dollar that was being billed and verify that, down to the penny, the bill amount was correct, the allocation was correct, there was no duplication of billing. There were thresholds: rules that you couldn’t bill more than X hours, etc. and the system needed to go line by line. Multiple calculations on every line, tens of thousands of rows. The system was the backbone of that processing.”
IMPACT & RESULTS
HAWAIIAN HOSPITALS
WEEKS OF DELTA VARIANT SURGE NURSING
WEEKS OF OMICRON VARIANT SURGE NURSING
TOTAL ROWS PROCESSED BY SALESFORCE
RIGORIOUS VALIDAITION OF PROPER USE OF FUNDS
Paramount in Spire’s priorities for the monitoring was rigorous verification of the proper use of state and hospital funds. “At the end of the day, the system helped validate and ensure that we accomplished our goals,” Sayin said.
With the system able to re-check invoice calculations and flag possible discrepancies on the high volume of data, the team was also able to direct resources more efficiently towards fixing issues, and keeping a detailed record of calculations.
Victor appreciated the thorough way that the system calculated costs by validating and recreating complex labor rate and time calculations, even to the point of calculating overtime time. The system also verified the share of costs attributable to each hospital.
TRUST IN SYSTEM ACCURACY ACROSS PARTNERS
The system was so trustworthy and useful that one of the vendors eventually wanted to use the system to create their invoices! Spire’s team had to decline because they couldn’t allow the system to be the primary source of evaluation for their monitoring. However, they were happy that the vendors also respected its powerful capabilities and accuracy.
BONUS: TIMELY PROGRAM METRICS TO SUPPORT EFFECTIVE NURSE COVERAGE
Because the system collected a rich set of pandemic-related data that could be easily queried, it also yielded an unexpected non-invoice benefit: providing qualitative program performance metrics for the nurse staffing to the state of Hawaii to enable data-driven analysis.
The Terranox team was honored to partner with Spire on their complex and critical project of monitoring surge staffing disaster response costs during the COVID-19 pandemic. Our system collaboration ensured that the Spire team could apply their rigor and precision to an extremely heavy volume of invoice data, and that precious state and hospital resources were directed where they were needed most at an unprecedented time.
