Improve the Way You Manage Patient Calls


By Charu Raheja, Ph.D.

As a practice manager or doctor, managing patient calls effectively is critical in ensuring high-quality, well-coordinated care for every patient. The first step is to make sure the people answering your phones triage patients efficiently and effectively. Establishing a consistent nurse triage system will improve the way you manage patient calls, improve patient satisfaction, and decrease unnecessary medical expenses. Triage nurses can direct patients to the appropriate care for their symptoms and give patients the peace of mind that their questions and concerns are being answered.

The benefits of nurse triage include better patient access, coordinated care, and cost savings. In addition, it gives patients better access to providers even if they are not seeking emergency care. This can improve patient satisfaction, prevent future complications, and allow providers to educate patients.

With the evolution of new technology there are several cost-effective options available for nurse triage services. We will detail three options available for setting up a nurse advice line:Hospital call centers play a significant role in any hospital’s clinical communications. Click To Tweet

1. Do it Yourself In-house: Start Your Own Call Center: Starting your own call center involves setting up the call center infrastructure. The requirements depend on the scale and number of calls received. For daytime calls, many practices choose to have their own staff nurses take calls using daytime triage protocols.

These protocols are available in book form or in electronic format. For night calls, the requirements include hiring an experienced call center manager, purchasing triage software for night-time protocols, and hiring clinical and non-clinical staff to answer the phones and handle patient calls.

Pro: Having your own system gives your staff the flexibility to perform multiple tasks in addition to triage, such as physician referrals, scheduling, disease management, class registration, and surveys.

Con: Setting up a call center requires a high initial investment. It is labor intensive for the nursing department, and it requires human resources and IT involvement. Moreover, there are significant differences in terms of hardware requirements and capabilities with various software programs, so it is important to do your research and speak with a variety of vendors. This is a long-term project with a slow return on investment.

The organizations most likely to succeed with this approach are larger organizations with high call volumes, who expect to handle over 50,000 triage calls a year. These companies are the right fit because they already have some call center infrastructure and they just need to add to it. The high call volume also allows the center to use nurses’ time efficiently.

2. Outsource to a Nurse Triage Center: If the thought of setting up your own call center seems too daunting, you could use an outside vendor for your patient calls. The vendor provides access to a call center infrastructure that patients can call to access a nurse when they have clinical questions or concerns.

Pro: This option has a relatively low start-up cost. Your practice would not need to train nursing staff, and there is no need for human resources and IT staff. Since the outside vendor is already taking calls, startup is quick, and there is an immediate return on investment (ROI). In addition, vendors may have more experience and expertise in the niche area of triage, resulting in better care for your patients.

Con: When outsourcing your patient calls, you will have less direct control over the nurses and some nurse triage vendors cannot integrate with electronic medical records (EMR).

For the best outcome, be careful about interviewing vendors and make sure you are comfortable with them. In addition, costs may vary significantly depending on the vendor and while you “get what you pay for” you get less from some than others. Still, assuming you have done your homework in interviewing and discussing costs, outsourcing can be a good option for small to medium size practices.

3. Use a Combination of In-house and Outsourced Services: In this model an organization uses its own nurse triage software and nurses during high call volumes and outsources the triage to a service during low call volumes. This combination can be accomplished seamlessly with the call center technology, integration engines, and communication platforms available today.

Pro: A combined model can prove to be a way to improve services and decrease costs. Most triage centers lose money when the call volume is low because nurses are sitting idle waiting for phone calls. By outsourcing during those low volume times, the call center can continue to provide service at a reduced cost.

Your organization can continue to provide the same level or increased levels of service and at the same time decrease your operating costs to work within a given budget. It also allows organizations to keep their current infrastructure and resources. Under this option, your practice may also be able to expand into other areas of call center work to increase revenues.

Con: Just as in the previous option, it is important to take time to find the right partner with the technology and service-level knowledge to implement a combined model. There can be an interruption in patient care if their system does not align with yours.

This model is best for organizations that have some existing nurse triage infrastructure and face budget cuts. Physicians also have their own practice-specific needs, and those requests must be followed by both parties consistently. Therefore, it is crucial to select your partner carefully. Make sure you interview and discuss your software and services with your partner before making a commitment.

Each patient encounter starts with a phone call. Make sure your nurse triage service, whether in-house, outsourced, or a combination, is a seamless experience for your patient.

It is important to examine options for managing patient calls and find the solution and product that aligns with your needs.

TriageLogicCharu Raheja, Ph.D., is the CEO of TriageLogic a leading provider of quality, affordable triage solutions, including comprehensive after-hours medical call center software, day time triage protocol software, and nurse triage on call. Customers include both institutional and private practices. If your hospital or practice is looking for information on setting up a nurse triage service, contact TriageLogic to get a quote or set up a demo. If your organization is also looking for a tool to decrease employee absenteeism and save on staff healthcare expenses, contact us to find out more about TriageLogic’s latest product Continuwell.


Hospital Call Centers

The Vital Ingredient in Clinical Communication

By Kevin Mahoney

 A robust and effective communication system is essential in any hospital, as it forms the backbone of the provision of exceptional patient care. The adaptation and growth of evidence-based medicine have led to growth in multidisciplinary approaches in patient care and increase in research among healthcare professionals.

Multidisciplinary approaches and evidence-based practice, therefore, have necessitated constant and efficient communication among health professionals, especially at the hospital level. The sensitivity of patient care and the fast growth of technology, both clinical and non-clinical, further necessitate a need for balance and maximizing of the right forms of technology for effective clinical communication.

The hospital call center serves as a vital platform in the cog of hospital communications. Often it serves as the patient’s first contact with the hospital. In general, the call center is tasked with providing patients and staff with information pertaining to emergencies, appointments, health monitoring, and the provision of specialist information. It is also a source of patient data and interdepartmental communication. This hospital call center platform, therefore, is multifaceted in its communication functionality. The facets of communications that are related to the hospital call center are patient-to-hospital communications, internal communications, and hospital-to-patient communications.

Patient to Hospital Communications: Call centers at healthcare facilities allow the communication of the patient with the hospital and provide treatment access and patient support. The hospital call center has evolved to be a key primary contact area in the healthcare system.

Treatment access begins with proper scheduling services that taps clinical assessment and triage. This is done to allow the patient to access the right specialized care specific to the individual. For instance, it considers previous admissions, patients’ insurance information, and urgent and emergent situations and classifies patient procedures as either inpatient or outpatient. Hospital call centers play a significant role in any hospital’s clinical communications. Click To Tweet

Patient support goes far beyond initial contact and the initial care received at the hospital. The medical call center has evolved to incorporate preventive and rehabilitative features into the platform. Moreover, call centers now use disease management programs to increase awareness of certain preventable diseases. Furthermore, they help the patient schedule appointments and remind them of screening programs.

The medical call center also helps patients access hotlines suited to their ailments, such as giving patients information about suicide prevention resources. Consequently, these platforms have improved communication features by integrating holistic curative, preventive, and rehabilitative features. This patient communication is an essential part of providing health services by a hospital.

Internal Communications: Additionally, the hospital call center supports clinical communication within the hospital staff. This is evident in environments where there is a centralized web directory. In such instances, the call center acts as the medium for vital information within the hospital. This essential information includes work schedules, contact information, and information about the employees on call. It is a critical component of providing well-coordinated care within the hospital system.

Furthermore, such call centers are tailored to communicate emergency codes and deliver critical messages to clinicians. These critical messages are essential, as they allow patient access to clinicians and contact among clinicians themselves.

A hospital call system, therefore, must be well-coordinated, time sensitive, reliable, and suited to the hospital devices available to the healthcare professionals. Hospital call centers and systems are further being improved upon to allow the tracking and escalation of messages provided to clinicians. This is essential in urgent and emergent service delivery in hospital environments.

Medicine is adopting a multidisciplinary approach to allow more holistic care and treatment to the patient. This requires constant and effective communication among medical professionals. Therefore, the hospital call center is essential, as it acts as a referral point among specialists and a resource for specialists to get access to a client base from the hospital.

Hospital to Patient Communications: Last, call centers allow the communication of the hospital and the patient who is the primary customer of the healthcare facility. The hospital marketing department benefits from the communications between the patient and the call center. The hospital call center is a point of increased patient satisfaction and improved marketing information. Patient satisfaction must be the most important goal and a practice ingrained within the organizational culture.

The hospital, therefore, should aim at optimizing the call experience for the patient. This can be done by cutting down the call waiting time, coordinating points of services, and improving patient registration and billing.

The internet has made it easy to widely disseminate information. A patient can communicate his experiences to a potential customer base. Patient experience, therefore, in the internet age, is an essential form of hospital advertisement. Improving patient experience builds upon the hospital brand and helps set it aside from the competition.

Optimizing patient experience goes beyond a single interaction to anticipate the needs of a patient and tailor services to meet those needs. The increasing need for data within the information age, therefore, cannot be understated. Data from call centers helps the marketing department find effective ways of communicating with the patient.

Each hospital call center must have a means of feedback. This helps identify and document potential issues the client had with the system. There is currently an adaptation of use of proprietary tools such as live metric dashboards and quality assurance and tracking tools. Therefore, most hospitals are collecting data to learn the needs of the patient and tailor their customer care services accordingly. For instance, most call centers now use customized call scripts; this ensures the provider maximizes care support and efficiency.

Optimizing the customer experience has led to call centers evolving as new and exciting forms of hospital income generation. The consequences of effective customer service are based on optimizing the patient experience, which leads to an increase in hospital revenue.

Final Thoughts: Clinical communication is a hugely faceted subject with far reaching consequences that go beyond hospital walls. Hospital call centers play a significant role in any hospital’s clinical communications. This role is expected to continue growing in the coming years as modern technology makes it easier and faster to communicate.

By optimizing communications, a hospital call center can improve patient health outcomes, fill an essential healthcare gap, and serve to improve overall patient care. It is, therefore, imperative that hospitals find effective ways of maximizing call centers, not just as a channel of communication, but also as a huge income-generating department.

1Call, a division of AmtelcoKevin Mahoney is a hospital and healthcare-related account advocate and sales engineer at Amtelco, a manufacturer and supplier of call center solutions. Contact him at



Vendor Spotlight on Echo, a HealthStream Company

Echo Access provider directory

Redeploy Your Legacy Call Center to Transform Patient Experiences

With CMS’s (Centers for Medicare and Medicaid Services) launch of the Consumer Assessment of Healthcare Provider and Systems (CAHPS) program in 2006, hospitals have dedicated significant resources to improving survey results. Centralizing access and strengthening trust through a patient experience contact center begins at the first point of contact. For example, perhaps the caller is new to the community and is looking for a physician referral.

That first touchpoint is critical. According to Society for Healthcare Strategy and Market Development (SHSMD) 2012, the first three seconds of the initial interaction influences both hospital selection and subsequent preference.

A patient experience contact center serves as a health network’s virtual front door. It delivers personalized, trust-building support, and referrals before a patient receives care and individualized follow-up and coaching after the patient returns home.

EchoAccessUnlike a legacy call center, the EchoAccess PX Hub™ provides the specific resources you need to deliver engaging experiences.

Tools that Transform Caller and Patient Experiences:

  • Automate satisfaction surveys and patient experience scores.
  • Track population health goals and document messages to callers and patients.
  • Monitor and improve kept appointment rates.
  • Deploy post-discharge surveys.

Provider Directory with Visual Ratings:

  • Strengthen trust with graphically illustrated CHAPS scores and comments from previous patients.
  • Enjoy the flexibility of four deployment options which are cloud-based and API (application program interface) enabled.
  • Discover the relationship between patient experience ratings and provider directories.

Physician Referral and Physician-to-Physician Referral:

  • Sort provider lists by rotation priority, proximity, or next available appointment.
  • Connect referring providers and their patients with a panel of expert providers.
  • Select from dozens of criteria to ensure the optimal provider match.

Class Enrollment:

  • Add value to patients with user-friendly class and event registration on the phone or online with secure payment.
  • Enable online users to manage their registration with MyEnrollment.

Gold Standard Clinical Triage:

Avoidable Readmissions Reduction:

  • Document and track calls and texts to both patients and caregivers to increase rates of kept follow-up appointments.
  • “It’s a new day in healthcare,” said Mary Alice Worrell; director, contact center services of St. John providence Health System. “Our contact center’s readmission reduction program, powered by EchoAccess, is a vital part of our standard of care.”
  • Learn how St. John Providence Health System reduced preventable readmissions.

Computer/Telephony Integration:

  • EchoAccess offers computer telephony integration (CTI) with CTI-ready telephone software. This technology reduces call times and results in more accurate data entry.
  • Seamlessly transfer calls to specific agents with the caller’s phone number and appropriate call classification.
  • EchoAccess will
    1. start the call,
    2. apply the call type (physician referral, class enrollment, health information, and so forth), and
    3. identify previous population records that match the calling phone number. This saves time for call center agents, shortens call length, and improves data accuracy.

Best Practice Content: Utilize a library of referral letters and reports, including caller letters, class configuration emails, and monthly operations reports.

HealthStream Benefits:

  • Includes HCAHPS score integration provided by HealthStream, a CMS-certified HCAHPS survey provider and Echo’s parent company. Patient satisfaction scores by provider is vital information for callers and patients when selecting a physician.
  • Provides the option of installed software, cloud deployment, or outsourced services for evenings, weekends, and peak call times.
  • Combines EchoAccess product expertise with patient experience consulting through the HealthStream Engagement Institute. The HealthStream Engagement Institute has coached over 350 healthcare organizations to create patient-centered cultures with measured increases in patient satisfaction, employee engagement, care quality, and profitability.
  • Clients can harness talent for patient experience journey mapping, enterprise contact center consolidation for integrated access, contact center operations, emerging technologies, and customer service certification.
  • Customer service certification assures your team has the skills and toolset they need to consistently deliver extraordinary patient experiences beginning at the first point of contact.
  • Echo, a HealthStream company, delivers healthcare’s only patient experience contact center software solution from a CMS-certified provider of HCAHPS surveys. HealthStream’s deep, nationwide experience provides unique insight into raising HCAHPS scores. Raising HCAHPS scores improves reimbursement.

Explore the timely benefits of redeploying your legacy call center to transform patient experiences. Exit the call center: Yesterday’s call centers managed transactions. Enter the patient experience contact center: Today’s patient experience contact center serves as the organization’s virtual front door. It delivers intentionally memorable experiences that mitigate risk, solidify loyalty, and reduce unnecessary readmissions. Compared to EchoAccess PX Hub, everything else is just a call center.

HealthStream Provider Solutions—comprised of Echo, a HealthStream® Company, and Morrisey®, a HealthStream Company—is dedicated to deploying process improvements, automation, and validated provider data to improve credentialing, privileging, enrollment, and patient experience contact centers for more than 3,000 hospitals and medical groups. Echo’s solution for hospital-based contact centers, EchoAccess, enables organizations to deliver intentionally memorable experiences that mitigate risk, solidify loyalty, and reduce unnecessary readmissions.






Do You Provide Contact Options For Your Patients?

A successful omnichannel strategy requires intentional implementation

By Peter L. DeHaan, PhD

Peter DeHaan, Publisher and Editor of AnswerStatHave you ever had a company ask how you wanted them to contact you? Options might include phone, email, text, fax, mail, or social media private messaging.

How well did they do at complying with your request?

With one company I asked for email communications, but they called me. When I reminded them I preferred email, they switched to that channel. But after too many emails failed to make progress, I switched to the telephone, which confused them. In the end, I accomplished my objective and gained something to write about in the process.

Another organization asked the same question. Text messaging seemed the way to go, since I envisioned short, succinct communications with them. Though I opted for text, they emailed me instead. In fact, they always email. Once when I called and left a message, they emailed me back. Another time I specifically asked for a text to confirm an appointment, but they emailed me. Email is their preferred contact method, even if it isn’t mine.

I applaud these organizations for asking my preference and criticize them even more for not following through. If you can’t comply, you shouldn’t ask. That way you don’t establish false expectations or cause frustration with your patient or customer.Providing excellent customer service relies on excellent communication. Click To Tweet

In considering these two experiences, a few thoughts come to mind, which apply to any contact center that truly has a customer-focused perspective.

Offering Channel Options Is Good: Letting patients and their caregivers select their preferred contact method is a customer-friendly move. It’s also a great idea, given that patients often have options for healthcare providers and are quick to exercise those options if you disappoint or disrespect them.

Not Honoring Channel Requests Is Bad: Not using the channel a patient requests is worse than not offering the option in the first place. If you can’t (or won’t) contact patients and prospective patients by the method they request, then don’t bother to ask.

Not Responding On Any Channel Is Even Worse: Making no effort to contact patients or customers when they request it is the worst possible error to make. And this mistake happens too often.

Knowing When to Switch Channels is Key: Sometimes a preferred channel bogs down communication. When emails or texts go back and forth without resolution, it’s time to pick up the phone, but before doing so, make that suggestion through the patient’s channel of choice. And if the patient opts to switch channels, make sure their contact history follows them to the new channel.

Asking people how they want you to contact them is great, providing you follow through. But if you don’t do as they request, you’re better off not offering it as an option. Conversely know when it’s appropriate to switch channels. And most importantly, always, always follow through.

Providing excellent customer service relies on excellent communication, whether it’s within the requested channel or if there’s a need to move outside of it. Just don’t arbitrarily jump channels. The only thing that will accomplish is patient frustration.

If your contact center has an omnichannel strategy be smart about the implementation.

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

AAACN Conference Hits Attendance Record

More than 1,200 nurses attended the American Academy of Ambulatory Care Nursing (AAACN) 42nd Annual Conference held recently in New Orleans, a number that broke all previous records for this thriving specialty nursing association.

With heightened interest in such areas as Care Coordination and Transition Management (CCTM), telehealth, and other ambulatory care nursing roles, nurses rely on the AAACN conference for high-level quality education. As a result, AAACN is enjoying a groundswell of growth and success as it expands, offering broad education and services that help nurses excel in their professional practice. AAACN Conference Hits Attendance Record Click To Tweet

“One of the best aspects of this conference is how warm and welcoming the AAACN community is,” said 2017-18 AAACN president M. Elizabeth Greenberg, PhD, RN-BC, C-TNP. “I’ve been so impressed by nurses’ willingness to share their expertise and help their colleagues reach their potential. During the conference I witnessed time and again the nurses working together to advance our practice and help our voices to be heard.”

Conference Highlights: Outgoing AAACN president Debra Cox, MS, RN, CENP, opened the conference on May 10, with the official “Welcome and President’s Address.” Cox encouraged attendees to make new connections at the event as well as share what they learned with colleagues at home.

Immediately after the welcome session, author and nursing leader Connie Merritt, BSN, RN, PHN, delivered the conference keynote address, “Pressing Forward in Challenging Times.” Merritt offered attendees ways to meet the demands of today’s complex healthcare environment by confidently leading and inspiring others.

Concurrent and general sessions on a broad variety of ambulatory care nursing topics continued through Friday, May 12. Additional continuing education was offered with 120 poster presentations that showcased the nurses’ best practices and innovations.

Attendees enjoyed special events, networking, and conversations with vendors in the exhibit hall. At the always popular opening reception, the silent auction, which benefits AAACN’s scholarships, grants, and awards program, raised $6,000.

The conference closed on May 13, with the Ambulatory Care Nursing Certification Review Course post-conference workshop. (View conference photos.)

Highlights include:

New Officers Inducted: Greenberg, who is Associate Clinical Professor, Northern Arizona University, Tucson, AZ, was inducted as AAACN 2017-2018 president for a one-year term. In this role, she will lead the AAACN board of directors (BOD) in fulfilling the association’s strategic plan and steering the direction and vision of AAACN in the coming year.

CEO Recognition: The BOD honored Cyndee Nowicki Hnatiuk, EdD, RN, CAE, and FAAN, who is retiring from her role as AAACN CEO. Hnatiuk served AAACN for twenty-two years and helped the association steadily grow and succeed. She received a lifetime AAACN membership and the highest praise from AAACN leaders.

“Cyndee is the quintessential nurse leader and professional,” Greenberg said. “More than any other individual, Cyndee has been responsible for guiding and nurturing AAACN into the exceptional organization it is today.”

Awards and Scholarships: The following awards were presented:

  • President’s Above and Beyond Award (highest award to AAACN members who exceed the expectations of their volunteer roles). Two recipients:
    • Joan Pate, MS, BSN, RN-BC, was recognized for her longtime commitment and exemplary service to ambulatory care nursing and AAACN, including ongoing and active contributions to AAACN Viewpoint and other publications, as well as serving on the Editorial Board and Leadership SIG Advisory Board.
    • Beth Ann Swan, PhD, CRNP, FAAN, was honored for continually seeking opportunities to elevate the role of the ambulatory care nurse and for her many contributions to AAACN, including serving as past president disseminating and implementing the Care Coordination and Transition model.
  • Research/Evidence Based Practice Project Award: $1,000, Julie Alban, MSN, MPH, RN-BC, CCCTM, Belleview, FL, for her study, “Ambulatory Care Nurses’ Role in Advance Care Planning.”
  • Conference Scholarship (members in nursing 2+ years): Sarah Espin, MSN, RN-BC, VHA-CM, Inverness, FL.
  • Conference Scholarship (members/New RNs in nursing two years or less): Linda Schnolis, BSN, RN, Philadelphia, PA.
  • Conference Scholarship (nursing students): Angela Williams, Boise, ID.
  • Education Scholarship: Gina Hernandez, BSN, RN, PHN, Valley Center, CA.
  • Clinical Excellence Award (sponsored by the Anthony J. Jannetti, Inc. Nursing Economic$ Foundation, given to a AAACN member who personifies clinical excellence in ambulatory care): $500, Jane “CJ” Mazzeo, BSN, RN-BC, CCCTM, VHA-CM, Leesburg, FL.
  • Administrative Excellence Award: Julie Tuttle, MSN, RN-BC, Nashua, NH.
  • 2017 Viewpoint Writer’s Award (given for an outstanding article published in the association’s official newsletter, Viewpoint): Dawn M. Rito, BSN, RN, Clinical Nurse, and The Metro Health System Cleveland, OH, for the article: Changing the Physical Environment in the Urodynamic/Gynecological Procedure Room, May/June 2016.

AAACN also awarded the Candia Baker Laughlin Certification Scholarship and Certified in Care Coordination and Transition Management (CCCTM) Certification Grant to two recipients. Those recipients will be announced after they have passed the ambulatory care nursing certification exam and the CCCTM exam.

The poster presentation winners are:

First Place: Group B, Poster 3: Enhanced Nurse Visits for Medication and Lifestyle Management for Patients with Uncontrolled Hypertension. Presented by a nursing team from the Mayo Clinic, Rochester, MN.

Second Place: Group A, Poster 4: RN Care Coordination for Patients with Metabolic Syndrome in Ambulatory Care. Presented by a nursing team from the Edward J. Hines, Jr. VA Hospital, Hines, IL

Third Place: Group A, Poster 22: A Toolkit for New Ambulatory Care Nurses: Applying Available Resources for the Job at Hand. Presented by nurses from the Veterans Health System/Southern Tier Outpatient Clinics North Florida South Georgia VHS, Inverness, FL; and the Department of Veterans Affairs, Jacksonville, FL.

Online Library: Nurses who attended the full conference have access to an extensive source of CNE contact hours in the AAACN Online Library, which can be used for certification and licensure requirements. For more information about accessing conference content, visit

2018 Conference: The AAACN 43rd Annual Conference will be held May 9-12, 2018, in Lake Buena Vista, FL. Poster abstracts are being accepted through December 15, 2017.

For more information about AAACN, visit; call 800-262-6877, or email

Medical Call Centers Are Here to Stay

TeamHealth Medical Call Center

By Gina Tabone

Changes to the United States of America political scene are upon us and most certainly will have an impact on the provision of healthcare. Regardless of party affiliation, several healthcare reform objectives need to remain in the forefront by future government leaders. Examples include enhancing quality of care, improving interdisciplinary coordination and collaboration, and better utilization of available resources.

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

The world of medical call centers 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 the United States. For example, 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 offer ideas to plot out the best plans for the future. Improving patient experience of care requires open access channels. Click To Tweet

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 impacted 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. Access means that patients can receive the most appropriate level of care needed, in a timeframe best determined by specially trained nurses guided by evidence-based tools. The patient learns to expect reliable advice that takes their current health state into account 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’ wellbeing is enhanced, everyone gains—especially patients. MCCs can stake a claim for making this 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 departments are now being outsourced by some of the largest hospital systems in the country. IBM is, by far, the vendor of choice. Patient Financial Services is another service with options for outsourcing where the benefits to an organization outweighs the cost 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 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, better outcomes, and lower costs.

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 multi-faceted decision that is reserved for leaders at a higher level than the call center. Organizations must evaluate which option best aligns with their mission, vision for the future, and strategic plans.

Medical call centers are branching out and taking on a variety of responsibilities that are well suited to be conducted remotely and reliant on state-of-the-art technology and a dedicated workforce. Once the technological infrastructure is created, the MCC can be enhanced to take on additional functions.

The task of appointment scheduling is the most common function 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 allows for requests to be tracked, acted upon, and measured, ensuring that established targets are being met in a timely manner. Without measurement, there is little possibility for improvement.

Patients can expect a standard process for medication needs and defined timeframes 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 also the chronic needs of vulnerable high-risk patients. The successful coordination and transition 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 patient and caregiver is vital and is often done via telephone, text, or email. Training the newly created transitional care 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 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 world 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 most 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.

Initially there were call centers; then access centers came along, followed by contact centers. In 2017, we are now called 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.


The Contact Center’s Role in Reducing Readmission

LVM Systems

Traci Haynes MSN, RN, BA, CEN

Reducing hospital readmissions has been a focus of the healthcare environment for many years. Steven Jencks MD, dubbed by many as the father of readmission research, along with Mark Williams MD and Eric Coleman MD, analyzed medical claims data from 2003-2004 to describe the patterns of rehospitalization and its relationship to demographic characteristics of hospitals.

They learned that almost one-fifth (19.6 percent) of the 11,855,702 Medicare beneficiaries who had been discharged from a hospital were rehospitalized within thirty days. They also found that 34 percent were hospitalized within ninety days; and that 67.1 percent of patients who had been discharged with medical conditions and 51.5 percent of those discharged after a surgical procedure were rehospitalized or died within the first year after discharge. Furthermore, of the 50.2 percent of patients rehospitalized within thirty days post medical discharge to the community, there was no bill for a visit to a physician’s office between the time of discharge and rehospitalization.

Additionally, the average length of stay (LOS) of rehospitalized patients was 0.6 days longer than that of patients in the same diagnosis related group (DRG) whose most recent hospitalization had been at least six months prior. The cost to Medicare for rehospitalizations in 2004 was 17.4 billion dollars (Jencks, S.F., Williams, M.V. & Coleman, E.A., 2011).

In 2007, the Medicare Payment Advisory Commission (MedPAC) reported to congress that 13 percent of patients rehospitalized within thirty days of discharge in 2005 were for reasons potentially preventable. These readmissions accounted for $12 billion in Medicare spending.

As a result, the Patient Protection and Affordable Care Act (PPACA) of 2010 mandated that the Centers for Medicare and Medicaid Services (CMS) implement a program in which hospitals with higher-than-expected readmission rates for certain designated conditions experience reductions (that is, penalties) in their Medicare payments.

Beginning in October 2012, the hospital readmission reduction program (HRRP) began adjusting hospital payments based on excess readmissions within thirty days of Medicare patients following myocardial infarction (MI), heart failure (HF), and pneumonia hospitalizations. The maximum penalty at that time was 1 percent of a hospital’s base Medicare reimbursement rate per discharged patient. Reducing hospital readmissions has been a focus of the healthcare environment. Click To Tweet

Beginning October 2013, the penalty increased to 2 percent and then to 3 percent the following year (2014). The first year, more than 2,200 hospitals were penalized for failing to meet standards, with 8 percent incurring the maximum penalty. In addition to the MI, HF and pneumonia penalties, readmission penalties now include elective knee and hip replacements and chronic obstructive pulmonary disease (COPD).

The healthcare reform mandate required addressing a long-time quality issue. According to Bisognano and Boutwell, the primary reasons for readmission were no physician follow-up visit, medication discrepancies, and communication failure during transitions of care (Bisognano, M. & Boutwell, A., 2009). Eric Coleman MD and others identified poor information transfer, poor patient and caregiver preparation and limited empowerment to assert preferences as the primary reasons for readmission.

Contributing factors include nurses not having time to thoroughly address the needs of both the patients and caregivers upon discharge, the hospital setting not being conducive to education that will drive behavior change before discharge, and the care continuum breakdown between hospital discharge and the handoff to primary care (Coleman, E.A., Parry, C., Chalmers, S., & Sung-joon, M., 2006).

The uneven impact of the penalties has been a significant concern for hospitals that care for a larger number of low-income patients. They claim it is more difficult for their patients to adhere to post-hospital instructions including payment for medications, dietary modifications, and transportation to follow-up appointments.

To address these challenges, some hospitals have implemented measures including discharging patients with medications, home visits, and follow-up calls. Other interventions include hiring specialty care coordinators and transition coaches to provide follow-up care for patients with multiple comorbidities, providing patients with extensive teach-back for multiple days prior to discharge so they’ll better know what to do once they are discharged. In addition, many include comprehensive medication reviews with a clinical pharmacist.

The contact center can be an integral team player in reducing avoidable readmissions by enhancing the quality of care in the hospital-to-home transition through the combined capabilities of technology and human interaction. While discharge planning should begin upon admission to the hospital and include arranging for durable medical equipment (DME), transfer to step-down as appropriate, home health care, transportation needs, communications with primary care providers (PCPs), and discussions with caregivers, the extended care team which includes the PCP, caregivers, pharmacist, and other members of the interdisciplinary team can be greatly improved by the services of the contact center in helping to comprehensively coordinate the patient’s care.

The patient and their caregivers will also benefit from the reinforcement of information provided, teach-back, appointment reminders, and coordination of services including transportation, as well as medication reconciliation and symptom assessment resulting in earlier interventions and improved outcomes. Extending the contacts beyond the 30-day penalty period will bring even greater benefits to patients/caregivers and may prolong readmissions indefinitely.

What readmission reduction activities are occurring within your organization? What is your contact center’s role in reducing readmissions? What level of service do you or can you offer?

Some contact centers make one post-discharge call to review the patient’s diagnosis, instructions, medications, and education materials and to ensure the patient has scheduled their follow-up appointment with positive results. Others make several outbound calls to the discharged patient including a call within the first 24 to 48 hours post-discharge.

In addition, the call center staff or care coordinator may reach out to the patient again after their first appointment, which ideally occurs within seven days post-discharge. This call typically reviews the follow-up appointment instructions, any changes in medications, assist in referrals and scheduling with additional providers or resources, and communicate to the interdisciplinary team as appropriate. During this contact, biometric monitoring may also be tracked through technology or as self-reported by patients or their caregivers.

Whatever level of service provided, it’s a win for the patients, their caregivers, and the organization. Utilizing the contact center to identify and implement communication strategies that effectively engage the patient and their caregivers adds value to the organization and the opportunity of better outcomes for their patients.

LVM SystemsTraci Haynes, MSN, RN, BA, CEN is the director of clinical services at LVM Systems, Inc.


Is Your Contact Center Effective?

Meeting the two essential elements of a contact is just the first step

By Peter L DeHaan, PhD

Peter DeHaan, Publisher and Editor of AnswerStatIt doesn’t matter if a call is answered in a modern contact center staffed with a team of trained professionals or by one weary person in a single-phone department. In both cases patients and callers evaluate their phone interactions in the same way, and they expect the same outcomes. Regardless of the circumstances, they compare each call with every other call and judge it accordingly. It matters not who took the call or the technology behind it.

Contact Essentials: At a basic level, patients look for two things when they contact you.

First, they want to accomplish their objective, the reason for their call. This may be to schedule an appointment, follow up on test results, or clarify discharge instructions. Or they might be calling because of a medical concern, hoping to talk to a triage nurse or find out if they should head to the ER. In short, they have a need, call you, and expect to accomplish their objective.

Second, though they may not realize it, they subconsciously want a positive feeling about the call. Do they perceive their need was met? Are they satisfied with the outcome? Do they sense they were treated with respect?Too often contact centers meet callers’ objectives but leave them frustrated in the process. Click To Tweet

Together these two characteristics combine to result in effectiveness. An effective call is a phone interaction where the patient’s purpose is accomplished, and they hang up pleased with the interaction. However, too often contact centers meet callers’ objectives but leave them frustrated in the process.

Effective Call: Being effective means the caller’s reason for calling is addressed, and the customer is pleased. A rating of effective sets the minimum expectations for a contact center. This establishes the center’s service baseline.

Ineffective Call: Calls that aren’t effective are failures. This means the callers’ objectives weren’t accomplished, or they weren’t satisfied with the results. Too many organizations run contact centers that are not effective. Wrong information is given; errors are not corrected; callbacks don’t happen; and repeated calls occur, with no movement toward resolution.

Beyond Effective: However, other contact centers offer the other extreme. They start with effective and then offer more. Their staff is professional, accurate, and consistent. They excel at being empathetic with callers, and they aim for first call resolution.

Whether you have one phone or hundreds of agents, first ensure you are effective in handling calls. Then strive to become more than effective. Become everything your callers hope for when they contact you. Then everyone wins.

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

Vendor Spotlight on 1Call, a Division of Amtelco: Over Forty Years of Innovation

Since 1976, Amtelco has provided innovative communication solutions to call centers around the world. In 1997, the 1Call Division was formed to offer enterprise-wide communication solutions designed specifically for healthcare organizations. 1Call is dedicated to serving the unique call center and communication needs of healthcare organizations, helping improve communications between patients, physicians, and staff by connecting people and information. Amtelco has been awarded twenty-eight patents, covering a wide range of communication processes.

Hospitals and healthcare organizations around the world turn to 1Call to solve their medical call center, answering service, on-call scheduling, call handling, secure messaging, voice processing, conference calling, and automated middleware notification needs. In an independent survey (by a Amtelco Satisfaction Research Study conducted by TMA+Peritus, February 2015) 100 percent of the respondents said they would highly recommend Amtelco and 1Call to another healthcare organization.

Five-Star Service and Support: Amtelco and 1Call are well known for continually developing comprehensive call center and communication solutions, all backed by superior five-star, after-the-sale service and support. Customer advocates and account managers are available to help customers and answer questions before, during, and after the sale.

1Call has a reputation for complete, professional system support, offering training, installation, and technical support staff on call on a twenty-four-hour basis. When customers need assistance for their call center solutions, 1Call’s customer support staff provides fast and reliable service.

1Call’s customer support staff includes trainers, installers, project managers, and technical support personnel. The customer support staff has an average tenure of over fifteen years, which is virtually unheard of in technology and IT businesses. All support staff members are in the United States. While most staff members work from the Midwest home office, there are several regional offices around the United States.

Help When Needed: When help is needed, it’s just a phone call away. 1Call customers can also email the support team or even access the online TechHelper tool for documentation, manuals, videos, and other training tools. TechHelper is available twenty-four hours a day, with unlimited access, and features a Google search engine. Emergency assistance for 1Call systems is available twenty-four hours a day, 365 days a year.

Software upgrades are included with support agreements, helping ensure 1Call customers always have access to the newest features.

In the Amtelco Satisfaction Research Study conducted by TMA+Peritus, 97 percent of the respondents said the Amtelco and 1Call service and support was excellent. 1Call looks forward to partnering with more healthcare organizations to provide this same level of service.

Solutions That Work: 1Call features a complete line of modular solutions specifically designed to streamline enterprise-wide communications, eliminate errors, and reduce training time for new operators. All the specialized 1Call solutions protect an organization’s limited resources, making each organization tremendously efficient and helping bring wellness to their members and their bottom line.

Each 1Call solution comes with the benefit of Amtelco’s years of experience in the field of call handling and messaging. Thousands of 1Call and Amtelco systems are in operation around the world, twenty-four hours each day.What do customers have to say about switching to 1Call? Click To Tweet

Easily Customizable: 1Call understands every healthcare organization has unique needs and sometimes receives unusual requests from physicians and departments. That’s why 1Call offers powerful solutions that are easy to customize, by the customer. Customers have access to a wide variety of administrative functions, including the ability to customize scripts for any department, with individual scripts for every physician, if needed.

When additional help is required, 1Call has a Script Pro team available to assist customers with any specific requests.

Why Choose 1Call? Hospitals continually recommend 1Call solutions, so more healthcare organizations continue to switch to 1Call. And it’s no wonder, with all the customizable hospital call center solutions available, the high levels of customer satisfaction, and quality support services.

What do customers have to say about switching to 1Call? Here’s one example: “It was a great decision switching to Infinity. The 1Call technology is innovative. It’s easy to learn, and it really seems to mold around what the particular needs of our hospital are. Everything runs so much more smoothly now. I think it’s also worth noting, the customer service—great. We couldn’t be happier.”

Strong Partner Relationships: 1Call forms solid partnerships with their customers. Each organization is encouraged to work closely with the 1Call team of consultants and engineers through each phase of system planning, configuration, and implementation. This helps ensure the 1Call systems are at their optimum performance levels to meet the communication needs of their organizations.

1Call also works closely with key technology partners to provide organizations with the solutions that best fit their communication and technology requirements. 1Call’s partners integrate at a high level with the call center, on-call scheduling, HIPAA secure messaging, alarms management, and emergency notification solutions to produce a comprehensive solution that satisfies the needs of each organization.

The 1Call technology partnerships include:

  • Apple iOS Developer Program
  • Avaya DevConnect Community
  • Black Box
  • Cisco Solution Partner Program
  • Cisco Developers Network
  • Copia OEM Partner
  • GENBAND Partner Program
  • Google Play Developer
  • Health Level 7 International (HL7)
  • Interactive Intelligence Global Alliance
  • Microsoft Developers Network
  • Mitel Solutions Alliance
  • NEC UNIVERGE Solutions Partner Program
  • SAP OEM Partnership Program
  • ShoreTel Innovation Network Alliance Partner
  • Spectralink Application Integration and Management Solvers Program
  • Unify (formerly Siemens) Technology Partners—Advanced Level Status
  • Vocera Solution Partner Program
  • Windows Development Center Member

One Company, One Solution: The development and customer support teams are in the Innovation Way hallway at the Amtelco and 1Call home office. These teams work together closely, and when a question arises, it’s a quick walk down the hallway to find the solution. One company, one solution: proudly located in the USA.

Recent Innovations: As customers have come to expect, Amtelco and 1Call continue creating innovative solutions. In addition to frequent enhancements to Intelligent Series, soft agent, and miSecureMessages, the newest innovations are MergeComm and Genesis.

The MergeComm Middleware Solution is designed to automate communications throughout an organization, speeding response times to help organizations provide better patient care. MergeComm takes an incoming message and uses a script to determine who needs to receive that information.

MergeComm can receive a message from a wide variety of sources, including alarms, alerts, HL7 messages, nurse call, severe weather alerts, TCP, WCTP, and web services. Notifications can be sent to an individual, an entire group, or the current on-call personnel. The notifications can be sent by email, miSecureMessages, IP phones, pagers, phones, smart devices, SMS, and Vocera badges.

The Genesis Software Switching Solution provides the Intelligent Series applications with advanced software-based telephony. Genesis builds on the features that made Infinity a leader in the industry. Genesis provides an all-inclusive call center solution with ACD, call management, reporting, and call center applications based on the Intelligent Series. A few of the many benefits of Genesis include reducing the need for hardware, virtualization of the switching platform, integrating with your SIP-enabled PBX, connecting remote agents, and automated overhead paging.

The Future: As technology continues to evolve and as customers have new communication challenges, 1Call and Amtelco will continue to develop new innovative solutions, as they have for over forty years.

1Call, a division of AmtelcoLearn more at

Use a Customized Follow-Up Plan to Reduce Hospital Readmissions


By Dr. Ravi Raheja

When patients get discharged after a hospital visit, it can be difficult for them to follow or remember discharge instructions. This can lead to higher readmission rates, longer recovery times, and overall lower quality of patient satisfaction.

Did you know?

  • Up to 20 percent of patients are readmitted within thirty days.
  • There is the potential to save 12 billion dollars on readmissions.
  • Hospitals could lose as much as 528 million dollars from Medicare cuts.

Why Hospital Readmissions Occur: A common cause for readmissions is poor follow-up by patients after the procedure. The stress and difficulty faced by patients during their hospital stay makes it common for them to forget or misunderstand the instructions given by providers during the patients’ hospital discharge. Often, patients go home confused about their medication orders, fail to follow the treatment plan, or neglect to follow up with a doctor visit in a reasonable time.

Family members may be able to help patients follow discharge instructions, but they are often distracted because of the hospitalization or not able to help with the patient discharge plan once they go home.

Offer patients customized continued care after patient discharge to:

  • Decrease ER readmission rates.
  • Ensure continuity of care.
  • Increase patient satisfaction.
  • Help patients avoid unnecessary ER visits.
  • Increase patient compliance with instructions.

Nurses trained specifically for post-op care can help a hospital reduce readmissions by creating a customized follow-up plan to keep patients on the correct path to recovery. A hospital staff member will fax the post discharge nurse the instructions from the hospital EMR for patients who have been discharged and are at risk for readmission. The nurses will make follow-up calls to confirm compliance with medications and screen for necessary follow up visits. If needed, nurses can also be available 24/7 for patients to call if a symptom arises. These calls can be customized to what doctors think will work best and can be adjusted at any time.A common cause for readmissions is poor follow-up by patients Click To Tweet

The ideal program allows each specialty in the hospital to have its own custom profile, so that each specialty can include custom instructions for the nurses to follow related to the care for specific procedures and specialties. Advanced follow-up systems can even create custom protocols to allow nurses to ask specific and related screening questions. Some examples of these screening questions include:

Medication Compliance

  • Did you get medicines?
  • Do you know how to take them?
  • Are you taking them?
  • Do you have any concerns about taking the medicine?


  • When do you have an appointment scheduled?
  • Are you able to keep that appointment?

Symptom Review

  • Do you know what signs or symptoms to look out for?
  • Do you know what number to call if you have a medical concern?
  • Do you have any questions you would like me to pass on to your doctor?
  • Do you have any symptoms you are concerned about right now?

Following a holistic post-discharge protocol can reduce readmission rates, shorten recovery times, and improve patient satisfaction.

TriageLogicDr. Ravi Raheja, is the medical director at TriageLogic, which uses innovative technology to offer a comprehensive and customizable post-discharge system. In addition to the customizable post discharge plan above, TriageLogic nurses also remain available for patients 24/7 should any symptoms or questions arise. If your hospital is looking to reduce patient readmission rates, contact TriageLogic to get a quote on post discharge follow-up service.