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Articles from AnswerStat

The Trouble with Medical Answering Service

By Joseph Sameh

Nationally, the medical answering service industry has a problem. Typically, when a person purchases a service, there is a perceived notion of value gained through that purchase. Housekeeping, snow removal, tow truck services, and office janitorial services are just a few examples. Physicians’ point of view towards answering services once fell into that category as well. But that was then and this is now.

The Problem: Managed care, by changing the one-to-one relationship between patient and physician to a triangle of physician, patient, and third-party payer has caused medical answering services to be perceived as a cost-center rather than a valued service. Each evening for more than 60 years, answering services have been providing overnight backup telephone support for physicians. Before managed care, most patients and their physicians had a one-to-one relationship that lasted throughout their lives. Most physicians were sole proprietors in private practice. When a patient called the doctor after office hours, the doctor naturally had great insight into the patient’s history and medical needs. The two grew old together. The invoice amount paid by the physician to the message service was viewed as part of the overall cost of maintaining good relations with patients in an era of increasing economic advantage for healthcare providers. A fee-for-service insurance reimbursement model characterized the era. As such, the patient and the provider were both beneficiaries of the after hours call. The patient received around the clock care that was expected and the physician knew the patient would be a loyal customer in return.

With the advent of managed care, certain concurrent events changed the landscape of medical practice management. One change that exerted great influence on the patient-provider relationship was managed care itself and the impact of its lists of network providers. No longer was the relationship between patient and provider under the control of the patient and the physician. It was suddenly under the influence and control of the insurers and employers.

Managed Care Organizations (MCOs) began to apply downward financial pressure for reimbursements to physicians. As a result, the patient/provider relationship hit a low point. Patients began to complain that not enough time was spent with them in the office. Sometimes physicians were no longer readily available after hours. Physicians began to complain that they couldn’t treat the individual appropriately due to managed care oversight. Physicians also began to experience income stagnation and even contraction. Consequently, physicians no longer perceived themselves as the beneficiaries of the after-hours transaction. The new beneficiaries of after-hours services became the patient, the answering service, and occasionally the pharmacy.

Unfortunately, the physician still has to retain 24-hour coverage, and therein lies the problem; physicians still must pay for answering service. Today, answering services for physicians are considered a necessary evil. When patients call after hours, the physician may be contacted by the answering service. If so, the physician and the patient discuss the crisis at hand and map out a strategy. For all the commitment, hard work, and effort of the call center staff, the only thing the physician perceives today is an invoice from the call center at the end of the month – that is with the exception of the middle of the night wake up call to treat the patient. How would you feel if you were a purchaser of this service?

Along with the emergence of MCOs and due to some of the same pressures, solo practices began to disappear as ever increasing group size became an unpleasant fact. This trend benefited the physician in some quality of life measures. Permitting and supporting a nightly call coverage scenario, one in which physicians began to experience evenings off on a regular basis, is one such benefit. The era of sole proprietorship was largely over. Now we have the day of the physician-employee. This further inflamed the breach in the patient/provider covenant as patients lost control over who would manage both their daytime and after-hours needs.

Development of large, multi-disciplinary groups led to another tension: the successful management of on-call coverage schema by the message center. Due to human error or lack of understanding, often the wrong physician may be paged or no one at all is contacted for urgent matters. Indeed, industry experts agree that incorrect message dispatch is the most daunting issue for physicians utilizing medical answering today.

Adding to this challenge, outside market forces have inevitably affected every provider to the health care field. Answering services are no exception to this reality. In terms of inflation-adjusted dollars, the rates for answering services are significantly lower today than they were 20 years ago. Labor costs are higher as a percentage of overall costs than ever. An abundance of high-tech equipment and a search for lower paid, entry-level employees answering phones for physicians is the result. When one adds the cost to adequately train and retain quality employees there is scant room for error on the employer’s part.

To add insult to injury, regulatory pressures on the health care delivery system have created more paperwork for every medical practice. Consequently, office staff has a greater burden than ever before. According to Howard Wolinsky, co-author of Healthcare Online For Dummies and a veteran medical and technology reporter for the Chicago Sun-Times, “If we could get physicians and their patients to communicate via email and avoid voice mail jail, we could save loads of time and even squeeze out more time for docs to spend with their patients face to face. Now that would be a breakthrough.” According to Wolinsky, “with the availability of broadband and new technologies, the pieces already are in place.”

Other sources, including Harris Interactive, reported that the results of a survey conducted in April 2002 indicate that 95 percent of patients want to exchange email with their physicians. However, a much smaller percentage of physicians do. This suggests that many patients hope physicians will take advantage of Internet technology to improve patient outreach efforts, but that physicians themselves may still be ambivalent. According to the results of the Harris Interactive survey, people are accustomed to using the Internet for customer self-service. Customers can now track package shipments, pay bills, order books, and do numerous other tasks without the participation of a customer service representative. More than 90 percent of people with Internet access would prefer to communicate with their doctor via email while only 15 percent of physicians would want to do so.

The most significant use of the Internet in the teleservices industry is in the self-management and maintenance of on-call schedules. As a result, many call centers have been reclassified into contact centers.

The Threat: A number of organizations are providing email access to physicians. Understanding the threat of this technology is crucial. These new providers will unquestionably grow and this trend has the potential to destroy the medical answering service industry as we know it.

These companies are well organized and superbly financed; some even have the support of pharmaceutical companies and massive electronic medical records suppliers. One such company, Medem, is endorsed by the American Medical Association. Think back to the introduction of voice mail and remind yourself how that technology changed the commercial telemessaging business. In a similar way, cable TV has hurt the broadcast networks. For those providing medical answering services, this is an even bigger threat.

The Opportunity: Admittedly, these players have the significant advantages of access and money but many don’t fully understand the operational dynamics of the health care call center market, the patients, and the practices. Many companies intend to charge patients to use their service. Why patients would flock to a “pay-for-email” model when they could place a phone call instead is hard to imagine, unless the office hold times are so staggering that any price is worth avoiding the wait. Banks have successfully implemented pay-for-service by providing notoriously poor service to their client base. Now banks charge for everything. In the U.S. we have what many believe is the best health care system in the world, but access can be a challenge. These new players are addressing the aspect of patient access.

Most of these companies rely on the physician as the contact point for the patient. Stated differently, if the patient’s call results in a physician requiring the patient to come in to the office, the doctor ends up asking the patient to call the office to schedule an appointment. The physician becomes the secretary for the secretary. Physicians answering phones at the front desk is not a viable option, yet these companies think physicians will want to answer all email messages.

However, there are some successful Internet self-service models. Federal Express successfully offered its clients an easy-to-use system. Customers can augment live customer service with Web-based self-service. This process saves millions of dollars annually in reduced labor and the more it is used, the more valuable it becomes. This is known as the “role of network” effect. In order for medical teleservice companies to survive in the age of managed care, they must adopt successful Internet strategies and capitalize on their industry experience before they are passed by.

Joseph Sameh is the founder of Mediconnect, Phone Screen, and NeedMyDoctor.

[From the Summer 2003 issue of AnswerStat magazine]

Support Center Site Certification

By Greg Coleman

If you are considering site certification for your support center you are probably deluged by the sheer amount of information, facts, and myths about the benefits of earning certification. You may also wonder what being “certified” means, how to go about it, and why. In this article, we’ll sort all this out and take a broad look at some of the benefits of certification along with some of the things to look for when selecting a certification program. Certification methodology and quality of results can fluctuate widely between the various programs and the more information you have now, the better off you’ll be when selecting the program that will best help you achieve your desired results.

Who Should Consider Certification and Why? Here are some of the reasons organizations choose to become certified, along with what to look for when selecting a certification program.

A Roadmap to World Class Support: The program should provide a framework for the development of your support organization. The certification criteria should provide guidance for ensuring that best practices are followed and should focus the organization on delivering the highest quality support possible.

  • Address Specific Support Related Issues: The certification program should cover virtually every aspect of support center operations. It should provide a focus on key operational areas that need attention. By gaining this focus, support organizations will have the momentum necessary to address long-standing issues, and improve overall operations in the process.
  • Validate Their Current Practices: Those companies that feel they are already delivering top quality support can use a certification program as a means of validation. Inevitably, areas for improvement will be identified through the certification process that will drive even higher levels of performance. The certification process should validate the practices in place within the organization and allow for attainment of industry recognition for the quality of support being delivered.
  • Market Support as a Competitive Differentiator: The certification program should provide the type of external validation required to help communicate the quality of support being delivered to your customers. Certified support organizations should have the rights to use the certification logo in marketing materials, enabling your company to better promote its services.
  • Drive Consistency in Support Delivery: Many support organizations deliver support through multiple support centers both regionally and across the globe. Consistent service delivery is a key component in maintaining and driving higher customer satisfaction levels. The certification program must provide a common framework through the program criteria and define the practices necessary to deliver consistent service levels across multiple support centers. The program should then measure the degree of consistency through the certification audit process.

Benefits of Certification: The benefits associated with earning site certification for your support organization are numerous. Among them:

  • Increase Customer Satisfaction: Increased customer satisfaction and loyalty through improvements in operational effectiveness and staff productivity
  • Benchmark Against the Best: You can benchmark your support operations against industry best practices and compare your operations against those of other world-class organizations.
  • Gain an Advantage Over the Competition: Your clients, shareholders, investors, and prospects will recognize the commitment your company has made to become certified. Use the certification process to set your organization apart from your competitors.
  • Improve Service Delivery: The improvements that you make in an effort to achieve certification will benefit your customers by providing them with improved service delivery and better trained staff, as well was better implementation and documentation of key processes and procedures. Virtually all support organizations could improve in one area or another.
  • Retain Customers by “Blocking-Out” the Competition: Your customers will recognize the commitment your company has made to becoming certified. Use the certification process as a customer retention tool to set your organization apart from the competition. It’s one thing to claim quality support; it’s another to prove it.
  • Leverage a Continuous Improvement Program: New products and services, changing customer demands, competition, and new markets are just a few areas that offer ongoing support challenges. Certification helps assure that your customers will receive a high quality of support. In addition, ongoing re-certification can drive continuous improvements year after year. You’ll have a continuous improvement program in place that enables you to provide world-class service to your customers.
  • Gain Consistency Across your Support Organizations: By certifying each support center in your organization, you drive process and performance consistency across your organization. For example, the Support Center Practices (SCP) Certification program defines a common vocabulary and best practice roadmap. Providing a common goal and vocabulary eliminates traditional organizational barriers that can derail other continuous improvement efforts across support centers.

Return on Investment: Certification creates value in many ways. It focuses your support center on results that directly affect your bottom line. Depending on the certification program you select, your initial investment can be less than one-half of a full time equivalent per support center with minimal implementation costs.

  • Efficiency: With a leading certification program you can expect greatly improved effectiveness and/or efficiencies of the processes in place within your support centers, including improved response times and lower operational costs.
  • Differentiation: Achieving certification with a leading program means you have joined the best of the best. It isn’t easy, but recognition of value seldom is. The best programs require you to pass a rigorous onsite audit covering all program elements to attain certification.
  • Consistency: Certification should improve the focus on strategic planning for your support organization. You should be able to implement common support practices leading to high quality support delivered consistently worldwide, develop consistent use of tools, implement standard set of support metrics, and enhance your support strategy and vision.
  • Recognition: Certification can help raise the internal and external awareness of value of the customer support organization. Internal recognition elevates morale within your organization and your customers will appreciate the value of post sales support. This helps you leverage service as a competitive advantage.

Selecting a Certification Program: Once you’ve decided to seek certification, do your homework, and select the program that is best for you. A few things to consider:

  • What is the program’s record of accomplishment? Who developed the certification criteria? Who sponsors it? How long has it been available?
  • Who are the certified participants? Check the names of organizations that have been through the certification process. How are they perceived in the market? Call a few of them and ask for their direct feedback and ask about the benefits they have received.
  • What is the market acceptance? Is the program the internationally accepted standard to which others are compared? How many organizations have adopted the certification program?
  • What are costs? Are all fees stated upfront? Are there associated consulting fees? Some certification programs require costly consulting engagements or additional fees. Research all the costs up front to avoid unwelcome surprises.
  • How often is the program revised and updated? Being world-class today doesn’t mean world-class next year. New trends and technology are continually raising the bar on superior customer support levels. Make certain that the certification program you selected is updated and revised on a regular, published schedule.
  • Program content: Look for a program that can quantify the effectiveness of your support based on stringent performance standards that represent best practices in the industry. The program should establish a foundation to build on existing quality processes and provide a clear focus on measurable results. Make sure the program is designed specifically to increase customer satisfaction and loyalty through improvements in operational effectiveness and staff productivity. Ensure that the certification program provides a continuous improvement process that enables you to provide world-class service to your customers. After all, that’s the bottom line.

Greg Coleman is the Vice President of Certification Programs for Service Strategies Corporation; call 858-674-4864 for more info.

[From the Summer 2003 issue of AnswerStat magazine]

Vendor Spotlight – Startel Corporation

Technology and Solutions Provider for Healthcare Call Centers

Startel Corporation was founded in March 1980 and is a leading provider of solutions for medical, healthcare, and university communications. Startel has been providing comprehensive communications solutions since its inception and continues to deliver reliable and flexible systems and applications. Customers using Startel’s solutions are able to increase customer satisfaction levels, manage human resources more effectively, reduce training costs, increase employee productivity, and maximize their return on investment (ROI) by taking advantage of the functionality provided by the system. In addition to a powerful system, Startel provides world-class training, custom software development, consulting services, implementation, and support.

Startel’s Soft Switch Solution:

  • Leading Edge: The open architecture of Startel’s Soft Switch ensures that the system will always be up-to-date with all new industry features, functionality, and will support all current trunking options, including SIP, as well as new protocols that may be introduced to the market in the future.
  • Reliability: Minimal hardware requirements provide for less potential failure points, while the software allows for full system redundancy and automated failover.
  • Scalability: Utilizing distributed processing, the system can be scaled to handle virtually any call volume. Processing power can be easily increased using load balancing
  • Mobility: One server connected to the LAN, with either SIP or PSTN trunking, provides telephony to agents throughout the world and supports a full range of IP phones and free soft phones. An agent simply connects via an established VPN gateway.
  • Flexibility: Support is provided for multiple hardware configurations, as well as both TDM and SIP trunking. It utilizes industry standard server class CPUs and supports a wide variety of interface cards for PSTN connectivity, such as FXS/FXO and PRI/BRI.
  • ROI: Users can increase their return on investment by utilizing minimal hardware and via hardware flexibility, allowing for smaller investments in hardware and the ability to easily upgrade hardware over time for better efficiency and lower costs.
  • Maintenance: Startel provides remote diagnosis and soft fixes. The use of load balancing allows for the performance of standard maintenance without taking the system offline.
  • User-Friendly Configuration: A GUI (graphical user interface) allows for remote access for configuration and maintenance.
  • Single Point of Access: All setup and configuration and be handled through a signal access point.
  • Rapid Application Development (RAD): Applications can easily be added due to a full software environment with no hardware modifications.
  • Fully Integrated to the Startel CMC System: The Soft Switch provides full computer telephony integration (CTI) to all Startel CMC functionality.

SMS (Short Message Service): SMS is functionally synonymous with “texting” or “text messaging.” The popularity of SMS has grown dramatically over the last several years, and it is estimated that 75% of cell phone users send text messages daily. Utilized initially as a consumer application, the proliferation of SMS as an alternative business communication has increased dramatically over the last 12 months and is becoming an essential part of the fully integrated business communications platform utilized by call centers worldwide.

Startel is pleased to offer customers with a robust, reliable, low cost, easily implemented/maintained, and fully integrated service. Startel’s SMS service is a pure software solution, the reliability is high, and the total cost of ownership (TCO) is greatly reduced over the SMS solutions. Startel offers two versions of SMS service: one fully integrated into the Startel CMC platform and the other for customers utilizing other call center solutions.

“We’re excited at the potential of Startel’s SMS Service to transform message delivery. SMS will continue to increase as a communication channel. We want to bring our clients innovative solutions that leverage our Startel CMC’s service offerings,” stated Christopher Bell, president of MedCom Professional Services, Inc., located in Levittown, PA. Patty Moreno, systems manager for Alert Answering Service located in Ventura, CA, added, “I like the fact that Startel’s SMS solution is fully integrated with our billing package and includes the ability to set unique IDs for clients and clients’ clients.”

Startel’s Enterprise Instant Messaging (EIM): Startel has created an enterprise instant messaging (EIM) Service that fully integrates with the Startel CMC platform’s administrative controls and can function as a standalone product administered via a Web Interface for customers utilizing other contact center solutions or simply wanting a standalone EIM service.

Startel’s EIM solution enables real-time text based communication between two or more participants over the Internet, the corporate Intranet, or both in combination. Selected features include the ability to transfer files via the IM service, remote desktop monitoring, the ability to send broadcast messages, conference room capability, and secure sockets layer (SSL) encryption capability, as well as all standard features one would expect with an EIM service.

Other Standard features of Startel Call Management Center (CMC): Other standard features of Startel’s CMC are that it is HIPAA compliant and includes a CTI Interface and health level 7 (HL7) integration. Software includes workforce management, intelligent dispatch, voice services, meet-me-paging, and Internet IntelliScheduler. It is a Windows 7, SQL-based system. Startel is a Microsoft Gold Certified Partner, as well as an independent software vendor (ISV).

New Location: Startel Corporation recently moved into their new state of the art facility located in the Irvine Spectrum, a high technology center of Orange County, CA. Just one of the many benefits in the new building is access to the fastest fiber optics service in Southern California, which will allow Startel to expand into hosted services. Their new address is 16 Goodyear, Irvine, CA 92618.

[From the Summer 2003 issue of AnswerStat magazine]

Seven Steps to Service Recovery

By Nancy Friedman, Telephone Doctor

Almost anyone who’s been in a customer service position has had to talk to an irate caller or been in an unpleasant situation. Even though it may not be our fault, we still need to know how to recover the situation. Here are seven steps to service recovery that will help make your day a better one!

  1. It is your responsibility: If you have answered the phone on behalf of the client, you have indeed accepted 100% responsibility. At least that’s what the caller believes. So get off the “it’s not my fault” syndrome and get on with the “what can I do for you?” position.
  2. “I’m sorry” does work: Every once in a while, I hear from a CSR who tells me they don’t feel they should say “I’m sorry” when it wasn’t their fault. Well, as stated above, in the caller’s mind, it is your fault. Saying you’re sorry won’t fix the problem, but it definitely does help to quickly defuse it. Try it; you’ll see.
  3. Empathize immediately: When someone is angry or frustrated, the one thing they need is someone who agrees with them, or at least makes them feel like they’re being understood. Be careful, though: “I know how you feel” is not a good thing to say unless you have been through exactly what they have experienced. Instead try, “That’s got to be so frustrating” or “What an unfortunate situation.”
  4. Immediate action is necessary: Don’t make a client wait for good service. Take their calls right away; return calls as soon as possible. Send out materials the same day, if possible. That’s recovery. Remember the Telephone Doctor’s motto: “It should never take two people to give good customer service.”
  5. Ask what would make them happy: In a few rare cases, the client can be very difficult. If you have tried what you considered “everything,” simply ask the client: “What can I do to make you happy, Mr. Jones?” In most cases, it may be something you’re able to do. You just may not have thought of it. So go ahead and ask them.
  6. Understand the true meaning of service recovery: Service recovery is not just fixing the problem. It’s making sure it won’t happen again. It’s listening to the client and taking the extra steps needed . It’s going above and beyond.
  7. Follow Up: After you feel the problem has been fixed, follow up. Once you’ve made the client happy, make an additional phone call a day or so later. Be sure to ask them: “Have we fixed everything for you?” “What else can we do for you?” Be sure they’re satisfied. When you hear “Thanks, you’ve done a great job; I appreciate it,” you’ll know you’ve achieved service recovery!

Nancy Friedman is president of Telephone Doctor®, a training company specializing in customer service and telephone skills. She is a frequent keynote speaker at association conference and is the author of four best selling books. Call 314-291-1012 for more information.

[From the Summer 2003 issue of AnswerStat magazine]

Improve Your Return on Your Recruiting Investment

By Jeff Dahltorp

Call centers traditionally leverage four recruitment channels for their staffing needs: the Internet, third party recruiters, print advertisements, and referrals. Using all four of these targeted approaches in the right mix and for the right reasons ensures that you are recruiting good employees while minimizing costs. Let’s briefly look at each of these approaches and then examine how they all work together.

Referrals: A well-managed referral program can be the most cost-effective way to hire new, quality employees. The majority of call centers have some sort of employee referral program in place that pays a current employee a “finder’s fee” for referring someone that is hired and ultimately stays with the company for 90 days, six months, or a year. These fees generally start at $50 and go up from there, depending upon the types of individuals someone is looking for and the size of the company.

The problem that some call centers face is a rising cost where there is no tracking done on the referrals that come through the system. Employees may refer someone after they see that a position has been posted online, placed in the newspaper, or turned over to a third party recruiter. If you end up hiring a person that was referred by an employee, your cost is not just the finder’s fee, but the cost of all the other advertisements as well. Use your referral program before you enter the market.

Print: This is the most traditional method used for locating employee candidates, but has become one of the least efficient in today’s economy. Ten years ago, placing an ad in the classified section of your local newspaper for an open position was really the only way to reach a large pool of candidates. Usually these people lived in the area and they were more likely to stay long term with your organization. At the same time, placing that advertisement could cost in the thousands of dollars in a highly visible publication and you may have only received a handful of qualified candidates or you just settled for the best of the bunch.

Today, the Internet has really taken a toll on the value of a print advertisement for recruiting. But the fact is that there still is a place for print advertisements depending upon the goals of your staffing organization. Certain people still prefer to look at the classifieds for new jobs, especially part time and entry-level positions. People who may not have direct access to the Internet may still read their local paper everyday. Reaching them through print can be very effective. Evaluate your objectives for filling a position to determine if there is value in a print advertisement.

Third Party Recruiters: The third party recruiter does serve an important function in any company’s recruiting effort, especially when locating a corporate-level executive or the hard to find specialist in a medical, engineering, or financial field. Often the network that these companies have to generate qualified, passive candidates is very impressive. As with print, think about the type of person you are trying to hire or the position you are trying to fill and determine if you can handle it through a referral, print or the Internet. If not, then it might be best to start with a third party recruiter.

Internet: Ten years ago, no one even knew what the Internet was. Five years ago there were a few career sites online but none of them were well recognized. At that time, employers wondered, “Why would you place a job online when there are very few people who have access to those job postings?” Today, utilization of the Internet and the thousands of career sites that cover all job specialties and industries is the norm. For a very low cost relative to print and third party recruiters, a company can have access to thousands of candidates from all over the world in just days. However, this can be a double-edged sword.

When you have thousands of applicants, you want to make sure that you are interviewing the best candidates. New technologies are on the market today that can prescreen, test, and rank your candidates before a recruiter even sees the resume. These technologies can also be used for those candidates you receive from referrals, print advertisements, and third party recruiter.

Combining These Four Methods: In reality, no call center can meet its staffing needs using only one of these four approaches on its own. A mix of two or more of these methods is truly effective in finding and retaining the best candidates. Start with the referral process. If you don’t currently have a referral program, then get one set up. There are a number of good companies in the market that have the technology to manage referrals and payment of finder’s fees. If you do have a referral program, make sure that your employees know about it and how it works. Having them refer people through an internal system allows you to track those candidates and referrals before you post a job online or with a third party recruiter.

After you have a functional referral process, look at the types of positions you have open. Would these open positions be best filled by an Internet posting, a third party recruiter, or an ad in the newspaper? Just about any position can be filled using the Internet but you can’t expect one general job board to meet all your needs. There is a reason why there are hundreds of successful career sites on the Internet; they all have a place for attracting qualified candidates. You simply need to know which ones to use for your company hires. Third party recruiters can be incredibly efficient, but they can be costly. Make sure that you are not relying on them for all your hires. Reallocating some of the print and third party recruiter budget to the Internet or to new generation recruiters and technology can help you reach the same results at a lower overall cost per hire.

Your decisions should be based on your company, your technology, and your budget. Creating a recruiting process that incorporates an employee referral program and a strong Internet presence supplemented by third party recruiters and print advertising will generate candidates that will make you and your management proud by optimizing your workforce while minimizing costs.

Jeff Dahltorp is the Director of Global Marketing and Business Development for TruStar Solutions, which helps organizations create exceptional hiring strategies.

[From the Summer 2003 issue of AnswerStat magazine]

Hospital Answering Services Could Be Risky

By Mike Wilson, JD

Hospitals that provide answering services to physicians at below fair market value (FMV) may risk violating federal or state law – with serious consequences. “Stark II” is a federal law to discourage doctors from referring Medicare and Medicaid patients to entities with which they have a financial relationship, which can include indirect compensation in the form of benefits. For example, hospitals that rent office space to physicians below FMV may violate Stark. Possible penalties include denial of Medicare and Medicaid payments, reimbursement of past payments, and exclusion from Medicare or Medicaid in the future, as well as civil penalties of up to $100,000.

The federal Anti-Kickback Statute prohibits physicians from receiving compensation for referral of patients covered under Medicare, Medicaid, and other federal health programs. Again, compensation could include indirect benefits such as below FMV office leases. Unlike Stark, Anti-Kickback also requires proof of intent to induce referrals. The Anti-Kickback Statute has potential criminal penalties, civil penalties of up to $50,000, treble damages, and exclusion from federal health programs. Some states also have laws similar to Stark or Anti-Kickback.

Language in the Stark regulations suggests that free meals for doctors in the hospital cafeteria, for example, are subject to Stark. Concerns then may be, are free or heavily discounted answering services for doctors a kind of “compensation” subject to Stark? If so, the arrangement would fall under one of the exceptions in the regulation or it would be a violation. For example, if the “compensation” does not exceed $300 per year (and meets other requirements) or is provided at fair market value (and meets other requirements), there is no Stark violation. However, the exception most likely to apply to answering services is the “medical staff incidental benefits” exception.

Medical Staff Incidental Benefits: This exception has eight requirements, all of which must be met (when reading the quotes from the regulation below, substitute “answering service” for “compensation”):

  1. “The compensation is offered to all members of the medical staff without regard to the volume or value of referrals or other business generated between the parties.”
  2. “The compensation is offered only (emphasis added) during periods when the medical staff members are making rounds or performing other duties that benefit the hospital or its patients.”
  3. “The compensation is provided by the hospital and used by the medical staff members only on the hospital’s campus (emphasis added).”
  4. “The compensation is reasonably related to the provision of, or designed to facilitate directly or indirectly the delivery of, medical services at the hospital (emphasis added).”
  5. “The compensation is consistent with the types of benefits offered to medical staff members by other hospitals.”
  6. “The compensation is worth less than $25 per occurrence of the benefit.”
  7. “The compensation doesn’t take into account the value or volume of referrals or business generated.”
  8. “The compensation arrangement does not violate the Federal anti-kickback statute.”

Third Party Enforcement: Many courts have held that third parties can bring an action against violators of Stark or the Anti-Kickback Statute under the False Claims Act. This act allows “whistleblowers” to sue violators and be compensated with a percentage of the recovery. The False Claims Act has its own set of penalties, including treble damages and attorney fees.

This article is not intended to give legal advice. This is a highly specialized area of law and litigation over Stark has yet to generate much case law for guidance. In addition, further regulations are to be issued in the near future. Given the potential exposure, prudent hospitals will seek sound legal advice before offering professional answering services to physicians.

Mike Wilson is an attorney and author. He teaches at Sullivan University in Lexington, Kentucky.

[From the Summer 2003 issue of AnswerStat magazine]

Fraud Alert Issued: Prohibited Telemarketing by Health Care Suppliers

By Kathryn L. Holloman and Corrine Parver, Esq

On March 3, 2003, the Department of Health and Human Services’ Office of the Inspector General issued a Special Fraud Alert regarding unsolicited telephone contacts with Medicare beneficiaries. Despite a ban on such contacts by the Social Security Act, the Department found widespread violations of the Act. Therefore, the Special Fraud Alert was issued. Because teleservices and marketing firms may be affected by the Act, it is important to familiarize yourself with this important law that is receiving so much attention.

Despite the statutory prohibition against unsolicited telephone contacts set forth in Section 1834(a)(17) of the Social Security Act, the Office of the Inspector General (OIG) Alert noted that some Durable Medical Equipment (DME) suppliers were using independent marketing firms to make unsolicited telephone calls to Medicare beneficiaries. In response to this lack of compliance to the statutory provisions, on March 3, 2003, the OIG issued its Alert regarding telemarketing by DME suppliers.

Three provisions of the Alert follow: First, the Alert reaffirms that DME suppliers are prohibited from making unsolicited telephone contact with Medicare beneficiaries. Then, it expressly prohibits both unsolicited telemarketing conducted directly by a DME supplier and unsolicited telemarketing conducted by another party on behalf of the DME supplier, except in the three circumstances set forth in Section 1824(a)(17)(A) of the Social Security Act. The OIG based its decision to apply the prohibition to marketing agencies on the theory that DME suppliers cannot do indirectly that which they cannot do directly. The Alert, therefore, expands the statutory language of Section 1834(a)(17) to apply to unsolicited telephone contacts by independent marketing agencies as well as by DME suppliers.

Second, the Alert also holds DME suppliers responsible for verifying that both the marketing activities conducted by, and information purchased from third parties do not involve impermissible activities. Specifically, DME suppliers are required to verify that information purchased from third parties was neither obtained nor derived from a prohibited activity. DME suppliers must also confirm that prohibited activities are not involved in marketing activities conducted by third parties with whom the DME supplier contracts or otherwise does business. The Alert expands the scope of Section 1834(a)(17) in that no language in the statute addresses these issues.

Finally, the Alert states that both DME suppliers and telemarketers are potentially liable for false claims for payments generated by impermissible solicitations. Claims for items or services that are generated by prohibited telephone solicitations are considered false claims. Both the DME supplier and the telemarketer are subject to criminal, civil, and administrative penalties for causing the filing of false claims. The Alert, therefore, expands the prohibition against payments for false claims and the potential penalties for filing such claims applying to claims generated by independent marketing agencies.

Details about the Social Security Act: Pursuant to Section 1834(a)(17)(A), suppliers of Medicare-covered items may not make unsolicited telephone calls to Medicare beneficiaries regarding the furnishing of covered items, except in three specific circumstances:

  • The beneficiary has given the supplier written permission to make contact by telephone;
  • The contact regards an item the supplier has already furnished to the beneficiary; or
  • The supplier has furnished the beneficiary with at least one covered item during the fifteen-month period preceding the date the supplier contacts the beneficiary.

If a supplier improperly contacts a beneficiary, Section 1834(a)(17)(B) prohibits Medicare payments for items furnished subsequent to the unsolicited contact. Specifically, the statute provides that no payment shall be made for any item furnished by a supplier that knowingly contacted a beneficiary in violation of the law. The OIG classifies these claims for payment as false; violators will be potentially subject to criminal, civil, and administrative penalties.

Summary: Section 1834(a)(17) of the Social Security Act prohibits both unsolicited telephone contacts to Medicare beneficiaries by suppliers of Medicare-covered items, and payment for items furnished subsequent to prohibited contacts. The Alert expands these prohibitions by applying them to independent marketing agencies working on behalf of DME suppliers. It also requires DME suppliers to verify that information purchased from third parties and marketing activities which are conducted by such parties do not involve prohibited activities.

Ms. Holloman, a second year law student at University of North Carolina Law School, was a Summer Associate at Dickstein Shapiro in July 2003. Ms. Parver is a partner in the Health Law Services Practice of Dickstein Shapiro Morin & Oshinsky LLP, a Washington, D.C.-based law firm. She may be reached at 202-775-4728 or parverc@dsmo.com.

[From the Summer 2003 issue of AnswerStat magazine]

Case Study: Remote Call Center Agent Stations

By Gary J. DuPont

The use of remote workers is increasing and often expands the pool of available talent. Recognizing the need to address attrition, load balancing, quality and costs that are problematic to all call centers today, Masco Services Inc. (MSI) took proactive steps utilizing remote workers to change its call center staffing paradigm. It serves as a model and complements a corporate initiative to reduce traffic in Boston’s Longwood Medical Area.

MSI is utilizing two technologies to accomplish the integration of remote workers. The first implementation involves the use of the Teltone Office Link product. It is a flexible, affordable solution that offers seamless connectivity from any location. Two units are required per agent, one at the agent site, the other at the host/automatic call distribution (ACD) location. This technology allows a remote agent to dialup and log into their Avaya ACD. Once logged on, the agent appears to the ACD like any other on-site agent. Agents use 2500 compatible telephone sets with 10-20 programmable speed dial buttons for ACD access codes and frequently called numbers. Staff working on different shifts can share access to the unit. However, agents cannot use the proprietary ACD sets at the remote site.

All connections are made using feature access codes. Several routine call types are sent to these remote agents. A call whisper feature on the PBX/ACD identifies the call type to the agents. The client database is available to the remote worker via high-speed Internet connection and a virtual private network (VPN). The greatest advantage of this application is the ability to build and test the system one agent at a time without significant up front investments.

The second technology that MSI uses is the Avaya Definity Extender unit and a standard Avaya CTI application. This technology permits remote agents to dial up and log into the ACD over standard analog lines, using Avaya proprietary digital ACD telephone sets. The host unit (or Avaya switch) has two ports, one for the ACD and one to the switched line; at the agent end, one port is for the switched line, the other for the digital proprietary set. The telephone interfaces with the PC to provide computer telephony integration (CTI) using Avaya Passageway units. Working closely with Xtend Communications, MSI’s agent console vendor, the remote agent has full functionality to the console features and ACD. Again, high-speed Internet access is required in addition to a VPN. This technology is compatible with Avaya and Nortel ACDs, but there may be restrictions on how far from the central office the agent can be located.

No matter which technology is deployed, toll charges may apply so it is important that the remote agents have a flat-rate long distance price plan. Remember that the technology is only as good as the people using it. MSI recommends that call centers develop a sound interviewing and selection process and establish firm policies and procedures to monitor performance, quality assurance (QA), and communication pathways to the home office.

In the future, MSI plans to change its remote agent platform to Avaya IP Agent, a soft phone application that works through the agent’s personal computer. It is a cost effective solution that will allow them to expand their remote worker program. Avaya IP Agent allows the agent to work from any PC, as long as there is high-speed access via VPN to the corporate network. Remote agents will be able to administer CTI screen pops more easily, eliminating the use of extraneous hardware devices.

Gary J. DuPont is Director of Telecommunications for Masco Services Inc.

[From the Summer 2003 issue of AnswerStat magazine]

Benchmarking Your Call Center

By Peter Lyle DeHaan, Ph.D.

Peter DeHaan, Publisher and Editor of AnswerStat

What is benchmarking? At its simplest, benchmarking is objectively comparing your call center with others. Brad Cleveland of Incoming Calls Management Institute states that “Benchmarking is comparing products, services, and processes with those of other organizations, to identify new ideas and improvement opportunities.” Whereas Dr. Jon Anton of Purdue University defines benchmarking as “A structured, analytical approach to identify, deploy, and review best practices to gain and maintain competitive advantage.”

Benchmarking is a safe, anonymous, and effective way to obtain input from peers which can be used to compare and contrast your call center operation to others. This feedback provides a baseline for determining areas of deficiency, as well as success. Benchmarking produces quantifiable results, real numbers from real businesses, thereby offering real solutions. Also, once a benchmarking process has been implemented, it can be easily repeated and updated on a periodic basis. This provides a time line of successive snapshots of your business. In essence, benchmarking makes it possible to create a report card showing your successes, your shortcomings, your improvements, and your relapses – all with respect to your peers, but done so privately and confidentiality.

Therefore, call center benchmarking is the comparison of your operation with statistical results from the norm of industry peers. These numeric measurements are called metrics. Metrics can be in the form of financial data, sales numbers, operational quality and efficiency, human resource efficacy, or whatever is deemed to be the most valuable to the participants, though typically and primarily they are operational in nature.

Successful benchmarking follows a progressive path towards a desired outcome. First and foremost, there must be a desire to obtain and use the information. Next, you need to determine who will be invited to participate. It is essential for participants to have an interest in the results and a commitment to contribute. Beyond that, it is imperative that all participants have sufficiently similar businesses. In many cases, it is wise to select those using common equipment or software platforms, since operational metrics are hard to reliably compare when their sources employ dissimilar statistical paradigms.

The third step is to determine which numbers to measure. It is recommended to start small, obtaining only a few key numbers (as participants become engaged in the process and realize the value of it, then other metrics can be added). It will then be necessary to develop a standard determination of how the information will be gathered or the calculations will be made. For without a standard methodology, each participant will make the calculations as they see fit, rendering any results unreliable. These two steps can be both time-consuming and contentious. Assistance from someone with experience in benchmarking or a background in statistical analysis is most beneficial at this point. This outside assistance serves to greatly simplify the process and save valuable time. Also, if this person does not have a direct vested interest in the results, they are better able to objectively guide the process.

The fifth step is a critical one. It is to develop the survey form, which includes documenting the source or calculation of the data. Although this seems like a simple and straightforward process, it is one fraught with peril, as a less than ideal survey form will doom the process to misanalysis or failure. Again, someone with experience in benchmarking or developing survey forms will be most helpful. Then, regardless of the quality of the survey form – or its developer – it is of paramount importance to test it. What may seem perfectly clear to those who developed and reviewed the form, could cause confusion or misinterpretation to those completing it. Therefore, a small field test should be conducted. Any problems uncovered in the test will need to be corrected before the benchmark survey is distributed to all participants.

The next two steps are the most important, as concerns in these areas can cause otherwise willing participants to decide not to complete the survey or to color their responses. Quite simply these steps are to gather the completed surveys and then to compile the results. Concerns reside in who performs these two steps. It is imperative that this person or group be trusted and respected by all participants and that there not be any perception of impropriety or a conflict of interest. As such, it is recommended that someone who is not participating in, and will not benefit from, the benchmarking results be assigned the task of both collecting and tabulating the responses.

The results of the benchmarking survey are only presented in aggregate form and then only to those who responded. All individual answers must be fully protected. In some cases, such as providing cross-sectional or demographic analysis, certain sections may need to be eliminated due to a small number of responses which would effectively expose one or two participants. The results, often along with an analysis and commentary, are distributed to all who submitted data.

Although conducting a benchmarking study once is valuable, the real benefit comes from repeated studies over the course of time. Therefore, it is important to follow-up with those who participated to determine any problem areas needing correction or additional data to be collected. These changes must be made before the survey is repeated. Depending on the nature of the information, the survey should be repeated at least annually, possibly quarterly, or even monthly.

Some examples of benchmarking metrics:

Operational

  • Percent of calls answered
  • Average time to answer
  • Percent of calls placed on hold
  • Average hold time
  • Occupancy (percent of time spent working)
  • Average call duration
  • Average wrap up time
  • Number of calls answered per month
  • Amount of time spent on calls per month
  • Schedule adherence

Sales and Marketing

  • Number of sales made
  • Sales per hour
  • Average revenue per sale
  • Number of inquiries
  • Closing ratios
  • Source of leads

Human Resource

  • Annual turnover rate
  • Average employee (CSR) tenure
  • Cost to hire one new employee
  • Cost to train one new employee
  • Starting pay per hour
  • Average hourly rate

Financial

  • Percent of revenue spent on labor
  • Percent of revenue spent on marketing promotions
  • Percent of revenue spent on all sales and marketing efforts
  • Number of clients
  • Average revenue per client
  • Cost per sale
  • Profit margin

Conclusion: Benchmarking is a valuable mechanism to bring outside experience, information, and knowledge into a business. With this input, business goals become more defined and realistic; direction, clearer; and focus, sharper. It is an opportunity for improvement that should be seized.

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.

[From the Summer 2003 issue of AnswerStat magazine]