By Nicole Limpert
A person medically underserved is someone who does not have health insurance. Estimates from the Centers for Disease Control and the National Health Interview Survey cite that in 2017, 29.3 million, or 9.1 percent of the population were uninsured.
Vulnerable Populations: Multiple studies have found that vulnerable populations in the United States, including the elderly, low-income, ethnic minorities, migrants, and people who received limited education, are also medically underserved.
People with various life experiences may interpret symptoms differently, such as thinking a seizure is a spiritual issue rather than a medical complaint, or expressing concerns about depression as anger rather than sadness.
Poor Access to Healthcare: Living in a rural location and having inadequate transportation present challenges when trying to access healthcare. Rural areas are sparsely populated, resulting in a lack of available services. Rural communities comprise roughly 20 percent of the United States, yet less than 10 percent of doctors practice in these communities.
People in rural areas rely on their own transportation to and from health services. A report released in December 2018 from Pew Research Center, found the average travel time by car, to the nearest hospital for rural Americans, is about 17 minutes compared to 10 minutes in urban areas.
However, even people in urban areas have difficulty visiting their doctor’s office. Transportation can be a challenge for people with disabilities, those with chronic illnesses, the elderly, and people who are low-income. Approximately 3.6 million Americans, from both rural and urban areas, experience missed or delayed medical appointments due to transportation issues.
Support from Healthcare Call Centers
Technology enables medical call centers to effectively become an extension of a hospital or clinic’s operations. The communication software used by medical call centers can securely access a patient’s electronic medical record (EMR), update EMRs with notes, and record calls needed for insurance claims and workmen’s compensation. Because everything is documented, detailed reports can be generated for reporting purposes.
Medical call centers can provide or facilitate healthcare-related services 24 hours a day, 7 days a week. They play a critical role in helping to serve the medically underserved, by addressing two of the biggest barriers to healthcare: language and transportation.
Language: Healthcare staff work with an enormously diverse patient population. Understanding a person’s language leads to better healthcare. Multi-lingual call centers hire operators to assist non-English speaking patients or use confidential over-the-phone interpreting (OPI) services for access to hundreds of different languages.
Transportation: Patients with mobility challenges or who live in rural areas don’t have to leave home for some services. Operators can coordinate care, make follow-up calls, schedule visits, contact on-call medical staff, and manage referrals.
Some call centers staff nurses or multidisciplinary teams (such as a resident, pharmacist, and social worker) who are qualified to make health assessments, give medical advice, and escalate critical concerns. These call centers can offer nurse call helplines, emergency mental health counseling, and other critical support.
Helping Hospitals that Help the Underserved
Reduce Penalties: A recent study done by Harvard suggests that hospitals located in low-income areas are more likely to receive penalties due to Medicare and Medicaid’s survey-based reimbursement programs. Patients are asked to provide information about their healthcare experience via the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Unacceptable survey outcomes can result in hospitals losing some reimbursements.
The American Medical Association Journal of Ethics reports that the Centers for Medicare and Medicaid Services (CMS) can currently withhold one percent of Medicare payments—30 percent of which are tied to HCAHPS scores. When Medicare and Medicaid account for more than 60 percent of all care provided by hospitals, the possible amount of dollars lost due to poor patient experience is a significant number. In 2017 alone, approximately 1.7 billion dollars in reimbursements were withheld from hospitals.
Healthcare call centers play a critical role in patient satisfaction surveys, because they function as a virtual lobby for a hospital and are often the first point of contact with a patient. The patient’s experience with coordinating their care via call center agents can positively affect their feedback on the survey.
Reduce Readmissions: The CMS reports that nearly one in five Medicare patients are readmitted to a hospital within 30-days of discharge, yet a recent study from the University of California San Francisco (UCSF) and published in JAMA Internal Medicine found that twenty-seven percent of all 30-days hospital readmissions are preventable.
Medicare’s Hospital Readmissions Reduction Program (HRRP) lowers payments to Inpatient Prospective Payment System (IPPS) hospitals who report too many readmissions. According to the CMS, 2,573 hospitals received penalties in 2018 and had around 564 million dollars in payments withheld.
Studies indicate that a post-discharge call program can help hospitals reduce their readmission rate. IPC Healthcare (IPC) tested the effect of post-discharge calls on readmission rates from October 2010 through September 2011. The IPC call center contacted 350,000 discharged patients to check symptoms, review medications and treatment plans, and remind patients of follow-up appointments. Successful contacts occurred with thirty percent of patients, with an estimated 1,782 avoidable readmissions prevented over that year.
Nicole Limpert is the marketing content writer for Amtelco and their 1Call Healthcare Division. Amtelco is a leading provider of innovative communication applications. 1Call develops software solutions and applications designed for the specific needs of healthcare organizations.