A Day in the Life of an Offshore Medical Coder



By Dr. Liza Alcances, MD

The life of medical coders is completely different from the life of clinicians. Weekends are usually free, the shifts are fixed, and there are not a lot of different activities that fill their days. Coders may miss the exciting work of hospital duty, unique patient complaints, and endless rounds, but there is something to be said about an organized and sedate work life.

An Early Start: Most medical coders work days. A few companies require their coders to work nights, parallel to their US counterparts. Day shifts start as early as 7 a.m. This means that coders have to wake up early, allow for adequate travel time, and get to their offices on time. The dress code is usually business casual, so dressing for work depends on the coder’s fashion sense.

Life on the Production Floor: Each coder works on a computer, either a desktop or a laptop. Most will have the codes already in the software, removing the need for using hard copies of the manuals. Depending on the project, coders can be assigned cases directly from the system they’re using or assigned charts by their supervisor or team leaders. Quotas are set depending on the type of coding they do.

Generally, outpatient coders work on more patient charts, and inpatient coders work on a lesser number of charts. They are not allowed to pick the charts to work on, and so they gain experience working on a wide variety of cases. They must also finish the work assigned to them or meet the required quota, so the coders must stay focused and manage their time. Since they work on protected health information (PHI) and must meet US privacy standards, mobile phones are not allowed on the production floor.

Breaks and Lunch: Two short breaks are given, one in the morning and one in the afternoon. Coders may use the time to take snacks, smoke, have a power nap, or go to the break rooms or to the pantry. Many companies provide indoor entertainment devices, like game consoles, table tennis, foosball, and the like. Some have quiet rooms, meant for sleeping.

Lunch breaks are longer. Most would have their own canteen, and many companies are situated in areas near commercial establishments. Coders won’t go hungry, and usually have enough time to get some coffee or dessert after lunch.

Home Sweet Home: Since coders start their day early, they also end the workday early. Most are usually off by 4 p.m., leaving them ample time to spend with their family or indulge in other activities. Of course since they have to go back to work early the next day, they also go to sleep early.

Other Activities: Audits and team meetings are common occurrences. These are done with their superiors and sometimes with their US counterparts. The quality of their work must be top-notch, and companies require at least about 95 percent accuracy in their coding.

Companies usually hold town hall meetings quarterly. They also schedule team building sessions, family day, sports fests, and other activities that allow coders to release stress. Some companies sponsor seminars and appoint management trainees so that coders will have additional skills that they can use to better themselves and to help the company.

In Summary: The life of a medical coder isn’t something the entire healthcare community is aware of. Medical coding is a specialized occupation, requiring specific knowledge and high analytical skills. There are many challenges but also many opportunities. Some might think that the coder has a boring desk job, but as one of the occupations highly desired in the healthcare BPO, it can also get exciting.

Dr. Liza Alcances MD, RN, CPC, CPC-I, CIC, is the assistant manager, training—healthcare at TeleDevelopment Services.

Medical Call Centers Are Here to Stay


TeamHealth Medical Call Center


Patient Care is Non-Negotiable, and Contacts Centers Can Play a Key Role

By Gina Tabone, MSN, RNC-TNP

Changes to the American political scene are upon us and most certainly will have an impact on the provision of healthcare. Regardless of party affiliation, there are several healthcare reform objectives that need to remain in the forefront by future government leaders. Examples include enhancing quality of care, interdisciplinary coordination and collaboration, better utilization of available resources, gaining efficiencies, and reducing the per capita cost of healthcare.

Focusing on these concepts will contribute to the goal of improved outcomes for both individuals and overall patient populations we serve. The benefits achieved must continue regardless of who is leading the country. Nurse triage as a component of an integrated medical call center is a pivotal intervention and no longer optional.

The world of medical call centers (MCCs) has finally gained the recognition and credibility in the healthcare marketplace that many of us have been trying to expound for two decades. Centralized medical call centers are rapidly emerging as the backbone of health systems because they are integral in achieving better patient outcomes.

The new administration has wisely sought healthcare advice from the most innovative physician leaders in America. Toby Cosgrove of Cleveland Clinic and John Noteworthy of the Mayo Clinic were invited to meet with President Trump to share their thoughts on the Affordable Care Act (ACA) and suggest ideas to plot the best plans for the future.

Concerns were expressed that the current model needs to focus more on patient health and wellness and less on the avalanche of paperwork. This has negatively affected the day-to-day responsibilities of clinicians who are held accountable for reporting on hundreds of quality indicators. These points of contention are agreed upon by most caregivers. Cleveland Clinic and Mayo Clinic have improved patient access, outcomes, and satisfaction by integrating state of the art integrated call centers with clinical access across their multi-state enterprises.

Hopefully, their example will resonate and continue to motivate other organizations to rapidly integrate outsourced or optimized in-house MCCs as a proven solution for reaching the three goals of the triple aim: improving the patient experience of care, improving population health, and reducing the per capita cost of healthcare.

Improving patient experience of care requires open access channels to care. Access means that patients are able to receive the most appropriate level of care needed, in a time best determined by specially trained nurses guided by evidence-based tools. The patient learns to expect reliable advice, taking into account their current health state and is consistently available day or night. Gaps in care are eliminated and delays are avoided, leading to favorable patient outcomes and higher reimbursements in a fee-for-value model. When patients’ well-being is enhanced, everyone gains—most especially the patients. MCCs can stake a claim for making that happen.

The year 2017 will have many organizations taking a close look at their operations and making tough choices about what functions are best accomplished internally and which ones can be entrusted to an outside partner. IT is a department that is being outsourced by some of the largest hospital systems in the country. Patient financial services is another service with options for outsourcing where the benefits to an organization outweigh the costs incurred. Incentives for meeting targets are common. Last, there is a surge by strategic decision makers to explore nurse triage services being performed by an outside call center partner.

The common denominator in all three areas where outsourcing is increasing is the fact that there is a reliance on human capital and all of the contingency costs that goes along with being an employer. High labor costs often consume up to 70 percent of many call centers’ operating budgets. Outside partners can assume the responsibilities with greater efficiency and better outcomes for a lower cost. There is also the possibility that many vendors are willing to assume some of the risks associated with the successful attainment of goals.

The choice to retain, outsource, or develop a hybrid of both is a multifaceted decision that is reserved for leaders at a higher level than the call center. Organizations have to thoroughly evaluate the options to determine which one best aligns with their mission, vision for the future, and strategic plans.

MCCs are branching out and taking on a variety of responsibilities that are well suited to be conducted remotely and reliant of state of the art technology and a dedicated work force. Once the technological infrastructure is created, the MCC can be enhanced to take on additional functions. Appointment scheduling is the most common task of many MCCs and often happens in tandem with the strategy of centralization. Electronic medical records (EMR) products have customized templates embedded with providers’ schedules that are used for office visits, imaging, or procedural appointments. Outbound calling campaigns are often conducted in conjunction with scheduling for appointment reminders.

Centralizing all medication refill requests is emerging as a successful addition to many MCCs. Call center technology such as CRM (customer relationship management) allows for requests to be tracked, acted upon, and measured to ensure established targets are met in a timely manner. Without measurement there is no possibility for improvement. Patients can expect a standard process for medication needs and a defined time for responses or resolution. Medication management and compliance is critical for optimal outcomes, so implementing a process that fosters it is a good idea. Patients stratified as high risk garner the most advantages, which contribute to maximum reimbursements for medical treatments.

MCCs have taken on the significant task of not only caring for the acute needs of primary care patients, but the chronic needs of vulnerable high risk patients as well. Successful coordinating and transitioning of care is central to every health system’s strategy for sustainability today and growth tomorrow. Nurses are the clinicians assigned to figure out how to morph from case management to transitional care coordinators.

Regular communication between the patient and the caregiver is vital and is often by telephone, text, or email. Training the newly created care/transitional nurses in the fundamentals of remote patient care is imperative and is based on the standards of care for telephone triage nurses. The practice of triaging the acute symptoms has branched out and will serve as the starting point for nurses involved in coordinating care.

It is up to those of us established in the medical call center industry to continue to proclaim the unlimited value of a MCC to the healthcare industry. In many healthcare organizations more than 10 percent of employees spend the majority of their day doing their job on the telephone. The benefits of centralizing and consolidating the work they do are undeniable.

C-suite leaders must accept the fact that medical call centers are no longer considered an expense but an investment with impactful ROI (return on investment).

Initially there were call centers, then access centers, followed by contact centers, and in 2017 we are engagement centers. The task at hand is to capture the limited attention of decision makers and educate them on the role MCCs play in a fee-for-value system and the distinct results that are possible. The future may be uncertain, but there remains a need for products, services, and expertise that bring the call center to the forefront of patient care.

TeamHealth Medical Call CenterGina Tabone, MSN, RNC-TNP, is the vice president of strategic clinical solutions at TeamHealth medical call center. Prior to joining TeamHealth, she served as the administrator of Cleveland Clinic’s Nurse on Call 24/7 nurse triage program.

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Should You Use an On-Site System or Internet-Delivered Solution?

By Peter L DeHaan, PhD

Peter DeHaan, Publisher and Editor of AnswerStatWe understand a computer room full of equipment. It’s tangible. We can see it, touch it, and kick it (but don’t do that). It’s how we’ve done things for decades, since the beginning of computers and telephony switches.

Contrast this to internet-delivered solutions, which go by a myriad of names, such as SaaS (software as a service), cloud-based solutions, hosted services, and a few more labels that have come and gone. The oldest I can remember is provided by ASPs (application service providers), but I haven’t heard that in years. For the sake of discussion, let’s call all variations of this offsite provisioning concept as internet-delivered solutions.

An on-site system allows for greater control. But with control comes responsibility: maintenance, database backups, software updates, spare parts inventory, disaster recovery, backup power, and technical staff. Financially, an on-site system (hardware and software) represents a tangible asset, which is a capitalized purchase and a depreciated line item on your balance sheet.

While there are usually some ongoing costs for an on-site system, these are minor in comparison to the onetime purchase price. An on-site system doesn’t require internet access to operate, but with the increased need to access information and remote systems through the internet, this advantage is rapidly diminishing.

Although vendor stability is a concern for both options, with on-site systems, there is at least the potential for the call center to continue operating if the vendor fails; this is not so with the alternative.

Internet delivered solutions represent a newer way of provisioning a call center. With it the responsibility to install, maintain, and update equipment is removed, but along with it goes the associated control. Financially, an internet-delivered solution is a service, which shows up on the income statement as an expense. It is not a capital expenditure and there is nothing to depreciate. The only costs are a predictable, ongoing monthly expense, which is generally proportionate to usage.

Internet delivered solutions also offer the flexibility to quickly ramp up and ramp down capacity as needed. Operations may be deployed anywhere in the world where there is reliable internet access, easily accommodating remote agents.

However, there are two chief concerns with cloud-based solutions. One is the requirement of a stable internet connection for the call center or remote agents. Without internet access, the call center is effectively down. The other concern is with the vendor. Do they provide always-on, fully redundant, carrier-grade stability, with 24/7 tech support? Are they financially viable to offer cloud-based service for the long-term? If they stumble or fail, the call center immediately suffers the same fate.

For much of the call center industry’s history, on-site systems was the only option. Some call centers continue to pursue this approach, not because they’ve examined the alternative, but because that’s how it’s always been; they see no point in changing. This is shortsighted. Equally unwise are call centers that race headlong into internet-delivered solutions, wanting merely to follow the current trend. They dismiss the alternative without consideration simply because it’s the old way of doing things. An unexamined strategy is really no strategy at all.

Neither approach is universally right. Both have advantages; both have disadvantages. Take a careful look at the pros and cons of each approach. Then make a strategic decision on which one is the best for you and your call center. Your organization’s future may be at stake.

Peter L. DeHaan, PhD, is the publisher and editor-in-chief of AnswerStat and a passionate wordsmith. Connect with him on his blogs, social media, and newsletter, all accessible at www.authorpeterdehaan.com.

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Vendor Spotlight: LVM Systems


LVM Systems


LVM Systems, one of the industry’s largest providers of hospital-based healthcare call center solutions, celebrated another successful year in 2016. This marked its twenty-ninth consecutive year of annual profitability since its founding in 1988.

Driven by comprehensive software, customized training, and exceptional support services, LVM has established a reputation for quality. At LVM, past accomplishments drive ongoing improvements and the development of additional functionality to increase the success of its clients.

LVM has again taken the lead by bringing to market a comprehensive, individually customizable, multi-morbidity care management program. Appropriately named, the Co-Morbidity Care Management Program (CCMP) assists hospitals in cutting costs through better care coordination and advanced health coaching solutions. Included in the program are annually updated standards of care, diabetes distress screening, Zung depression survey, adherence report card, and patient and physician letters.

LVM’s extensive health coaching solutions combine detailed clinical content along with the technological capabilities needed to structure and run a multi-level, multi-morbidity program. The health coaching solutions enable clients to track outcomes, cost savings, and revenue associated with the patient over time, linking these values back to the initial and on-going interactions.

Since being officially recognized as a disease state, eradicating, or at least reducing, obesity has gained critical importance. And with many obese individuals also suffering from additional chronic health conditions, the ability to address multiple morbidities within a single program is more important than ever in order to effectively manage resources and save costs.

According to the Agency for Healthcare Research and Quality (AHRQ—2013), 71 cents of every dollar of US healthcare spending goes to treating people with multiple chronic conditions. AHRQ further found that “More than a quarter of all Americans—and two out of three older Americans—are estimated to have at least two chronic physical or behavioral health problems.”

Further supporting these findings was a study by the Partnership to Fight Chronic Disease (2015), which found that 191 million people in America had at least one chronic disease and 75 million had two or more chronic diseases.

Despite this growing number of high-risk, high-cost patients in need of coordinated care, the Centers for Medicare and Medicaid Services recently passed a final pass-through pay rule estimated to cost hospitals more than $3 billion a year in supplemental funding to safety net providers. Consequently, today well-coordinated, cost-effective care is more critical than ever.

It’s not just about cost savings. The Partnership to Fight Chronic Disease in a 2016 study, noted that, “In America 1,100,000 lives could be saved annually through better prevention and treatment of chronic disease.” This should be care management’s top priority.

To improve communication with a hospital’s associated organizations enabling them to easily integrate with the core Centaurus call center system, LVM has developed iCentaurus, a remote reporting function. iCentaurus enables the call center to provide restricted report printing capabilities to any related organization from remote locations via the web. The call center determines the reports and specific parameters the associated organization can generate. Now, the partnering care facility can access patient care management reports whenever desired.

LVM constantly adds increased functionality, greater usability, and enhanced call handling efficiency to its base system. Client input assists LVM’s development team to assure the products and services LVM delivers address the industry’s greatest needs.

Recent enhancements include:

  • Send real-time photos videos via the Internet to the call center nurse of the condition prompting the triage call (such as a rash, burn, laceration, etc.) This allows the triage nurse to use an otherwise missing critical triage tool: visual assessment.
  • Saving the photos and videos to the call transaction file makes them available for inclusion in the patient’s EHR or paper chart
  • Interactive patient history, accessible at any point during the call
  • Discount fee structures for various programs, memberships, and classes
  • Ability to send an email of any report as a secure, web-based document to any recipient
  • Override options to hide system controls or unlock fields
  • Functionality to store documents to a database attached to the individual’s record
  • Color-coded records, for example: high acuity triage calls.
  • Global gmail.com addresses to enable patients to directly reach hospital departments.
  • Automated system notifications that monitor and display specific data, such as status bar, balloon notifications, or pop-up messages.
  • Check data routine that suggests maintenance reports that need to be run
  • The ability to host an installed solution or run it as SaaS hosted by LVM in one of its two, high-security data centers.

In addition to its advanced pediatric and adult nurse triage functionality, LVM’s healthcare call center solutions include CRM database segmentation functions along with a full array of physician referral, class, and membership management systems, patient transfer, and behavioral health input functions, among others.

LVM SystemsFor more information or a demonstration of LVM’s call center solutions contact Carol Zeek, regional VP, sales, at 480-633-8200 x279 or Leann Delaney, regional VP, sales at 480-633-8200 x286.

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10 Critical Steps of Taking a Triage Call


TriageLogic


By Marci Lawing, RN BSN

The goal of every triage call is to make a patient feel comfortable and heard, while at the same time collect the critical information from the patient and get them to the appropriate level of care based on their symptoms.

Step 1: Introduce Yourself. Use your first name, title, and the practice or physician you represent. It’s imperative for you to clearly identify yourself and state your credentials as a nurse employee of the practice for which you work. When you introduce yourself, you create a relationship.

Step 2: Collect Demographic Information. Before you are ready to hear your patient’s concerns, you will need to know some of this basic information. Age, gender, and other data will affect your triage protocols, so be sure to collect all the necessary demographic information. This information is needed so it can be put in the appropriate chart and followed up.

Step 3: Gather Medical History. Get a brief medical history so you do not miss any important surgeries, medications, or relevant medical information from the recent months or years. You’ll want to know your patient’s medical history before they detail the current issue.

Step 4: Let the Patient Talk. Now that you’ve armed yourself with all the necessary information you need to proceed, let the patient speak freely about their current concerns. Be an active listener. That means you don’t just listen, but you participate in the conversation by asking any probing questions needed to ascertain a full description of their complaint.

Step 5: Document the Assessment. Once you’ve listened carefully to the patient, document your assessment carefully with the necessary details.

Step 6: Choose the Right Protocol. With the right triage protocol, this step can be fast and efficient. Be sure to document the answer to each question and make any additional notes needed.

Step 7: Get the Patient to the Right Level of Care. Now that you’ve followed the protocols and completed the assessment, you’re ready to recommend the level of care your patient needs. Be sure to speak clearly and at a pace the patient can follow while you detail every step they need to take.

Step 8: Give Relevant Care Advice. Provide solutions based on their symptoms in order to help them find the best path to care.

Step 9: Make Sure Your Patient Knows When to Call Back. Confirm the patient fully understands your triage advice and knows when and who to follow up with.

Step 10: Offer Reassurance. Make sure your patient is able and willing to follow the plan you discussed. It is important, especially with serious symptoms, that the patient follows your triage advice. If told to go to the ER, verify with the patient that they have access to safe transportation.

You can’t underestimate the power of empathy. Over 80 percent of patients who call in to their physician’s office may not need urgent care, but they all urgently need empathy, someone to listen, and someone to care. That’s the role of the triage nurse. In addition to being a good clinician, a critical thinker, and making sure everyone stays safe, you are also there to provide empathy and care advice to help patients.

These 10 Critical Steps of a Triage Call will help you stay on track and ensure patients get the quality care they deserve.

TriageLogicMarci Lawing, RN BSN, is the clinical nurse manager at TriageLogic LLC. TriageLogic’s online learning center is available free of charge to telephone triage nurses and teams as an educational resource and practical training guide. Along with course videos, coursework includes class notes, related articles, and learning materials. You will receive a TriageLogic Telephone Nurse Triage Certification for each completed course. Managers can also set-up teams and check their individual nurses’ progress in the course.

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Selecting a Nurse Triage Consultant

TeamHealth Medical Call Center


By Gina Tabone, MSN

Healthcare reform has placed pressure on organizations to provide access to clinical care in a manner that improves patient outcomes while appropriately utilizing resources. Nurse triage, a proven mechanism for achieving these goals, can be made even better with the help of a nurse triage consultant.

If you are considering working with a medical call center consultant, your organization is already a step ahead because you recognize the value of industry expertise. As a responsible leader, you will likely select a consultant who can meet your needs, direct your efforts, and ensure success for your call center, organization, and ultimately you. Remember, your reputation is on the line. Your best interests are served by selecting a consulting group that is established, knowledgeable, and intuitive in respect to remote clinical care. When you’re looking for advice about a specific subject, there is an inherent intelligence that only comes from someone with personal and professional experience in that area. Medical call center expertise is not only a reasonable requirement, but also a vital factor to consider when hiring a consultant to develop a new medical call center or enhance your existing one.

Centralized call centers are rapidly emerging as the backbone of health related systems. Nurse triage offers patients direct access to 24/7 clinical care. The patient populations served by nurse triage programs include primary care, behavioral medicine, diabetics, recently discharged, and chronically ill. The scope of service is vast and so is the network of caregivers. The call center and services offered, both clinical and non-clinical, do not exist in a vacuum. To be successful there needs to be an endorsement from the C-suite of the medical call center and its value in achieving strategic goals. Executive leadership needs to encourage staff in IT, telephony, nursing, informatics, marketing, and compliance to emphasize that their expertise is essential to the realization and effectiveness of improved access and patient satisfaction.

A medical call center nurse triage consultant provides an objective lens and is able to envision not only what success will look like, but also what needs to be done to attain it. There is no better combination of talents than a consultant who has both medical call center experience and the experience of being a clinician, namely a nurse. Nurses make a commitment to serve the need of the number one benefactor in healthcare: the patient.

Every piece of technology must be selected and implemented with the expectation of a streamlined communication pathway that results in successfully meeting the patient’s needs. Patients primarily prefer contacting providers by phone, texts, or emails. There is also an expectation that whenever illness strikes, a skilled clinician is waiting to help them. That is a reasonable expectation.

Ensuring that patient preferences are understood and provided for is a top priority for healthcare executives. Satisfied patients are often engaged patients, which often lead to improved health outcomes. Improved outcomes result in a better state of health for individuals and the population as a whole. Patients tend to rate their care more favorably and reimbursements are ultimately higher, resulting in the healthcare organization remaining sustainable.

Spending time on-site with a medical call center nurse triage client requires a team effort and ultimately one common goal: optimal patient care. A consultant is provided with a panoramic view of many facets of the operation with a focus on access, clinical care, potential for success and the patient experience. Each health system is distinct, but there is no denying that there are underlying commonalities. Consider these three recommendations when selecting a medical call center consultant:

  1. Only collaborate with subject matter experts who respect that patients come first.
  2. Understand that executive endorsement is imperative for success.
  3. The supreme benchmark that we all must achieve can be found in the answer to a single question: Is what I am doing improving the patient experience?

TeamHealth Medical Call CenterGina Tabone MSN is a medical call center nurse triage consultant who teams with various healthcare organizations to develop and optimize medical call center services that exceed patient, provider, and employee expectations. Contact her at gina_tabone@teamhealth.com.

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Prepare for Change in 2017

By Peter L DeHaan, PhD

Peter DeHaan, Publisher and Editor of AnswerStatI don’t want to write about the US presidential elections, but I need to. Here’s why: Because of the election, expect changes in healthcare for 2017 and beyond.

There are two scenarios:

Scenario one will produce a backpedaling of existing laws and regulations as it relates to healthcare, which will spill over to the healthcare contact centers that support the industry. This could range from a complete repeal of the Affordable Healthcare Act, to congressional tweaks that make adjustments, to executive orders that alter the status quo. This all adds up to change. The only variables are the degree and speed of the modifications required. Healthcare contact centers need to prepare for this possibility and be ready to adapt as these transformations occur.

Scenario two (which I think is unlikely) is that no laws are repealed, no new laws are passed, and no executive orders take place that effect healthcare. In this option everything continues as is. However, the current trajectory of this is still change as the existing laws and regulations continue to play out. (An object in motion will continue to stay in motion.) It’s just that in this outcome we have a decent idea of what the adjustments will entail. Healthcare contact centers need to prepare for this possibility and be ready to adapt as these transformations occur.

So scenario one, the likely outcome, will require us to make quick and informed adjustments to how we work in the healthcare contact center industry. Scenario two, the less likely outcome, will also require altering our contact center practices; it’s just that the volatility of change will be less.

In either case, expect the people who contact us to be confused or angry, possibly both. We will need to be ready with answers for them, or at least have the ability to sooth their angst in a time of unknown. Now is the time to prepare for both scenarios.

This coming year, 2017, should be an interesting one for the healthcare contact center industry. Change, it seems, is the new normal.

Peter L. DeHaan, PhD, is the publisher and editor-in-chief of AnswerStat and a passionate wordsmith. Connect with him on his blogs, social media, and newsletter, all accessible at www.authorpeterdehaan.com.

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Spotlight on the TeamHealth Medical Call Center

TeamHealth Medical Call Center


In today’s world, the rapidly evolving healthcare industry has placed its focus on providing access to high quality, patient-centric care, with an unprecedented emphasis on cost containment and continuum of care. Companies, communities, and medical professionals are challenged with the overwhelming task of balancing quality care with new cost initiatives.

The need for call center solutions has never been greater.

The TeamHealth Medical Call Center (THMCC) is a premier provider of safe, professional 24-hour medical call center solutions. THMCC provides its client partners with a wide range of cost-effective healthcare services, including:

RN Telephone Triage

  • Services are branded to each practice with the ability to gather pertinent data and customize a documentation system that allows practices to drive specific directives for both pediatric and adult populations.
  • Another key feature is the ability to integrate patient information into EMRs to meet patient centered medical home and ACO (accountable care organization) requirements.
  • THMCC registered nurses use Schmitt/Thompson Clinical Content Triage Guidelines for both pediatric and adult populations.
  • Services also include post-triage appointment scheduling and a wide range of post-discharge transitional care initiatives.

Pediatric Triage: Providing high quality pediatric nurse triage requires a special skill set beyond standard care provisions. TEAMPeds addresses this need by directing pediatric patients to an RN staff specially trained in pediatric telephone triage. The TeamPeds program includes:

  • Specialized RN pediatric training and competency testing
  • Ongoing required monthly pediatric in-service requirements for RNs
  • Ability to email care advice
  • Error-free provider on call system
  • TEAMPeds RN supervisor
  • Pediatric medical director
  • Pediatric QI (quality improvement) program

Nurse Advice Lines: Nurse advice lines and community lines can direct your patient population to the most appropriate level of care while promoting your services. Nurse advice lines can offer branded healthcare and program information that promotes a healthy community and creates an awareness of an organization’s centers of excellence or specialty programs. The reporting and data collection features also provide valuable information about the healthcare needs of your population.

Additional benefits of a THMCC community or nurse advice line include:

  • Readmission prevention and appropriate care utilization
  • Patient acquisition
  • Revenue reconciliation reporting
  • Branded EXITcare or customized health information emailed to callers
  • Web-based branded online self-triage program
  • Appointment scheduling
  • Physician referrals

A dedicated ED (emergency department) nurse advice line or triage service helps hospitals respond to calls from patients with inquiries concerning their need for emergency care. THMCC ED nurse advice and triage line services:

  • Provide access for callers questioning their need for an ED visit
  • Promote appropriate ED utilization
  • Prevents unnecessary readmissions
  • Provides opportunity to refer other services within system
  • Eliminates the risk of ED handling clinical questions
  • Allows clinical ED staff to stay focused on in-house patient care
  • Refer all real-time call records on callers to the ED

Transitional Care: In many cases, the provision of care is not complete when the patient visit or hospital stay ends. THMCC works with healthcare providers to develop relationships with patients that support care plan compliance long after they return home.

Transitional care management means preparing patients for their first visit, and then accompanying them through post-visit follow-up and post-hospital care. THMCC’s post-discharge callback services are fully customizable to the needs of specific patient populations, which include:

  • Outbound daily call campaigns for both clinical and non-clinical populations
  • Specialized scripting utilized for high-risk patients
  • Inpatient or ED patient population
  • EMR (electronic medical record) access available
  • All calls performed 24-48 hours post-discharge
  • Optional callback line for patients experiencing symptoms

The value of these transitional care efforts can be measured in ROI (return on investment) in the following areas:

  • Readmission prevention
  • Improvement in HCAHPS (hospital consumer assessment of healthcare providers and systems) scores
  • Daily escalations or interventions
  • Monthly reporting:
    • Core indicator analysis: medications, discharge instructions, follow-up appointments
    • Positive and negative trending items
    • Recognition
    • Patient satisfaction

Avoidable readmissions are a major financial problem for the nation’s healthcare system. For patients, hospitalizations alone are stressful, even more so when they result in subsequent readmissions. THMCC’s outbound call campaign services are specifically designed for high-risk patients, and include:

  • Initial post-discharge call within 24-48 hours: additional four calls at weekly intervals
  • Assessment of patient’s understanding and compliance to medication, discharge instructions, follow-up appointments, and current symptoms
  • Optional callback line for patients experiencing symptoms

Physician Answering Services: With ever-increasing workloads and patient care responsibilities, physician burnout is a very real concern for hospitals, healthcare organizations, and private practices. The stress of a work/life imbalance can lower physician job satisfaction and hinder physician recruitment.

Delegating the workload to a specialized team of medical professionals can significantly reduce physician burnout. THMCC realizes that in order to take care of patients, they must also take care of their providers. Collaborating with the TeamHealth Medical Call Center and their team of telephone triage RNs can provide the proper work/life balance for physicians, which in turn, will mean the best possible care for patients.

THMCC offers physician and practice answering services to provide seamless access for clinical and non-clinical calls. Patient coordinators deliver a high level of customer service and are supervised by a RN. Features include:

  • After hours, daytime support or 24/7 options
  • Emergency backup for unscheduled closures
  • High volume overflow
  • Translation services
  • Branded services
  • Customized scripting
  • Customized directives and protocols
  • Error-free paging system
  • Secure electronic messaging through TeamDoc Mobile, a web-based application
  • All calls recorded
  • Robust reporting

The TeamHealth Medical Call Center enters into true partnerships with clients to provide the individual service offering, with measurable results, and to develop a long-term relationship. Technology allows THMCC to meet the needs of the changing healthcare industry while they continue to make the patient experience their primary focus. Creating successful, long-term client relationships is their goal

TeamHealth Medical Call CenterFounded by a team of physicians more than twenty years ago, the THMCC has the advantage of having a provider perspective in each aspect of the services they provide. THMCC understands the special bond between physician and patient. Like their clients, they value each caller as an individual who deserves a clinically correct and caring response from their staff to ensure a positive experience, which adds value to their relationship with their clients. More than twenty years of experience and ten million triage calls show that the TeamHealth Medical Call Center’s medical call center solutions can serve a vital role in patient care coordination efforts.

To learn more call 888-203-1118 or visit www.thmedicalcallcenter.com.

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How Well Do You Understand HIPAA?

By Janet Livingston

Most people in the call center industry have a general idea of what HIPAA is, but they lack an understanding of how to apply it to their healthcare call center operation. Ignorance, however, is not a sound defense for HIPAA violations.

HIPAA, the Health Insurance Portability and Accountability Act, has critical ramifications for medical call centers. Passed by the US congress in 1996, the law is now over a decade old. As far as call centers are concerned, HIPAA, among other things, requires call centers to keep personal health information private, both when stored and when moved. There are fines, as well as public embarrassment, for database breaches and employee disclosures of private healthcare information.

Though this is not comprehensive legal advice, the following recommendations do address some basic, commonsense steps to move toward HIPAA compliance by covering key risk areas that are often overlooked. Follow these quick tips now to reduce penalties and pain later.

Fortify the Building: Safeguard your call center facility with building locks, surveillance cameras, door alarms, and a secured lobby. If employees use a separate entrance, don’t overlook it. Require them to be buzzed in or provide a keypad entry lock, with individual codes for each employee. Change lock codes periodically and retire individual codes as soon as an employee no longer works at your call center.

Implement Internal Security: Not only does the call center facility need security and secured access, but internal security is also a critical issue under HIPAA. Specifically, certain areas must be restricted to unauthorized personnel and all non-personnel.

For example, the operations room should be off limits to visitors and even some ancillary staff. Only scheduled agents and relevant management should be allowed entrance into the operations room. In the event that a client or prospect wants a facility tour, allow them only to view the operation from a distance, perhaps through a window in a soundproof room overlooking the operations room. Similarly the technology hubs, such as the computer room and telecommunications center, should be under lockdown at all times and accessible only to authorized technical personnel.

Establish Technology Safeguards: As mentioned, the primary space that should have limited access is the equipment area, which houses your call center’s computers, servers, and network technology, as well as the telecommunications switches and interfaces. But this restriction doesn’t just apply to people in your facility. There should be no physical external accessible points to your telephone or internet service. Furthermore, remote access to equipment and data should be thoroughly password protected for authorized personnel and vendor use only.

Escort Visitors: Any clients, prospective clients, vendors, and nonemployees need an escort through the facility. Accompany visitors at all times. If they’re interested in viewing operations, they should do so by observing it from inside a soundproof, glassed viewing area. They must be supervised throughout their tour. Make sure they do not photograph or record anything during their visit. A best-practice policy is for them to check all electronic equipment at the front desk or leave it in their car.

Invest in Paper Shredders: While many dream of a truly paperless office, the reality is that despite well-meaning intentions, paper containing sensitive information will be produced. This might be through negligence, oversight, or expediency. Regardless, these paper documents must be destroyed as soon as they are no longer needed. The obvious solution is to shred such documents in a micro-cut shredder.

Deploy Shred Bins: All sensitive or potentially sensitive documents requires shredding. However, shredders are loud devices that don’t align well with the call center’s need to minimize noise. Though immediate shredding is ideal, this is sometimes impractical, in which case locked shred bins should be conveniently placed around the call center. Authorized personnel routinely shred the contents of the locked shred bin according to documented security protocols.

Enforce a Password Policy: Passwords are unpopular but necessary, yet password misuse and abuse is the weakest link in most call centers. Good passwords help keep personal health information private. A thorough password policy must be developed, taught, followed, and enforced. Putting a great plan into a document means nothing if staff isn’t instructed in what it says, and staff instruction means nothing if the enforcement is lax or altogether lacking. When given an option, most people will take whatever password shortcuts they can, not recognizing the pitfalls and risks they subject their companies to.

At minimum the password policy should mandate regular software-controlled password changes, not reusing previous passwords, and never sharing passwords with anyone regardless of the circumstances. Password policy violations remain a vulnerable area at many call centers. Education and enforcement are essential, with the consistent actions and attitudes of management establishing the perspectives of all other employees.

A lack of compliance with HIPAA regulations can result in monetary damages in the form of fines for security breaches and reputation damages in the form of negative publicity over security violations. While HIPAA only covers the healthcare industry, these security tips are emerging as call center best practices across all industries. Therefore every call center should move toward implementation.

Janet Livingston is the president of Call Center Sales Pro, a premier sales and marketing service provider and consultancy that provides custom training solutions for all levels of call center staff, both in the healthcare industry and across all verticals. Contact Janet at contactus@callcenter-salespro.com or 800-901-7706 to learn more about arranging specific training for your organization.

Moving From “Sick Care” to “Health Care”


LVM Systems


By Mark Dwyer

In 2012 our government enacted legislature that mandated U.S. hospitals reduce re-admissions by emergency departments (ED) admits for the first thirty days post discharge. To force this change in behavior, rather than waiting for hospitals to choose to proactively address the overall health of their communities, the government began penalizing hospitals who had higher than average readmission rates through a deduction in their reimbursed Medicare payments.

This was a radical change in American healthcare as it put the onus of keeping patients well on the hospitals and providers who treated them. No longer could hospitals simply wait for individuals to require hospital care, rather it became their responsibility to proactively manage ED admitted patients for at least the first thirty days post discharge. If they were unsuccessful in providing the patient with the tools and help needed to keep them from re-admitting, they bore the weight of a financial penalty.

Initially, the penalty amounted to 1 percent of the hospital’s total annual Medicare reimbursement. It was tied to three specific DRGs (diagnosis related groups): acute myocardial infarction (AMI), heart failure (HF), and pneumonia. Each hospital was scored against its neighboring hospitals to determine which ones had readmission rates in the highest twenty-fifth percentile of their surrounding hospitals. If a patient who had been admitted via the ED due to one of these three DRGs required readmission within thirty days post discharge, and the hospital’s readmission rate was in the highest twenty-fifth percentile of hospitals in the area, the hospital’s overall annual Medicare reimbursement was reduced by 1 percent. Although 1 percent may not seem like a lot, when it was applied against the hospital’s entire Medicare reimbursement dollars it was significant—especially for hospitals operating with only 2-3 percent profit margins.

But the government didn’t stop there. In year two of the program, the percentage of Medicare reduction was increased to 2 percent of the hospital’s total annual Medicare reimbursement amount. Then in year three, not only was the percentage again increased to 3 percent of the hospital’s overall Medicare reimbursement, but three additional DRGs were added: elective knee replacement, elective hip replacement, and chronic obstructive pulmonary disease (COPD).

At this point many hospitals began paying attention, especially when over 2,200 U.S. hospitals were penalized for failing to reduce their readmission rates. To address this ever-increasing reimbursement reduction, hospitals had to implement programs to manage Medicare patients post discharge for at least the first thirty days. To do so, many home grown programs were introduced with varying success.

A number of healthcare software vendors also began developing and marketing programs to help educate and manage the patients post discharge. Some of these programs involved on-site care management visits, phone calls, reminder texts, and emails. Some also involved extensive motivational programs designed to not only assist the patient in remaining proactive in their care but also the patient’s caregiver. Too often the Medicare patient’s primary caregiver is their elderly spouse who is also battling a litany of health issues. Assisting them and other familial caregivers was determined to play a critical role in the process.

But what about the many patients who suffer from more than one chronic disease? Some vendors realized that many Medicare patients suffer from co-morbidities. It is not unlikely for an individual with diabetes to also be obese or someone with HF to have been admitted with an AMI DRG. Initially, since these various disease states were defined as separate care plans, patients suffering from co-morbidities experienced multiple interactions post discharge to manage all conditions that could possibly result in a costly readmission.

To motivate patients and their caregivers to follow post-discharge instructions regarding medications, to make and attend post-discharge provider appointments, and to integrate with the hospital’s care management or medical call centers, vendors have begun collaborating with leading content developers. By adding patient educational and motivational training content to their software programs, post-discharge programs can enable the nurse or care coordinator conducting follow-up calls to select the specific information needed to address each of the patient’s multiple issues. This co-morbidity program approach eliminates the need for redundant calls to address each of the patient’s healthcare issues. Instead it enables the nurse or care coordinator to select the content, surveys, motivational scripts, and other resources needed to meet all of the patient’s unique needs across a wide array of health conditions.

Future thinking hospitals and providers who see the need for follow-up beyond the initial thirty days post discharge are beginning to take a stand for long-term health management by using customizable co-morbidity programs. This is a real step in the direction of healthcare management. Imagine a future where healthcare generates greater revenues from having empty beds, keeping area residents healthy and at home.

LVM SystemsMark Dwyer is the COO of LVM Systems, Inc. For more information about LVM’s Co-morbidity Care Management Program (CCMP), contact LVM Systems sales at 480-633-8200 x223 or info@lvmsystems.com.

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