Imagineyou are in the hospital after an emergency appendectomy, and you have a simple but urgent question about the payment of this just-delivered health service. Your physical and mental stress is a load made only heavier with that pending insurance coverage conversation. You are in no mood to struggle with an exasperating app or digital exchange, you want a straightforward reassuring dialogue—one delivered with good, old-fashioned empathy.
From another perspective, the expectations are higher for your engagement team. The right customer service agent must deliver on several levels as an empathetic advocate who can listen, relate, and resolve the issue at hand. Simply put, with all the renewed digital efforts toward optimized customer experience (CX), healthcare customer service remains highly challenging.
The recent COVID-19 surge exposed CX teams to an all-new type of issue, one which no bot or digital channel had ever dealt with. What’s needed is a fresh approach to empathy-based engagement as part of the healthcare customer experience.
Now is the time for healthcare to learn a few lessons from technology-retail elites like Apple, which is renowned for its low-tech empathy focus. Apple aims for Geniuses to walk a mile in someone else’s shoes and recognize the emotions their customers feel and change those, to make them feel better. The Apple manual advises the “Three F’s: feel, felt, and found.” This means connecting, relating from personal experience, and consoling with issue resolution. Healthcare would do well to borrow from this model and reduce friction points to result in more effortless, empathetic problem-solving.
Ultimately, there is still a solid foundation for every contact in healthcare to chart a basic blueprint for compassionate issue resolution. An optimized experience, delivered by an agent empowered to provide empathetic customer satisfaction, should comprise this flow.
Empathy begins with active listening. From the first word spoken by the customer, the agent must focus 100 percent on the communication. This point in the conversation is critical as an opening to bond and win immediate customer trust. Agents shouldn’t make notes while listening. Unless they listen properly, they cannot react to the situation of the customer.
Reduce any miscommunication with follow-up questions.
Acknowledge the Customer
Address the caller with a member or patient name and personalize the communication with a concierge touch to earn trust and loyalty. By using unified desktop and disparate systems, today’s agents can preemptively acknowledge the issue without spending time on a longer intake process. There are also opportunities to track prior visits to eliminate abrasion with unnecessary restating by the member or patient.
Show understanding. Remain calm. The adage is that you never truly know what a person is going through, but with healthcare, it’s even more critical. This is because one thing is clear with healthcare customer calls, and this is that a health issue affects the member or patient’s life. Empathy at this stage might mean a reassuring tone with, “I understand this is difficult. I’m here to help.”
Do not interrupt the customer, instead show attentiveness.
Demonstrate intent to resolve the issue, with the understanding that it won’t necessarily be the case, since not everything is within our control. At this stage, it’s key to let members and patients know that empathetic customer care means trying their best to help, with the understanding that some conditions or procedures may not be covered. Aim for authentic communication, with an added personalized touch, and “thank you” or expression of gratitude for patience.
Over the past fifteen years clients have evolved their metrics focus from a quality, first call resolution and call center customer satisfaction (CSAT) to net promoter score (NPS). One emphasis that has remained the same, however, is empathy, as the leading attribute in every single interaction that drives all these metrics. And while empathy is required for all customer service, in healthcare, even more so, the mission is to address the critical, personal impact related to health, finance, and often-raw emotions.
Helping customers resolve their issues is a delicate balance of all three of these things. That’s what makes healthcare customer service as uniquely fulfilling as it is challenging.
Srikanth “Sri” Lakshminarayanan is vice president, center of excellence for healthcare engagement services. Sri is a domain expert supporting the deployment, stabilization, and growth of capabilities in voice and related services in HGS’s healthcare programs.
Remote patient monitoring is part of a new era of medical technology. In the wake of the COVID-19 pandemic, remote services and technology have been extremely valuable to patients, doctors, and healthcare organizations. Remote patient care typically means helping patients over the phone. Remote patient monitoring (RPM) takes care one step further and helps doctors collect and evaluate data from patients who use an electronic medical device.
RPM is starting to gain traction by the medical field because it improves patient care. Many of these devices can capture data not observed by the patient. As a result, providers can monitor important vitals and intervene before a patient even presents a concerning symptom. This cuts down on both morbidity and mortality while saving costs and decreasing Emergency Room (ED) visits. A recent article in the Center for Technology and Aging asserts that the healthcare industry “could reduce its costs by nearly 200 billion dollars during the next twenty-five years if remote monitoring tools were used routinely in cases of congestive heart failure, diabetes, chronic obstructive pulmonary disease (COPD), and chronic wounds or skin ulcers.”
There are many questions for providers and hospitals to ask themselves as innovative technology continues to become available. Technology is an investment, and changes to existing systems require effort. Is remote patient monitoring worth it, and will it soon be the standard of care for chronically ill patients? What are some requirements to consider while setting up an RPM program?
Which Patients Benefit Most from RPM?
According to the CDC, six in ten Americans have a chronic condition such as heart disease, lung disease, or diabetes. Four in ten have two or more chronic conditions. These chronic patients help make up more than eighty five percent of the 3.5 trillion dollars in healthcare costs across the nation annually and are responsible for eighty percent of all hospital admissions. It costs 3.5 times more money to treat chronically ill patients than those without these conditions, and they make up many of the leading causes of death in Americans.
RPM is especially effective for these types of patients. Continuous management of chronic conditions is burdensome in traditional office or clinic settings. Patients bring in notebooks or phone apps filled with notes, self-assessments, and symptoms. The onus is on the patient, and the reliability of that data falls into the hands of individuals, which can result in inconsistent or partially inaccurate information. RPM takes this burden from patients and relies on accurate, consistent technology. It also allows providers to measure additional important vitals and to receive the information daily.
Chronic health patients have been on the rise. We need solutions to help treat these patients in an effective and economical way. RPM addresses these needs.
How RPM Helps Manage Chronic Care Costs
A study published by the National institute of Health in 2016 by doctors Usha Sambamoorthi, Xi Tan, and Arijita Deb states that “The presence of MCC [multiple chronic conditions] has profound healthcare utilization and cost implications for public and private insurance payers, individuals, and families.”
These conditions require detailed, comprehensive care that can prove challenging. RPM allows for nurses and doctors to have access to health information of a patient in real time, and makes it possible for clinicians to issue health orders that can curb unnecessary emergency department visits by reacting to changes seen from a patient’s monitoring device.
It also gives doctors more access to their patients and creates opportunity for early education in patient behavior and an overview of patient participation in their treatment plan. Doctors can get a look into a patient’s activity and use nurses for check-ins to encourage the patient to comply with health orders. It gives doctors the power to give quality care outside of clinical settings and increases health outcomes. RPM gives doctors the information they need on a timely basis, which allows for swift intervention for high-risk patients.
Benefits to Providers
One concern for doctors when implementing RPM is the possibility of an increased workload, with doctors having to monitor patients regularly even when the patient is not receiving direct care. Doctor burnout is common, and its alleviation has its own value. An Ernst and Young’s 2018 survey on digital health showed that almost sixty five percent of physicians believe that “technology that captures consumer-generated data will reduce the burden on doctors and nurses specifically.”
However, there are solutions for providers to cut down on their work while providing better patient care through RPM. First, most monitoring devices have their technology programmed to inform the provider when there are anomalies or potential patient problems. Second, doctors can also use an outside remote nurse service to monitor the data coming from the devices. An efficient RPM company who provides this service can improve patient care while decreasing the workload on the physicians.
Industry Willingness to Implement RPM
According to a Spyglass Consulting Group report in 2019, at least 88 percent of healthcare organizations have an interest in investing in some form of remote patient monitoring technology to pivot to value-based care. Eighty-nine percent of practices surveyed in Spyglass’s report say that they are actively drafting strategies to get patients to take an active, continuous role in managing their chronic health issues. RPM as a prong to this strategy gives a continuous link between patient and doctor, and it supports these kinds of initiatives.
Health insurance companies have shown an interest as well. In 2019 the Centers for Medicare & Medicaid Services proposed several amendments designed to increase remote patient monitoring programs by improving reimbursements. Some of these amendments include reimbursements for RPM setup and patient education, which is a big incentive to providers who are thinking of implementing this technology. Revisions to who may monitor these devices have also occurred. This allows registered nurses (RNs) or medical assistants to do the bulk of the monitoring, freeing up physicians and nurse practitioners.
Remote patient monitoring offers a way for practices, hospitals, and health insurance companies to lower their costs, deliver continuous quality care, and alleviate doctor workloads. As we move forward, the value of remote patient monitoring will continue to evolve for healthcare organizations and implemented into care plans for the chronically ill.
Pulsar360, Inc. is a Colorado-based company, with origins dating back to 2001. It’s one of the oldest VoIP service companies in the United States and Canada and an early proponent of cloud technology for the communications industry. Today, as an established unified-communication-as-a-service (UCaaS) provider, Pulsar360 delivers a comprehensive set of offerings including:
a cloud-based enterprise class IP PBX,
premise-based IP PBX,
session initiation protocol (SIP) trunking,
business continuity disaster recovery solutions,
T.38 faxing that meets HIPAA, GLBA, and other industry compliance regulations, and
Unparalleled Experience and Expertise
Pulsar360’s top-notch leadership team has years of experience serving the telecommunication needs of business customers, as well as building and managing enterprises of significant scale in the telecommunications industry. They understand that long-term customer relationships are earned, and customers will not be acquired and retained based on price and technology alone.
They require their team and their authorized partners to spend the appropriate time upfront to validate the integrity of the customers’ network. This is followed by a consultative sales process to develop customized solutions for their clients, as opposed to selling a packaged solution.
Once awarded the business, an in-depth implementation process is used to guarantee that design and features meet the customer’s requirements and expectations. The resulting smooth transition to the new services, responsive communication, and resolution of issues are paramount in establishing these long-term relationships.
As an employee-owned company, everyone has a personal stake in customer satisfaction and the company’s success. One testament to their customer satisfaction is that an outside industry consultancy (Franklin Court Partners) reported that Pulsar360 has the lowest attrition rate in the industry. They’re continually focused on providing an excellent customer experience, as well as expanding and enhancing their suite of service offerings.
99.99 Percent Reliability
Pulsar360 is one of a handful of providers with facilities and networks in both the United States and Canada. They have been perfecting their platform and network for over seventeen years. Their operating platforms are some of the most advanced in North America.
They currently operate four data centers (three in the US and one in Canada), each with redundant infrastructure for all their service offerings. In addition, they have a presence in five additional geographically dispersed data centers.
Pulsar360 provides services to hundreds of call centers and telephone answering service customers. Understanding the special requirements of this industry, they have made a significant investment in their network infrastructure and solutions.
National Network Redundancy
Each Pulsar360 datacenter has connectivity to several national networks. If there is a problem with quality or service issues with one network, calls route to another. With tier II access, Pulsar360 can re-route customer traffic away from regional carrier issues.
They provision each SIP trunk to two of their geographically dispersed data centers. If there is a data center issue, carrier issue at the data center, or other problem, the other data center takes over for all trunks and DIDs associated with those trunks.
Pulsar360 provides 20 percent burstable trunking to call center and answering service clients at no additional charge. This can be adjusted even higher on the fly for seasonal needs.
Toll-Free Number Redundancy
All toll-free numbers are provisioned with two national carriers. In the event of a major failure at one carrier, all the customer’s toll-free numbers are directed to the secondary carrier.
Customer Administration Portal
This feature provides instant activation of DIDs and toll-free numbers, administrative management for all services and features, and multiple reports.
Business Continuity and Disaster Recovery Solutions
Pulsar360 provides several automatic failover alternatives, from simple automatic failover to secondary and tertiary internet connections, to automatic failover to a hot stand-by cloud business continuity and disaster recovery system.
If the customer’s premise or cloud system goes down, calls automatically failover and are delivered directly to operator desktops via softphones. Calling party ID and customer name or account number are delivered to the operator. It also includes a cloud-based IVR with multiple call queues, skills-based routing, and more when in failover mode. These options are flexible and customizable based on the customer’s unique requirements.
Quality of Service
With Pulsar’s SD-WAN offering they can provide quality of service (QoS) over the internet to their data centers. This—coupled with their 24/7 internet quality of service monitoring and issue alerting that includes scheduled VoIP quality tests with archived test results—insures they deliver the reliability to meet and exceed their customer’s expectations.
Pulsar360 has wholesale arrangements with numerous global carriers and competitive local exchange carriers. In addition to offering competitive rates and to alleviate finger pointing, the network services can be in Pulsar360’s name. They will receive issue notification by their circuit monitoring and will interact directly with carriers. They also interact directly with the customer’s system provider on issues. This provides one point of responsibility for their customers.
Over the years Pulsar360 has received numerous awards and recognitions. They recently received the 2020 Internet Telephony “Product of the Year Award” and the “Hosted VoIP Excellence Award” before that. They were also named a “Top 10 Cloud Communications Company” by Cloud Technology Insights.
Consider Outsourcing to Better Manage Call Traffic and Increase Availability
By Peter Lyle DeHaan, Ph.D.
As your healthcare call center grapples to deal with more calls than perhaps ever before, you seek ways to maintain the service level you provide to callers. Ideas include using automation, increasing employee schedules, and hiring more staff.
A fourth option is to outsource calls to another call center—an outsource call center—that specializes in taking calls for other healthcare organizations. Before you dismiss this as a bad idea, consider four common types of outsourcing scenarios.
Outsource Certain Call Types
Analyze the types of calls you answer and the appropriateness of your existing staff to take them. As an example, assume you handle triage calls, appointment schedules, call transfers, and medical answering service. Note the number of calls and the amount of time you spend in each category. Now document how many agents can take each of these call types and the number of hours they work each week. See how well your staffing aligns with your call types.
Next identify the biggest gaps. By way of example, let’s assume you discover triage nurses taking routine messages for doctors. This is a huge mismatch. What if you send routine calls to your outsourcing partner, thereby freeing your nurses to do what they do best and what’s most important?
Of course, the opposite scenario is too many triage calls and not enough nurses. You can outsource those too, but it might be to a different outsourcing partner, one that specializes in telephone nurse triage.
Another scenario that’s ideal for outsourcing is at unexpected times when call traffic exceeds the schedule you carefully devised to meet the projected call volume. Instead of having calls pileup in queue, reroute them to your outsourcing call center partner.
Outsource Specific Times
Third, look for daily or weekly patterns to see how well staffing matches up with traffic. You may discover—or confirm—that your third shift staff doesn’t have enough work to keep comfortably busy. Outsource those third shift calls to your outsource partner. Then move your third shift employees to second.
Of course, depending on the type of work your operation handles, you could have the opposite scenario where not much happens during regular business hours, with all the action happening evenings and weekends. Then outsource first shift weekdays and reallocate those personnel to evenings.
Outsource Specific Days
Assume you have difficulty scheduling enough agents to handle your Sunday traffic. You can save yourself the hassle by sending those calls to your outsourcing call center partner and shut down your call center on Sundays. Then you can reschedule your few Sunday employees to other days of the week.
Many call center managers summarily dismiss outsourcing, either because they see it as a loss of control or because they perceive a lack of quality. Yet today’s leading healthcare call center outsourcers provide a high quality of service, often matching or even exceeding their client companies. Just vet them with care and make your decision based on outcomes, not price.
When you consider the benefits of being able to reallocate your staff to where they’re most needed and to better serve your patients and callers, outsourcing is a viable option that warrants careful consideration.
Peter Lyle DeHaan, PhD, is the publisher and editor-in-chief of AnswerStat. He’s a passionate wordsmith whose goal is to change the world one word at a time. Read more of his articles at PeterDeHaanPublishing.com.
Each year, approximately 16 percent of patients in United States hospitals are readmitted within thirty days of discharge. Readmissions and the additional treatments they entail are costly to both patients and insurers. Increasingly, they are costly to hospitals as well.
A portion of readmissions is unavoidable, such as a planned readmission for chemotherapy or an unexpected adverse event unrelated to the original diagnosis. However, many other readmissions are preventable through high quality clinical care and effective patient education and discharge procedures.
The Financial Impact of Hospital Readmissions
To reduce hospital readmission rates nationwide, the Centers for Medicare and Medicaid Services (CMS) began financially penalizing hospitals with higher than expected readmission rates via their Hospital Readmissions Reduction Program (HRRP) that began in 2012. The cost of those penalties across United States hospitals increased significantly from a total of 290 million dollars in fiscal year (FY) 2013 to an estimated 563 million dollars in FY 2019.
Failure to reduce readmissions has become more expensive over the program’s lifetime. In the first year of the HRRP, the maximum penalty was 1 percent of Medicare reimbursements withheld. By design, that maximum penalty has since increased to 3 percent.
National hospital readmission rates have dropped since the program launched, but not enough to decrease penalties. Of the 3,129 general hospitals evaluated in the HRRP in 2019, 83 percent received a penalty.
The increases are due in part to additional health conditions included in the program. In the program’s first year, CMS evaluated the readmission rates of patients with heart attacks, heart failure, and pneumonia to determine whether a hospital faced penalties. Today, CMS also measures readmission rates of patients with chronic lung disease, hip and knee replacement, and coronary artery bypass graft surgery. Scheduled readmissions are not counted.
Additionally, the program is set up such that CMS evaluates each hospital’s readmission rates relative to the national average for each condition. Even as readmission rates drop overall, there will always be hospitals that have more readmissions than the national average.
A 2016 study on hospital profitability published in the journal Health Affairs found that most hospitals in the United States are not profitable, and the median acute care hospital is losing 82 dollars per discharge. Given those numbers, it’s imperative for hospitals to reduce readmission rates and reduce the amount of Medicare reimbursements left on the table.
Readmission Rates and Causes in the United States
Some patients will always be readmitted after discharge. However, the wide range of readmission rates across hospitals suggests that there are addressable factors behind readmissions. In some cases, a readmission may be related to what happened during the original hospitalization. In other instances, patient readmission ties to what happens after discharge from the hospital.
A study on preventability and causes of readmissions published in JAMA Internal Medicine in 2016 reviewed the cases of 1,000 general medicine patients readmitted within thirty days of discharge across twelve United States hospitals from April 1, 2012 to March 31, 2013. Of those 1,000 readmissions, 26.9 percent were potentially preventable.
According to the study, common factors in potentially preventable readmissions were related to what happened at the time of discharge and after the patient went home. The authors cited emergency department decision making at the time of readmission, patient failure to keep important follow-up appointments, premature discharge, and lack of patient awareness about who to contact after discharge as the most common factors.
The study’s authors concluded that “High-priority areas for improvement efforts include improved communication among health care teams and between healthcare professionals and patients, greater attention to patients’ readiness for discharge, enhanced disease monitoring, and better support for patient self-management.”
CMS’s steep penalties are motivated by a desire to provide better patient care and, in doing so, to reduce healthcare costs. One of the best ways for hospitals to prevent unnecessary readmissions is by calling patients after their discharge to check in on symptoms, review medications and treatment plans, and offer patients an opportunity to ask questions about their recovery.
Post-Discharge Patient Education
Often, a patient is readmitted because they didn’t follow the correct medication regimen, lacked understanding of the treatment plan, or failed to follow up with their primary care physician after discharge.
Ideally, patients receive thorough education about medication regimens and treatment plans throughout their stay and at the time of discharge. However, literacy and comprehension rates vary across patient populations, and patients don’t always understand written or verbal discharge instructions.
Additionally, at the time of discharge, patients are preoccupied with the logistics and excitement of going home. Attempts at patient education might not be effective, no matter how well delivered. Once patients have arrived home, the complexity of managing their new medications and daily routines on their own becomes much more apparent.
Several studies have found that other factors, including the patient’s social support network, marital status, gender, and income can affect a patient’s ability to follow discharge instructions and manage their care at home.
Whether it’s addressing a lack of comprehension regarding a patient’s treatment plan or addressing a lack of support in enacting that treatment plan, a post-discharge phone call can provide a way for hospitals to help patients stay well at home.
Using Calls to Reduce Readmissions
Hospitals have many opportunities throughout a patient’s healthcare journey to reduce the chance of readmission. One commonly cited way to reduce readmissions is by improving patient education around managing their care after discharge.
Specifically, implementing a post-discharge phone call to review medication regimens and treatment plans, discuss symptoms and other concerns, and check in on home health services and follow-up appointments helps reduce readmission rates.
A paper published in the American Journal of Medicine in 2001 found that when pharmacists called patients two days after discharge to review whether they had obtained and understood how to take their medications, patients were much less likely to visit the emergency department within thirty days of discharge. Ten percent of those who received a phone call from a pharmacist went to the ED, compared to 24 percent of patients who did not receive a call.
In another program, IPC The Hospitalist Company (IPC) tested the effect of post-discharge call center outreach on readmission rates. Nurses at the IPC call center called 350,000 discharged patients from October 2010 through September 2011. During the calls, nurses talked through each patient’s symptoms, medications, home health services, and follow-up appointments. The nurses answered patient questions about discharge instructions and, if the patient had a serious medical need, contacted the patient’s hospitalist or primary care physician.
Nurses successfully reached 30 percent of patients. This program prevented an estimated 1,782 avoidable readmissions over the course of a year.
Setting Up a Post-Discharge Call Program
Research suggests that the best time for a post-discharge call is within the first two to three days after a patient arrives home. At this point, the patient has had the opportunity to settle in, fill medications, make follow-up appointments, and it is still early enough for a nurse’s call to make an impact. Many patients won’t answer on the first try, so nurses should plan to call more than once.
The first step in setting up a post-discharge call program is to ensure that call center staff have the best number to reach each patient. Sometimes the number in the patient’s record is different from their home or cell phone number. IPC The Hospitalist Company found that by asking patients for the best number to reach them or their caretaker, they were able to increase their successful call rate from 30 percent to more than 40 percent of discharged patients.
Customized Care Call Scripts
Providing nurses with diagnosis-specific scripts can help make care calls more efficient and effective, as many conditions have standard red flags nurses should check in on, such as weight gain after discharge for heart failure. Virtually any type of script is easy to create, including common scripts for post-surgery, diabetic, and pediatric post-discharge calls. Setting up a unique script with detailed questions for each, helps to ensure patients understand discharge instructions, address any medication questions, and help ensure the patients are not experiencing symptoms that would cause them to be readmitted.
Nurses should also have access to physicians’ discharge notes to review patient-specific follow-ups. Physician discharge notes must be completed in a timely manner to give nurses the information they need for the calls.
To supplement the post-discharge nurse phone call, organizations can also use HL7 integration to receive discharge notifications and set up automated appointment reminder calls. This helps increase the likelihood that patients make it to their appointments and receive the prescribed follow-up care.
To avoid penalties and help patients to stay healthy at home, hospitals can leverage call centers and post-discharge phone calls with customized scripts to check in on symptoms, review medications and treatment plans, and remind patients of follow-up appointments. Studies suggest that such measures reduce the rate of readmissions.
For hospitals, implementing a discharge call center program can help avoid or reduce Medicare readmission rate penalties. For patients, the program can improve their post-discharge care management and health.
The 1Call Division of Amtelco is a leader in developing software solutions and applications designed for the specific needs of the healthcare call center marketplace. 1Call features a complete line of modular solutions specifically designed to streamline enterprise-wide communications, save an organization’s limited resources, and make them tremendously efficient, helping them bring wellness to their members and their bottom line.
What does your healthcare contact center stand for? How do you stand out in an industry with many options? Understanding who you are is the first step to determining your distinctive characteristics. But why does this matter?
This is important because when you have a unique quality then your stakeholders have something to rally around. They have a reason to be proud. Short of that you offer nothing to draw them in and keep them close. They have nothing to celebrate.
Though this most obviously applies to outsource call centers, it’s also applicable to in-house operations too. Here are some categories to consider.
The first place most call centers look at to distinguish themselves is their service level. They often focus on quality service. Though there are many ways to define this, some look at customer satisfaction (CSAT). Most every call center claims to offer quality service. However, saying it and doing it are two different things. To trumpet service quality with integrity requires that a third-party confirm it. Self-pronounced claims of quality service mean nothing.
Aside from quality, other service level considerations might be answering calls quickly (average speed to answer: ASA) or handling requests on one contact (first call resolution: FCR). Other ways to stand out include a low error rate or around-the-clock accessibility.
A second area to consider is how you relate to your staff. Though few employees—if any—will say they’re overpaid or over appreciated, look at how you regard your staff. Employees who receive proper compensation and know how much they’re appreciated tend to work harder and produce better outcomes. The side effect of this is improved service to callers, as well as a healthier financial position.
In call centers, where margins are thin, leaders often struggle with their compensation packages. They know that a 5 percent increase in payroll can move a profitable (or cash-positive) operation into an unprofitable (or cash-negative) one. Yet others successfully apply the adage of “pay more and expect more.”
Not all approaches to enhancing the relationship with your staff, however, require a financial investment. Also consider intangible ways to stand out. This includes letting employees know how much you appreciate them, connecting with them on a personal level, and even taking a simple step of giving them a sincere “thank you” for their work.
A third area to consider is the financial aspect. Is your operation fiscally strong? A call center that produces consistent positive cash flow has long-term viability. This means they generate profits for their owners or are a profit center for their organization. They stand out. Having financial stability can permeate an entire operation with positivity.
Next, do you provide your staff with the best tools possible? Is their work environment something they’re proud to enter every day? Though these may not seem as relevant of a consideration to use to define your call center, they can be. Employees in a top-notch work environment will speak highly of their jobs and their employer to their families and friends. This can ripple through the local area, elevating the call center in the process.
Though it’s good to address all these areas and strive to make them as good as you can, it’s impossible to make everything a priority. Attempting to do so will cause all areas to suffer.
Without neglecting any of these considerations, however, strive to elevate one above all others. Let this become the distinctive characteristic that your call center is known for and celebrated. This will help you stand out among all others and have a lasting impact for all stakeholders: your callers, your employees, and your organization.
Peter Lyle DeHaan, PhD, is the publisher and editor-in-chief of AnswerStat. He’s a passionate wordsmith whose goal is to change the world one word at a time. Read more of his articles at PeterDeHaanPublishing.com.
The COVID-19 pandemic has placed telehealth at the forefront in providing healthcare services. It has forced changes in the environments in which clinicians typically practice. Individuals who, under non-COVID-19 conditions, would seek access in an emergency department (ED), urgent care, or healthcare providers’ office are now avoiding these settings. And with community spread, the Centers for Disease Control and Prevention (CDC) recommends alternatives to face-to-face triage and visits in an office setting if screening can take place via telehealth (that is over the phone, through patient portals, or online self-assessment tools). A recent report from Frost and Sullivan suggests that telehealth will increase by over 64 percent nationwide this year and continue to increase in the years ahead.
The Agency for Healthcare Research and Quality (AHRQ) defines telehealth as “the use of telecommunications technologies to deliver health-related services and information that support patient care, administrative activities, and health education.” It typically consists of a two-way, real-time interaction over distance between a patient and a clinician using audio or visual technology.
Many consider the terms telehealth and telemedicine synonymous and interchangeable. However, telemedicine can describe a more limited set of remote clinical services such as diagnosis and monitoring.
In recent years, telehealth has become more recognized, especially in the aftermath of natural disasters (such as hurricanes, tornados, earthquakes, floods, and blizzards), when seeking routine care can be dangerous for both clinicians and patients. There was a tremendous uptick in telehealth interactions following Hurricanes Irma, Maria, and Harvey in 2017. Crises tend to increase the urgency of telehealth needs.
Using telehealth in rural communities to bridge the healthcare gap delivering routine care or providing access to specialists that typically exist in more urban areas is well known. Telehealth also makes services more readily available or convenient for individuals with limited mobility, time restrictions, or transportation issues. Furthermore, telehealth can help communicate with and coordinate care for individuals with chronic conditions in supporting self-management as well as assist with earlier interventions in the face of impending exacerbations.
The critical need for the recent social distancing between providers and patients has driven increased demand for telehealth. In response to the pandemic, the Trump administration has expanded access, albeit temporary, with changes to telehealth reimbursement policies.
Beginning March 30, 2020, the Centers for Medicare and Medicaid Services (CMS) allowed more than 80 additional services through telehealth. Clinicians can bill immediately for dates of service on or after March 6, 2020. According to CMS, it will now pay for telehealth services under the Physician Fee Schedule at the same amount as in-person services.
Healthcare providers, including physicians, nurse practitioners, clinical psychologists, and licensed clinical social workers, are now able to offer telehealth to Medicare beneficiaries, including standard office visits, mental health counseling, and preventive health screenings. Medicare often is the early adopter for changes in reimbursement, with other health plans following their lead.
A May 9, 2020 report in Modern Healthcare, said that Providence went from 700 video visits a month to 70,000 a week. New figures from Blue Cross Blue Shield of MA reported that daily claims for telehealth grew from approximately 200 to more than 38,000 in May. A May 26, 2020 article in FierceHealthcare reported experts predicting 1 billion telehealth visits by 2021, and currently almost half of practicing physicians are now using telehealth appointments.
With this shift in practice, healthcare providers will increase their use of telemonitoring devices to measure blood pressure, pulse oximetry, heart rate, temperature, and weight readings. Telemonitoring also will assess EKG tracings and views of the retina and tympanic membrane, as well as other data to diagnose patients.
There is growing concern about the decreased number of ED visits for emergent situations such as acute myocardial infarctions, cerebrovascular accidents, and other life-threatening situations. Recent statistics, as reflected in emergency medical system calls, offer evidence of increased deaths at home. EDs also report that patients are waiting too long to seek care, and as a result, have often suffered irreversible damage.
An article in HealthDay News on May 20, 2020 reported that U.S. EDs are seeing about half as many heart attack patients as usual. The data from Kaiser Permanente Northern California included 4.4 million patients. In looking at records from January 1 through April 14, they found that the weekly rate of hospitalizations for heart attacks decreased 48 percent. Moreover, fewer individuals with pre-existing cardiac conditions went to the ED from March 4 through April 14, when compared to pre-COVID-19 timeframes from the year before.
Telehealth Nursing Practice
Telehealth, in support of the Institute for Healthcare Improvement’s (IHI) triple aim has shown improved access, quality, and cost-efficiency of healthcare delivery and has resulted in an increased demand for telehealth nursing practice (TNP).
A medical call center with TNP registered nurses (RNs) using decision-support tools provide recommendations for care at home or accessing a higher level of care based on the caller’s symptoms. RNs do not give a diagnosis, nor do they prescribe medications, although in certain situations, RNs can provide refills or e-prescribe medications based on physicians’ orders.
The breadth and scope of TNP have advanced throughout the years. It has had a major presence in the United States since the 1960s, in Canada since the 1970s, and the UK beginning in the 1990s.
In the last half of the 70s, health maintenance organizations (HMOs) began using telephone triage and advice services as a gatekeeper to control consumer access to care. In the 80s, hospital marketing departments used telephone triage as well as physician and service referrals, class registration, and health education and information services to attract and keep their market share. Once again, in the early to mid-90s, managed care organizations further expanded telehealth services for demand management, recertification, and referral authorization due to the ever-increasing incidence of chronic illness and multi-morbidities as well as the associated rise in healthcare costs.
Present-day, the COVID-19 pandemic, has led to the role of telehealth nurses providing triage, surveillance, and monitoring for disease management, care management, case management, care coordination, and clinical prevention programs.
The use of telehealth has grown exponentially during this pandemic. It has filled a much-needed void in providing qualified medical care by clinicians without the necessity of commuting to a higher level of care. It has proven positive outcomes and high degrees of satisfaction. Telehealth is convenient and accessible, and while an option for many medical situations, it is especially important to know of its reliability during a public health emergency.
Traci Haynes, MSN, RN, BA, CEN, CCCTM is director, clinical services at LVM Systems.
1Call’s mission: Working together to provide the very best communication product solutions, backed by the best support available.
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 clinical 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 received twenty-eight patents, covering a wide range of communications processes.
Hospitals and healthcare organizations around the world turn to 1Call to solve their medical call center, answering service, on-call scheduling, on-site and remote operator, web-based communication, call handling, secure messaging, voice processing, conference calling, and automated integration engine notification needs. In an independent survey, 100 percent of the respondents said they would highly recommend Amtelco and 1Call over other healthcare communication providers.
1Call has a reputation for complete, professional system support, offering training, installation, and technical support staff on call on a 24-hour basis. When customers need assistance for their call center solutions, 1Call’s customer support staff provides fast and reliable service. Customer advocates, solutions architects, and product managers are available to help customers and answer questions before, during, and after the sale.
1Call understands that every healthcare organization has unique needs. 1Call’s customer support staff includes implementation specialists, installers, project managers, and technical support staff. 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 many of the staff members are in the Midwest home office, there are several regional offices around the United States.
Help When Needed, Pandemic Response
When the coronavirus became a pandemic and hospital call centers experienced a sharp increase in call volume, 1Call supported customers by offering free operator licenses. Because 1Call’s software can turn any desktop or laptop computer into a professional operator station, the service department also helped in setting up remote operator stations so staff could work safely from home.
“The free license offer from 1Call came at the right time. Additional operators were up and running quickly. I can’t tell you how appreciative I was to be able to have the ability for more agents to cover all of our calls,” said Shelley White, MS, CHAM, FACHE and director, patient access services for State University of New York (SUNY) Upstate Medical University
Customers have access to 1Call’s support team via phone, email, or the exclusive online TechHelper tool, where documentation, manuals, videos, and many more training tools are available. TechHelper is available 24-hours a day, with unlimited access. Emergency assistance for 1Call systems is available 24-hours a day, 365-days a year.
Software upgrades are included with support agreements, helping ensure that 1Call customers always have access to the newest features.
In an independent customer satisfaction survey, 97 percent of the respondents said the Amtelco and 1Call service and support was excellent (Amtelco Satisfaction Research Study conducted by TMA+Peritus, February 2015). 1Call looks forward to partnering with more healthcare organizations to provide this same level of service.
Streamlined Hospital Communication Solutions
1Call features a complete line of modular solutions specifically designed to streamline enterprise-wide communications, reduce errors, and lessen training time for new hospital call center operators. All the specialized 1Call solutions save an organization’s limited resources, making each organization tremendously efficient, enhancing the patient experience, and improving their bottom line.
Each 1Call solution comes with the benefit of Amtelco’s forty plus years of experience in the field of call handling and messaging. Thousands of 1Call and Amtelco systems are in operation around the world, 24-hours each day.
Easily Customizable Clinical Communications
1Call understands that every healthcare organization has unique needs and that they sometimes receive 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. 1Call also has a scripting team that is available to help customers with any specific requests.
Why Choose 1Call?
Hospitals continually recommend 1Call solutions to other healthcare organizations. So, more healthcare organizations continue to switch to 1Call. “Pretty much all of the 1Call team worked long hours as we trudged towards the cutover. I was constantly amazed to be getting email replies to questions at all hours of the day and weekends,” said Kevin Mallon, project manager for Canterbury District Health Board in Christchurch, New Zealand. (Watch video testimonials.)
Strong Partner Relationships
Hospital CIOs and CTOs are under tremendous pressure to do more with smaller budgets and staff. It’s paramount that they have a reliable health communications IT partner. 1Call forms solid partnerships with 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 that the 1Call systems are at their optimum performance levels to meet all 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 services to produce a comprehensive solution that satisfies the needs of each organization.
The 1Call technology partnerships include:
Apple iOS Developer Program
Avaya DevConnect Community
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.
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 Web Agent, miTeamWeb, MergeComm, and Genesis:
Web Agent: 1Call’s next generation, call-handling application, Web Agent, is a web browser-based telephone agent interface. Web Agent is compatible with most modern web browsers, enabling agents to process multi-channel calls on desktop computers, laptops, and tablets. Web Agent can perform directory searches, scripted messaging, and dispatching, and provide access to call log recordings, web content, and on-call schedules.
MiTeamWeb: MiTeamWeb is 1Call’s mobile-friendly web application that gives physicians and hospital staff fast access to on-call schedules, messages, directories, call logs, and status information using a secure browser connection on a PC, smartphone or tablet. The app features customizable widgets, allowing each user to personalize their miTeamWeb home screen.
The MergeComm Integration Engine: MergeComm automates 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 go to an individual, an entire group, or the current on-call personnel. Notification methods include email, miSecureMessages, IP phones, pagers, phones, smart devices, SMS, and Vocera badges.
The Genesis Platform: Provides the Intelligent Series applications with advanced software-based telephony. Genesis provides an all-inclusive call center solution for healthcare call routing, 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 SIP-enabled PBXs, connecting remote agents, and automating overhead paging.
Priority Call Override is a feature of Genesis that ensures urgent calls receive appropriate priority treatment to provide better care to patients. Code calls, emergency calls, crisis calls, and other priority calls can override less urgent calls, allowing agents to take immediate action. The call routes to the most qualified operator available and notifies all agents that a priority call is in progress.
As technology continues to evolve (and everyone knows it will) and as customers have new communication challenges, rest assured that 1Call and Amtelco will continue to develop new innovative solutions, as they have for over forty years.
Those of us in the healthcare communication field already know the value of telehealth and virtual care. As the COVID-19 pandemic evolved, telemedicine gained worldwide recognition as a critical healthcare tool to keep both patients and medical staff safe.
Telehealth has predominantly been used to bring healthcare to rural areas or isolated populations, such as overseas military personnel and those who work in the maritime industry. Until recently, the Centers for Medicare & Medicaid Services (CMS) placed certain stipulations on telehealth providers and would only reimburse for services provided in rural areas with specific audio-visual equipment.
However, due to the COVID-19 pandemic, on March 6, 2020 CMS relaxed restrictions and removed many of the conditions clinicians had to adhere to in order to provide telehealth services to patients living across the United States. Later, CMS expanded its telehealth adoption to include eighty-five new telehealth services to their covered list and set provider reimbursement rates for telehealth visits to be the same as in-person services.
Many people are new to the concept of telemedicine. On July 31, 2019 JD Power reported that nearly three-quarters of Americans weren’t aware of telehealth options or didn’t have access to technology to partake in telehealth. Yet, the American Hospital Association states that 76 percent of U.S. hospitals were already using telehealth before the coronavirus pandemic. Currently, forty-eight states require telehealth coverage in insurance plans.
Healthcare-related industries already had infrastructure in place and were prepared for the use of telemedicine and telehealth. However, few, if any, expected how quickly the use of these virtual tools would grow or how they would be used in new ways when COVID-19 began to spread. The coronavirus pandemic has dramatically accelerated the adoption of telemedicine usage. Telehealth visits sky-rocketed by 50 percent in March 2020 according to data from Frost and Sullivan, and analysts at Forrester Research estimates that virtual healthcare interactions will reach more than one billion by the end of 2020.
The pandemic has affected call centers in every industry. Most business websites have placed a message at the top of their home page warning of long hold times and delays in service.
In healthcare, communication setbacks can mean life or death. Understandably, hospital call centers experienced a substantial increase in calls early in the pandemic. Many healthcare call centers assist with telehealth efforts and they also serve as a hub for their healthcare organization during a crisis.
“We played an immediate role in the hospital’s corporate response to the coronavirus pandemic,” explains Shelley White, MS, CHAM, FACHE, director of patient access services for State University of New York (SUNY) Upstate Medical University.
“A COVID-19 hotline was established, and we took calls from multiple counties in our area. Within two weeks, our call volume drastically increased, and we needed more space in our call centers to work while practicing social distancing. We used free operator licenses from our vendor to set-up additional remote operator workstations so more of our agents could work from home. This kept our staff safe while serving the community.”
Running a call center in a virtual server environment, or in the cloud, is giving hospitals the ability to stay flexible and available by using remote operators. These tools are scalable and result in fully functioning call handling to transform any personal computer into a professional telephone agent station.
Call Center Software Assists Telehealth Communication
Using telehealth for virtual appointments with medical staff and patients has been essential during this pandemic. There are other ways healthcare systems use telehealth communications. Hospital call centers are using their communication software, often in new ways, to provide their communities and staff with accurate information, quick responses, and in some cases—hope.
Nurse Triage Centers: Agents use a customized script to triage calls.
Improved Navigation Menus: Callers are directed to additional, updated information.
Non-Clinical Services: Telehealth also refers to remote, non-clinical administrative uses such as establishing and maintaining on-call shifts for COVID-19 volunteer pools. They can even create announcements using a song, tone, or message to broadcast throughout the hospital when a coronavirus patient is released. It’s a wonderful way to spread hope and encouragement to patients and staff.
Many telehealth agents are working from home and it is crucial for them to have access to the IT support they would normally use when working in the call center. Jennie McWhorter, information services operations manager for Ephraim McDowell Health in Danville, KY explains how the system can help here as well. “We have entered a ‘Telehealth Support Hotline’ in the call center software that allows the operators to connect to our help desk directly,” says Jennie. “This is very important as our main help desk line is usually a voicemail-only system that creates a ticket in our help desk software.”
Remote Operators Help Medical Staff
Shelley White’s team has also been able to help staff who are still located within the hospital. SUNY Upstate Medical University is the only ACS certified Level I Trauma Center in the region and serves about 1.7 million people and 28 referral hospitals. Shelley says, “During this coronavirus crisis, our ER registration is short-staffed, but we are able to help by watching our track board, which is tied into the EMR system with Epic. When a COVID-19 patient is admitted, we can call the patient to register them and verify insurance information over the phone. This process would normally be done in-person by ER staff, but we can do it remotely and ease some of their workload.”
According to numbers reported from Becker’s Hospital Review on April 7, 2020, employees from 243 hospitals have been furloughed during the pandemic. Hospitals are taking steps to save supplies, suspend elective procedures, and focus on treating COVID-19 patients.
To avoid layoffs, some healthcare organizations reassigned their medical staff as remote call center operators. “We were able to redistribute existing staff from other departments and tap into their skills to cross-train them to work for the switchboard,” states Shelley.
“In our situation, patient access staff and medical answer teams were trained on easy calls and were then able to work from home as remote operators. These staff members are now even more valuable to our organization.”
Kathleen Kerrigan BSN, RN, and manager of medical communications center, radiology contact center and pager services for Nebraska Medicine mentions her experience: “Nebraska Medicine has created a flex pool for employees that work in areas of the organization that have closed or severely cut their workflows due to COVID-19. I was able to add nineteen of these employees to my team, including both nurses and agents.”
Telehealth as the New Normal: Telehealth has suddenly become crucial for patients and healthcare organizations. The use of telehealth has undeniably shown what a valuable tool it is in maintaining a healthy population.
Hospital call centers and healthcare professionals have already shown agility in adapting communications software in new ways to improve telemedicine applications while enhancing patient care—even during a pandemic. Advances in technology and our ability to use it could soon make the use of telehealth a standard healthcare practice.
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.
As the coronavirus pandemic progresses, nurse triage plays a critical role in helping healthcare organizations, hospitals, and practices manage their overwhelmed systems. Triage nurses evaluate and direct patients to the best level of care for their symptoms. As the weeks passed since the original national emergency announcement, our nurse triage center has seen important trends on what callers experience.
Traditionally, triage nurses use standardized protocols from Drs. Schmitt and Thompson to evaluate patients. Nurses can also use custom doctor orders to share handouts with patients, connect the patient to a doctor, or direct patients to appropriate local facilities such as drive-through testing centers.
The coronavirus pandemic brought new concerns, new protocols, and new care advice that needed to be developed to help address patient symptoms. Nurses were quickly trained and given new guidelines to address patient questions as the problem unfolded. As we look back over these last several weeks, we’ve seen changing trends among callers and new issues arising that the healthcare profession will need to address.
We quickly saw a 30 percent increase in patient phone calls to triage nurses as news of the Coronavirus broke. During the first weeks most callers were worried and trying to understand which symptoms to look for. They asked questions about the virus, what precautions to take, and where to go for further help if needed. Overall, there weren’t many reports concerning symptoms related to COVID-19.
As time went by and the media began to pay closer attention to the virus and air all the details on news networks, we saw a swell of anxiety in our callers. While there were still not many callers who reported concerning symptoms associated with COVID-19, we started to receive more phone calls related to anxiety, depression, and suicide.
Updates on Caller Issues for the End of March and Early April
Our nurses have now received several calls from distressed patients who show the concerning symptoms of the virus. The nurses used the protocols to determine which callers now have symptoms that require further evaluation by a doctor. But while patients with COVID-19 like symptoms are told to seek the appropriate level of care and go to the hospital, a new issue emerged.
Patients are avoiding the ER due to worry about virus transmission. Unlike anything seen before, nurses find that patients who have serious symptoms that require an ER visit are refusing to go. These callers are reporting that they do not want to go to the hospital for worries about catching the virus from a hospital setting, or that they don’t want to intrude on an already burdened system.
Compounding the situation, after the caller is convinced to seek medical attention, hospitals may turn them away. This is either because the hospital is unable or unequipped to help. Some cities may also have facilities that are focusing on COVID-19 cases. Because of this, they do not have the capacity to help other patients. The confusion among patients about where to go to get help can increase morbidity. This is especially true with health issues such as chest pains, which hospitals regularly address and evaluate.
Healthcare centers and hospitals are working hard to manage the extra care needed for the influx of COVID-19 patients. Many cities have developed hotlines to help alleviate the workload of healthcare professionals and determine which patients need to be seen by a nurse. New solutions are being implemented daily as we learn more about this epidemic and how it is affecting our communities.
Dr. Ravi Raheja is the medical director at TriageLogic, a leader in telehealth technology and services. The company’s goal is to improve access to healthcare and reduce costs by developing technology for providers and patients, backed by high-quality nurses and doctors.