A teaching hospital involves a LOT of people who are not employees:
students, instructors, consultants, vendor employees, contractors,
community physicians, and others. Fully 25% of the individuals who
have some direct relationship with the organization may be non-employees.
It is critical to accurately identify and track every one of these
people, because they often have access to patients or confidential
up the non-employees
As mentioned in "Who works here?",
we knew that we had many non-employees in the enterprise but knew
next to nothing about them. Human nature being what it is, simply
making a policy that non-employees must be "registered"
would accomplish nothing in the long term. Every point of contact
between any non-employee and the enterprise had to be redesigned
to require the "registration" of the non-employee in order
to obtain anything (e.g., security
badge, computer accounts or contractor payments) for the non-employee.
bit of synergy for this effort came from the accounts payable team,
who requested an automated process for payment of self-employed
contractors (individuals who receive a Form
1099 at year-end). Automating this process would save both finance
and purchasing a significant amount of time, helping to provide
an ROI for developing a non-employee management application.
users see a simple menu (shown at right). This allows contractors
to submit invoices and run a report to see their payment history.
It also allows supervisors and department managers to approve invoices,
add/edit non-employees in their cost centers, and run reports for
instructions for all users include a list of frequently asked questions
and step by step instructions for submitting an invoice. Managers
have detailed instructions for submitting and approving invoices,
adding a new non-employee, adding a contract or position, and creating
invoice reports. In addition to help documents, video instructions
are offered (see Lessons learned below).
Permissions for this application are granted in three ways:
specific cost centers
the entire application
are automatically granted permissions to edit positions and submit/approve
invoices for the specific non-employees
whom they supervise. Any supervisor in a cost center can add new
non-employees in that cost center.
permissions are granted at three levels:
rights (see above)
responsible manager for any cost center is automatically granted
"manager" permissions. This manager, in turn, may grant
superuser or manager permissions to anyone else, using the "Dept
permissions are designed to meet various specific needs:
organization special permission to identify tax IDs that
are shared among physicians in a group practice.
provides a mechanism for temporarily adding payroll employees
to the intranet database in advance of their being added to the
payroll system, which allows advance processing of computer system
accounts and security badges, etc.
coordinator special batch process to add new interns, residents,
house officers, fellows, and co-ops to payroll.
admin given to HR only for processing the batches of trainees
added by intern coordinators.
employees access to special process for adding new temporary
workers to the temp pool.
full rights for any function in the application
same as admin, and can emulate any user
The first step in tracking a non-employee is for someone who has
the "manager" role for the relevant cost center to add
the new non-employee to the worker database. This is actually a
somewhat complex process because of many regulatory compliance issues.
For example, the initial screen (shown below) when adding a new
non-employee displays two caveats about adding providers and contractors.
name of the new non-employee is matched with
the names of all existing workers (employees and non-employees),
using a our standard 5/3 comparison (matching first 5 letters of
last name and first 3 letters of first name). If any existing
worker is a possible match, the worker(s) with similar names are
displayed. If the new person is not already listed, the process
We chose to group all non-employees into five categories (shown
in the image below). The goal was to have as few categories as possible
for simplicity. These five categories aren't perfect, but they work
need minimal information about employees of
temp agencies, because the agency has the details about each
worker. We only need to know the agency, where the person will work,
their role, the internal contact person who is responsible for that
non-employee (supervisor), and the dates when the non-employee will
start and leave.
we chose to treat non-employees as much like payroll employees as
possible, for a couple reasons:
always better to keep processes as consistent as possible; and,
easier to group similar types of workers together if non-employees
are categorized with titles and account codes that are similar
to those used for regular employees.
have "positions" like employees.
Each non-employee "position" has a title, a start and
end date, and is assigned to a cost center and account code just
like employee positions.
non-employee may have multiple "positions" in different
departments, with different titles and end dates.
only difference between agency employees and vendor
employees is that the employer list has a different source
(see image below). The vendor list is pulled from the Meditech accounts
payable system. The Select Vendor button opens a vendor search window.
If the vendor cannot be found in the vendor dictionary, selecting
the "Cannot find vendor" checkbox exposes an additional
form where a vendor may be added (see second image below).
many cases, the vendor will not be listed in the accounts payable
vendor list, because many vendors are not paid directly by our organization.
For purposes of non-employee management, we consider a vendor to
be any company who pays the wages for someone who has a non-employee
role anywhere in our enterprise. We stretch this definition to include:
physicians who pay themselves a salary from their corporate entity;
at participating schools; and
ensure compliance with federal and state employment laws, the manager
adding a self-employed contractor must
assert that the contractor's role meets the requirements (shown
below). More detailed information is required about the non-employee,
including Social Security number for issuing a Form 1099 at year-end.
are various ways of paying a self-employed
contractor. If payment is by invoice (shown above), the contractor
typically will have an hourly rate and simply submit a number of
hours for an invoice. There is also an option for lump-sum invoices
(not shown). If the contractor will be paid with a monthly recurring
payment, the form changes a bit (shown below).
information collected for students
is shown below:
information collected for a volunteer
(shown below) has several differences from that collected for students
Having provided the necessary demographic and position information
about the non-employee, there are a number of steps required to
comply with federal and Joint Commission regulations:
that the name does not appear on federal exclusionary lists;
whether a criminal record check is required;
whether HIPAA training is required;
whether a business associate agreement is required; and,
whether a contract is required.
form used to determine these items is shown below (please note that
not all items shown would necessarily apply to the same person
the form was manipulated to show all options for illustration purposes).
of the links in the form above are self-explanatory, with one exception:
the link for "workforce"
which displays an explanation of the term (partially shown below):
the end of the process for adding a new non-employee, the manager
is prompted to submit a request for computer
system access (if needed) for the new worker.
Demographic and position data for a non-employee are edited using
the same forms (shown above). Adding a position follows much the
same process as creating the first position: click the Add Position
button (shown below) and supply all the relevant information about
the new position.
Unlike a payroll employee, it is very simple to "terminate"
a non-employee. There are two ways to do this:
the "terminate non-employee process (shown below); or
the expiration date for the employee's last position.
process accomplishes the same thing: sets the expiration date for
the non-employee "position," which is effectively the
same as termination.
searching by name (shown above), all matching names which are relevant
to the current user are displayed (shown below). Relevant names
all non-employees in any cost center for which the current user
holds the manager role in non-employee management; and,
non-employees for whom the current user is the direct supervisor.
"termination" date may be immediate or at any date in
the future. Multiple non-employees may be terminated simultaneously.
supervisor for a non-employee is notified once per month via e-mail
if any relevant non-employee's position will
expire in the next 60 days. The e-mail contains a link to
a page (shown below) where the supervisor may immediately terminate
the non-employee or move the end date a maximum of one year into
tool for supervisors and managers allows them to review the expiration
dates for all their non-employee positions, and update as
indicated (shown below).
Contractor invoices are submitted on-line, either by the contractor
or the contractor's supervisor:
the contractor has no unexpired contract with a positive balance,
the contractor cannot submit an invoice (each contractor position
must have a maximum amount, and invoices are cumulative decremented
from that maximum).
the contractor has more than one position with available funds,
the correct position for this invoice must be selected (shown
actual invoice process is very simple:
provide invoice period start and end dates (either by inputting
date or selecting from popup calendar) and the hours worked. The
invoice amount is calculated and the invoice is submitted.
screen displays full details of the current status of the
contract for the contractor (shown below). In addition, real-time
details of the invoice and payment history for this contract are
available in a spreadsheet.
a contractor submits an invoice, an e-mail request for approval
is sent to the contractor's supervisor, unless the contractor specifically
directs the e-mail to an alternate approver (in the supervisor's
approved contractor invoices are scripted into Meditech Accounts
Payable every Thursday night with an automated process, and queued
up for automatic check printing and mailing the next day. Finance
staff never touch contractor invoices.
All of the invoice data for "1099" self-employed contractors
may be viewed in a report, either for all invoices or for some subset
of those invoices (shown below). The cost centers available for
reporting are limited to those in which the current user has contractors.
to self-employed contractors are fully automated, so finance staff
never touch the process except in the case of a problem.
and purchasing departments have one less headache every week;
the promptness of payments is entirely in the hands of the contractor's
documented process to ensure full compliance with all regulations
for non-employees in a health care setting.
information about every worker in the enterprise.
initially had no idea of the full extent of non-employees in the
enterprise. Based only on system accounts, we calculated non-employees
as comprising about 10% of total workers. After integrating all
other contact points for non-employees such as security badges,
contractor payments, provider credentialing, etc., the real number
of non-employees had more than doubled to about 25% of total workers.
were fewer self-employed contractor payments than expected. The
number of problems associated with the old manual process made
the volume of these invoices seem quite high to finance and purchasing
staff. When the process was automated and we had real data, we
realized that the actual volume of invoices was fairly small.
tutorials are easy and inexpensive to produce with a good USB
microphone and screen capture software such as Camtasia
we were starting over, leveraging what we have learned during
the past few years, we might select slightly different categories
Posted 25 June 2008