The Contact Center’s Role in Reducing Readmission


LVM Systems


Traci Haynes MSN, RN, BA, CEN

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

References:

Streamlining Public Health Care Appointments with IP Contact Center Technology

By Kevin Simms

In the October/November issue of AnswerStat, we took a broad look at the intersection of healthcare and contact center, using health coaching and remote patient monitoring as just two examples of healthcare applications that are enabled or greatly enhanced by IP contact center technology. In this issue, we’ll take a look at another example of the “intersection” in action as it relates to this month’s feature focus on appointment scheduling and connecting with clinics.

Castilla y Leon is not only the largest region of Spain, but it is also the largest region in the European Union. Located in northwest Spain, it is also home to a diverse, mostly elderly, population of nearly 2.5 million scattered throughout the sparsely populated region – a challenging scenario for any healthcare system. In Castilla y Leon, SACYL is the umbrella organization responsible for the public health service in the area, managing 14 hospitals, 241 health centers, and 3650 local clinics. Among the many healthcare services SACYL provides is their appointment making service which receives more than twenty million calls per year from residents seeking to coordinate their doctor and diagnostic testing appointments.

A primary patient complaint had been that it was difficult to arrange medical appointments by phone. Large call volumes – especially during peak calling periods – coupled with lack of off-shift coverage, meant longer than acceptable time to schedule appointments. Furthermore, the large percentage of calls requiring simultaneous appointment setting for complex sequences of medical exams often required callers to make additional calls. Even though SACYL had a centralized appointment application, each healthcare facility was still responsible for its own appointments.

Eager to improve the appointment setting process and the customer experience, SACYL wanted to implement a unified call scheduling service for all their facilities to allow citizens to manage their appointments through an automated speech-enabled IVR system that could handle the many varied accents and dialectics of callers in the region. It was also a priority to have the ability to intelligently route the calls to an appropriate live attendant anywhere in the system when necessary. SACYL required the solution to be capable of handling high call volumes, especially during peak times, and they wanted the management of the solution to be both outsourced to avoid large IT personnel costs and to be a pay-as-you-go-model. Further, SACYL needed the solution to be scalable to support new applications while also having the ability to quickly implement new functionalities.

The answer to these challenges was a virtual IP contact center. Telefónica, the world’s fourth largest telco, delivered a system using Contact Center on Demand™ (CCOD) services with sophisticated natural language IVR. The result was a custom-tailored solution – unique to the public health sector – that manages the whole appointment process. The on-demand model enabled the rapid deployment of the service to all SACYL health service locations, including unlimited consolidated virtual call center sites, as well as remote teleworkers.

Among the immediate benefits that SACYL experienced with the Telefonica/CCOD solution were 24×7 availability for citizens, a drastic reduction in appointment wait times for callers, a first-call resolution rate of 99% (with 70% being self-service calls), and the huge savings resulting from the on-demand model and the outsourced management by Telefonica’s services.

The new IVR is so sophisticated that even elderly or foreign speaking people pose no problem to the system. Calls are being resolved without difficulty on the initial contact, and if and when the caller requires specialized attention, the call is intelligently routed to the appropriate health center.

Finally, the system’s unified reporting provides a unique consolidated vision of the whole service’s key performance indicators. This strategic view allows the health service to continuously improve caller satisfaction while optimizing performance and productivity.

With the initial solution proving successful, the service is being expanded to handle specific health campaigns, such as flu vaccinations and other larger scale programs. SACYL is also planning the extension of the service to include the handling of medical specialist appointments, health card changes, and assigned health center changes.

It is worth noting that it would have been difficult – if not impossible – to implement this scheduling and routing system without IP contact center technology. The ability to unify the disperse locations in the Castilla y Leon region on a single virtual platform, the power to integrate with business applications like SACYL’s scheduling software, the flexible on-demand delivery model, and holistic reporting are all benefits of unified, software-based IP contact center technology. SACYL’s application was specific to their own unique business challenges, but the underlying benefits of such IP contact center technology can apply to many other healthcare applications and is limited only by imagination.

Kevin Simms is the director of marketing at CosmoCom. Their unified, all-IP contact center suite enables medical organizations to fulfill complex customer interaction management requirements. 

[From the April/May 2010 issue of AnswerStat magazine]

Access Management: Appointment Scheduling and Beyond (Part 2)

By Sue Altman

Now that the business case is made for appointment scheduling (see “Access Management: Appointment Scheduling and Beyond, Part 1”), your call center needs to determine the best entry point. We’re covering the three most common scenarios:

  • From physician referrals to new patient appointments
  • From physician appointments to outpatient services
  • Merging the referral center with central scheduling or patient access.

From Referrals to Scheduling New Patient Appointments: From the survey results, the most common starting point would be organic growth.  This is growth from existing business versus growth through a merger with another call center or business unit. You may have considered converting referrals to appointments in the past, and for a variety of reasons, encountered barriers. Luckily, there are methods for accomplishing this: from a three-way call with the practice, facilitating online appointment requests, or gaining direct access to the practice schedules. You may need to accommodate several different scheduling processes at first. But over time, your outcomes data can be leveraged to establish best practices and drive convergence.

  • Is there a group of physicians on a single scheduling system? This is often the case with employed physicians or large group practices.
  • Physicians who are eager to grow their practices may be open to offering standing appointments for your call center to fill. It’s low tech, but it is very efficient. Any unused appointments can be returned to the practice by 10AM each day.
  • Three-way calling is still a common practice. Establishing a back-line into the physician office for use by the call center may help shorten wait times.

Restructuring staff roles may be necessary, and even preferred, over time. Currently call center employees are expected to know how to process 8-9 services and functions. You may consider designating certain staff to focus only on scheduling physician appointments in order to understand the intricacies in greater depth.

From Triage to Appointments: Telephone triage results in a disposition of “See Your Doctor” approximately 40% of the time. This presents an opportunity for call centers to make appointments while the caller is still on the line. During regular office hours, this scenario has the same options as mentioned above: direct access to schedules, use of standing appointments, or a three-way call. After hours (weekday evenings and weekends), the three-way call drops out, but the other two methods remain. This is a great customer service to the caller, who would otherwise have to wait to call their physician’s office until 8AM or 9AM the next morning. It can also be a benefit for the practice. They are bombarded with start-of-the-day calls. Each pre-scheduled appointment takes one more call from their frantic morning queue.

We interviewed Rita Svatos, RN, BSN, PN, director of NurseDirect for Affinity Health System. During daytime hours, her staff facilitates appointments through a warm transfer process, connecting callers to the office or clinic. But if an after-hours triage call results in a disposition of “See Your Doctor,” they can now arrange the appointment while the patient or caller is still on the phone. Once the triage process is complete, the call is transferred to a referral associate who accesses the appropriate physician’s schedule in Meditech and finds an open appointment.

Their venture into this service built upon their previous success in managing appointment cancellations. The referral associates had already proven their ability to navigate the Meditech scheduling system. The idea that they could also locate available appointments and schedule triage callers was a logical next step. Plus, it enhanced customer service and removed some burden from the practice or clinic’s call load the following morning. Other initiatives have helped make this transition easier. The number of different appointment types within Meditech has been consolidated, and the post-triage appointments have their own code, AH (After Hours), to identify which were made because of the NurseDirect service.

A Single Scheduling Center for Appointments and Outpatient Services: Kay Vogel, director of telecommunications and central scheduling, described her service at St. Alexius Medical Center as a central scheduling center that started when the Physician Hospital Organization (PHO) pursued a strategy of improving access. Prior to the formation of her centralized center, it was not uncommon for patients to try for 20 minutes or more to reach a receptionist at their physicians’ offices. At that time, there were multiple switchboards and scheduling desks; all were, in effect, small call centers. The prospect of centralizing resulted in more collective resources, and more staff meant better flexibility and call coverage potential.

The St. Alexius Call Center manages calls for the medical center and four primary care and specialty clinics. The staff now schedules for more than 100 providers, which equates to 340,000 appointments per year and encompasses scheduling for more than 1300 different procedures. Did patients benefit? Absolutely!  The gain in coverage from centralizing staff has meant greatly improved service levels. Plus, patients can schedule multiple appointments and/or procedures at the same time. For instance, a woman can schedule her check-up and mammography by placing just one call.

The call center still works very closely with the clinics. If a specific request falls outside of their guidelines, the call is transferred back to the practice. Similarly, if an urgent appointment is needed but none appear available for that particular specialty, the call is transferred to the practice, which has the final decision whether or not to “work a patient in.”  The collaboration is very patient-focused.

Enterprise Growth, an Evolving Process: In our previous issue, we touched on the evolution of central scheduling at Detroit Medical Center (DMC). Kathy Ingalls Hefni, RN, BA, had managed DMC’s triage, marketing, and referral center for several years. Detroit Medical Center had been growing rapidly through acquisition, and in 2004, the new System COO had a vision to enable scheduling across the multi-hospital enterprise. This project started with the combining of one hospital’s scheduling center to the triage and referral call center location. Five years later, the Health Access Center and Central Region Operator Services schedules for six of the seven DMC hospitals.

The growth has occurred in phases; each with adjustments in staffing and process, coupled with service analysis. Corporate Director Ingalls Hefni has gone nearly full circle in her thoughts regarding the optimal staffing model. When the first scheduling group was brought over, it was combined with her referral center and all staff was cross-trained. This functioned well to a point, but eventually the generalist role impacted service efficiency.

Now she has created specialty pods, each with expertise in either referrals and appointments or scheduling and pre-registration. Still, to maximize flexibility, all staff is knowledgeable on both processes. For example, if a patient appointment is made (by referral and appointment staff) less than 24 hours in advance, the same staff will verify insurance and pre-register the patient at the time of the call.

Ingalls Hefni believes staffing adjustments will be ongoing with continued growth and evolving technologies. At the time of our interview, she and her team were studying what to do about the growing number of electronic requests. Does ‘online’ become its own pod? Or, does it become a mini-specialty within each pod? They are currently completing due diligence on the electronic fulfillment process to develop a best practice.

Call Center Manager as Internal Consultant: Kathy Ingalls Hefni shared that with each consolidation, they gain new expertise in what to do and how to do it. Her team is often tapped to help other scheduling services on their operations. Acting as consultants, they evaluate service levels, wait times, and abandonment rates. They also look for symptoms, such as multi-step manual processes and instances of duplicate data entry, as indicators of areas for improvement in efficiency.

Like any project, the movement to scheduling is a sequence of steps: analyze, design, implement, analyze, fine-tune, and demonstrate value; then repeat these all again for the next phase. To be a successful change-agent, be prepared to use process improvement methods and gather adequate pre- and post-data to show the benefits to all stakeholders: 1) patients, 2) clinics, practices, and departments, and 3) the sponsoring organization.

Both Vogel and Ingalls Hefni described how data collection and analysis have been at the core of their growth strategies and successes. Improvements continue to be process focused and data driven, which means analysis is a key component of their roles as managers. At Primecare, Ms. Vogel is often asked by leadership, “How can we manage access better?”  Administrative reports become critical in demonstrating the facts of access management and reducing misinterpretation and incidental hearsay.

Beyond experience and analysis, all three managers touted the benefits of a good telecom system: one that provides data on how calls arrive, how they’re distributed to staff, and where calls are transferred. Call recordings and post-call data have been invaluable in resolving problems and supporting their actions if quality issues have been raised.

The three also strongly recommend managing variation. Rita Svatos mentioned that at one time, there were nearly 6,000 appointment types to choose from within Meditech. Navigating through that many options would have greatly increased the risk of error for her staff. Since that time, Affinity has worked as a system to consolidate appointment types and make scheduling more manageable. This consolidation is in preparation for open access scheduling. They now have the total down to approximately 100 visit types.

Similarly, Kay Vogel lists her biggest challenge as managing changes to their “protocols,” that is, the various rules and processes that must be followed for scheduling patient visits and procedures. The practices have been allowed to designate individual preferences on visit types, how they are scheduled, and when the practice takes time off for meetings or closures. Her software manages 75-90% of these, but staff still have to be on their toes when it comes to knowing the specifics of the protocols. Moving forward, new physicians will be given a template to use for setting up schedules and optimizing patient access.”

It’s All Good: All three leaders agree that scheduling has raised the profile of their call centers and put them in a stronger, more stable position within their organizations. They serve as key components of access management and, therefore, affect their organizations’ revenue cycles. Through their growth, their centers have realized benefits from increased budgets and staff, as well as upgraded infrastructure. Their organizations have gained from enhanced and standardized customer service, which has contributed to a service brand that is a competitive advantage in the marketplace.

[From the October/November 2009 issue of AnswerStat magazine]

Access Management: Appointment Scheduling and Beyond (Part 1)

By Sue Altman

The case has been made for taking stock of your call center’s value to your organization, then evaluating, and acting on, ways to become integral to core operations. From recent survey results, many call centers are still providing only referrals to physicians, not taking the caller’s interest through to fruition. In a sense, these actions tell callers, “We’ll help you get started, but the rest will be on your shoulders.”

There are many reasons offered as to why call centers stop short, from it takes too long (not enough staff) to we don’t have access to scheduling systems and the physicians want total control. While each of these barriers may have merit, there are powerful rebuttals and accommodations to overcome them. The bottom line is, taking a referral through to the appointment is the only direct line from patient need and interest to generating organizational revenue.

Why “referral-only” puts us at risk: The simplest answer is, “If you don’t do it, someone else will.”  This mantra is not limited to concerns about regional competitors. It may be just as true of your call center’s position within your own organization. A centralized scheduling center which facilitates appointments for your clinics or physician-hospital organization (PHO) knows which physicians are accepting new patients. The staff has keen knowledge of wait times and first-available appointment options. They could easily pick up the physician referral requests handled by the stand-alone marketing-referral call center, and they could facilitate an appointment with ease.

There is also a new “threat” in the market: for-profit call centers who handle referrals, appointment setting, eligibility/insurance verification, and accurate patient registration. For many healthcare organizations, this service would replace three or four internal departments. Outsourcing is attractive to senior leadership because it offers both a one-stop package with accuracy and service level guarantees and an interim business solution for health systems that need to restructure fragmented services (but cannot afford any disruption to patient access).

The Driving Forces

Customer Service: For several years, there has been a growing trend in healthcare to centralize communications and scheduling functions. Some of this has been driven by “ideal patient experience” initiatives. When evaluating service levels of the mini-call centers (scheduling units) across an organization, it is common to find that phones are not answered as well in point-of-service locations. These settings put staff in a situation of having to choose. Do I answer the phone? Or, do I take care of the person in front of me? The presenting patient wins out…and the phone waits.

By routing these calls to a centralized center, the point-of-service benefits from a quieter environment, allowing better service and greater attention paid to each patient. The benefits derived from dedicated staff, measurable quality metrics, and customer service training have also been described in studies of best practices.

Efficiency: Recently, the recession has escalated projects that deliver greater economies of scale and operational efficiency. Operating fewer, but larger, contact centers makes good economic sense and warrants enough staff to achieve better service levels.

Enterprise Systems: Every healthcare IT article these days expounds the virtues of electronic medical records (EMRs) and enterprise solutions. The leading systems include a variety of functions, including fully integrated scheduling. What this means is that many of our current barriers to scheduling will be resolved or, at least, minimized. Schedules of employed physicians will be accessible on the primary system. Affiliated physicians will also be moving to electronic schedules, thus consolidating the number of software systems schedulers would need to access.

But the most powerful drivers which have given appointment and scheduling centers more importance is their strategic role in access management and the organization’s revenue cycle. These two functions are the core of every healthcare organization’s financial survival.

Access Management: Access management deals with a host of strategies to enable attracting, scheduling, managing, and retaining patients. It has become much more complex than back in the 1980s and 1990s when marketing and referral call centers were first established. Back then, our industry’s focus was to attract patients, ideally those with commercial insurance, and connect them with our affiliated physicians and organization’s services.

In a recession, Medicare and Medicaid may now be viewed as relatively decent-paying programs. Today’s health systems are challenged to develop multi-tiered strategies for managing commercially insured, government funded, under-insured, and unfunded patients. The first point of contact – often a referral or scheduling center – needs to understand more than the insurance match process. Staff need to understand and be able to navigate the ins and outs of eligibility, enrollment, and authorization requirements.

Revenue Cycle: The term revenue cycle encompasses a broad set of administrative services, including the process of registering, benefit counseling, creating, submitting, analyzing, and ultimately collecting payment for patient medical bills. For our purposes, much of this activity is carried out in the business office and automated by robust analytical software. However, revenue cycle improvement gurus are recognizing that one of the most important steps is gathering correct demographic and insurance data on the front end, thus avoiding rework later. Stepping up your call center’s role in gathering the data required for registration, completely and accurately, raises your call center’s value and connects you to an integral part of your organization’s survival.

To summarize, there are ample reasons to move toward scheduling services. The following answers to the question “Why?” should provide motivation:

  • Improve patient access and be part of this solution.
  • Tie your center into mainstream revenue flow, thus raising its position within the organization.
  • Establish experience and expertise proactively in preparation for future consolidation.
  • Leverage the customer service skills your staff already has.
  • Growth, through co-location or expansion, brings small centers to an FTE count that can better handle fluctuations in call volume.
  • Similarly, larger FTE budgets better justify the expense of improved infrastructure, such as feature-rich telecom and call management systems.

And in keeping with the title “Surviving and Thriving in a Recession,” we’ve provided answers to the question, “Why now?” These include:

  • Consolidation and process standardization projects are already in high gear.
  • The “barriers” to scheduling are being removed. Healthcare organizations are on the verge of, or have implemented, enterprise master patient indices (EMPIs), EMRs and enterprise scheduling systems.
  • The recession has brought extreme attention to revenue cycle management. If you understand it and your center’s potential contribution, this is a prime opportunity to get involved.
  • All of the above rank high in the priority of funded initiatives.

[Read Part 2 of “Access Management: Appointment Scheduling and Beyond” in the October/November issue of AnswerStat magazine.]

[From the August/September 2009 issue of AnswerStat magazine]

The Advantages of Automated Appointment Reminders

By Bob Young

Today’s consumers have more choices than ever when it comes to selecting healthcare providers. And, as insurance coverage changes, deductibles, and out-of-pocket expenses increase substantially, those in charge of their family’s healthcare are becoming better informed. They are shopping for and choosing providers based not only on quality of care, but also – more than ever – on cost. To compete and thrive in this increasingly retail-driven environment, healthcare providers need new ways to streamline operations and lower their costs while maintaining and even improving the level of care offered to patients.

An automated way to deliver better, more cost-effective care: Appointment reminders are one area of operation – and a key patient touchpoint – where efficiencies can easily be gained. This is typically a cumbersome, labor-intensive process, where nurses and designated personnel call or send notices to patients, reminding them of impending appointments. Today, solutions are available that completely automate this critical function, removing the costs, inefficiencies, and potential errors associated with manual execution.

Leading healthcare providers across the nation have already migrated to these automated solutions, gaining a competitive edge by passing the savings on to consumers or reinvesting those dollars to improve care delivery.

Missed appointments are missed opportunities: In the day in the life of a busy healthcare facility, appointment reminders might not seem mission critical. However, missed appointments are missed opportunities for revenue and for improving patient relations. Having a system in place to prevent and minimize no-show patients is critical to keeping staff productive and your operation profitable.

The old way: Traditionally, the old method might work like this: paid personnel print out postcards, hand write each patient’s appointment information on a separate card, stamp the stack, walk it down to the mail room, and hope it reaches the patient in time. Or, staff members personally call each patient, taking valuable time away from their core duties. Either way, this approach has drawbacks:

  • Care providers are diverted from providing care.
  • Written reminders are prone to human error, such as transposed numbers or missed information.
  • Cancellations need to be manually logged, tracked, and re-opened (often too late to be refilled).
  • Information can be inconsistently communicated, such as affected by diction, staff turnover, or even the caller’s mood.
  • It is labor intensive and extremely expensive.

The better way: Today’s automated systems work efficiently. Every day, the healthcare facility’s scheduling or appointment system sends a file of the next day’s appointments to a Web-based appointment reminder software module. This file contains each patient’s first and last name (last name used for internal results logging, not used in the actual reminder call due to HIPAA compliance issues), phone number, appointment type, appointment location, appointment time and date, and his or her doctor’s name. Some facilities also choose to include additional messages important to the nature of the appointment, such as not eating or drinking past a certain hour.

At the pre-determined time, typically between 5 p.m. and 9 p.m., the appointment reminder system begins making calls to patient phone numbers on simultaneous lines. The played messages are assembled in real time by the system using pre-recorded phrases. These include common first names, the name of every physician or practice throughout the organization, dates, and times. It also includes “remember items,” such as fasting. In most cases, solutions providers work will with staff to personalize the phrases and flow before using the system.

Users tailor the script; the software does the rest: The script is based on client requirements and features a combination of pre-recorded messages selected from a user-friendly template, as well as text-to-speech. A sample of the reminder message might be:

  • Pre-recorded: “Good evening, this is Peggy from New York Radiology calling to remind you of your appointment. Your appointment is on July 21 at 1:30 p.m.”
  • Text-to-speech: “Please remember not to eat or drink anything after midnight the previous evening.”
  • Pre-recorded: “Please press 1 on your phone to confirm this appointment or press 2 to leave a message for our staff to reschedule.”

For patients who choose to cancel or reschedule their appointments, the system can transfer them to a call center operator who has access to the centralized scheduling system. During calling, the system can provide progress reports. After all calling is completed, the system generates reports displaying the results.

Eliminate inconsistencies; improve efficiencies: Automated reminder systems eliminate the inefficiencies and inconsistencies inherent in traditional, manual appointment reminder processes and deliver advantages across your entire organization:

  • Cut down the number of missed appointments
  • Maximize doctors’ time
  • Enable nurses and personnel to focus on providing care
  • Ensure consistent, HIPAA-approved delivery of patient information
  • Improve data tracking
  • Payback in a few months

Best integrated with call center suite: Alone, automated reminder systems will quickly deliver a tangible ROI. But to best realize the full capabilities of this powerful solution, healthcare providers are now integrating it with a suite of call center solutions that includes operator console, Web-based directory, speech recognition, call recording, notification, and call accounting. These organizations enjoy enhanced efficiencies, such as:

  • Having one version of the truth: appointment reminder software takes advantage of the foundation already in place, including real-time information about all patients, staff, and how they need to be contacted
  • Lightening the load on IT staff by connecting to an existing database, meaning IT does not need to worry about maintaining yet another database

Automate today; enjoy the benefits tomorrow: The business of healthcare has never been more competitive. Margins are thinner, and consumers are taking a more active and deliberate role in choosing which healthcare providers they see — and how often they see them. Leading healthcare organizations are switching to automated reminder systems to streamline operations, lower costs, enhance patient relations, and gain a competitive edge.

Bob Young is a product manager at Amcom Software; contact him at 800-852-8935.

[From the August/September 2009 issue of AnswerStat magazine]

Appointment Scheduling and Reminders

By Peter DeHaan, Ph.D.

Peter DeHaan, Publisher and Editor of AnswerStatFor as long as call centers have been answering calls for doctors, there have been requests to handle appointments, be it to set, cancel, or change an appointment. Although the doctors were serious about these requests and the call centers anxious to assist, the result was, at best, less than desirable and at worse, a complete failure. Problems with double booking, tracking cancellations, and coordinating openings were rampant, often overshadowing the benefits. The root cause of this was the lack of a centralized and common scheduling resource. Even after the advent of computers allowed schedules to be accessible electronically, connecting to a remote database was slow, cumbersome, and unreliable. Fortunately, the Internet has solved this last dilemma.

When powerful appointment scheduling software is married to the ubiquitousness of the Internet, the result is an up-to-date schedule, available to both the medical practice and the call center. This allows both medical staff and call center agents to fill, cancel, or change an appointment at any time, without the concerns of double booking or appointment overlap. With the Internet, accounts can also be easily dispersed throughout a multi-location practice or call center.

These programs can address a medical practice’s appointment-taking needs, while providing the option for remote access by supervisors, managers, and even doctors as they plan their day. Many of these scheduling setting programs are hosted software. This means that the call center does not need to purchase, install, maintain, or upgrade any software, but rather accesses it via the Internet. Fees vary from flat rate to usage sensitive. Some packages can alternately be purchased by the call center for in-house installation. This allows call centers to use the hosted version as they get started, with the option to purchase the software later, if it becomes cost effective to do so.

For all of this power and flexibility, these programs tend to be intuitive and easy to learn. The learning curve for agents is quick; they often comprehend the basics after just a couple of appointments and master the details within an hour.

Also, there is often a web component available, which can be extended to the patient or referring partners for self-scheduling. This can serve to increase visits and maximize doctor’s schedules. Common features include:

  • Multiple schedules (such as separate doctor and nurse schedules)
  • Multiple event or appointment types
  • Various length appointments
  • Ability to perform database lookups (to pre-populate fields with patient information)
  • Provision of drop down menus (to enforce database consistency)

Booking a full day’s worth of appointments, however, is just the first step. Unfortunately, it is all too common for appointments to be missed, either through neglect, forgetfulness, or patients who are simply too overloaded to remember. As such, reminding patients of their scheduled time, a day or two prior, is a needed task. Therefore, most appointment setting software also includes a means of confirming or reminding patients of their scheduled time. This can be completely automated and technology assisted, and often includes multiple contact methods, such as a phone call, email, or fax. Here are appointment scheduling vendors to consider:


1Call, a division of Amtelco: 1Call’s Web-based scripting product, eCreator, includes an appointment-taking application that can be customized to meet each scheduling need. Most of the scripting work is already done, making set-up fast. A customizable SQL database is included to provide speed and scalability.

Callers can be reminded of their appointments by email, fax, or on a website. The script walks agents through the call process, reducing training time. The data collected can be required and validated, reducing agent errors. The main features include:

  • Flexible script flow and customized screens
  • Web-based script, which allows for end-user access
  • Scalability to unlimited schedules, resources, and appointment lengths
  • Delivery of appointment data according to client needs, including Web access

For more information, contact 1Call at 800-356-9148, info@1call.com or www.1call.com.


Linx Appointment: Linx Appointment, from Szeto Technologies, is an appointment setting software package that can be purchased by call center and installed in their facility. It is one of the optional integrated functions offered in their Call Linx TAS System.

Although it is installed in the call center, the call center may in turn host the appointment service to their clients via their website.  No third party involvement is necessary.

For more information about Linx Appointment, contact Szeto Technologies at info@szeto.ca, 888-421-3737, or visit www.szeto.ca.


TeleVox Software: HouseCalls, an automated messaging system from TeleVox Software Inc. enhances provider-patient communication, automating the contacting of patients with important information.

Using natural voices, HouseCalls delivers messages at any time of the day, early evening, or weekend. The HouseCalls automated messaging system will confirm appointments; recall patients due for their next visit; follow-up on missed appointments; deliver account balance notifications and more.  Patients can choose whether to receive their messages by phone, text, or email.  Personalized messages can include patient-specific details related to a visit, such as name, date, time, and location, as well as procedure instructions or even a personal note from the doctor.

While keeping patients up-to-date and ensuring a positive patient experience, the HouseCalls system reduces appointment no-shows,  streamlines office productivity, and reduces expenses, and eliminates appointment mail-outs. TeleVox has a worldwide presence in over 14,000 practices and organizations and delivers millions of messages weekly via telephone and the Internet.

For more information on TeleVox Software’s HouseCalls automated messaging system, visit www.televox.com.


Peter DeHaan is the publisher and editor-in-chief of AnswerStat magazine and a passionate wordsmith. Connect with him on his personal blogs, social media sites, and newsletter, all accessible from peterdehaan.com.

[From the June/July 2005 issue of AnswerStat magazine]

Physician Referral and Appointment Setting

By Sue Altman

Even though the call center industry has been performing Physician Referral for nearly 20 years, the name of the service is misleading. We say “referral,” but in truth, our actual goal is new patient acquisition – that is, physician appointments. Senior management is rarely interested in how many physician names were given out in the course of a month. They’d much prefer to know bottom line figures such as “new patients connected with our physicians,” or “kept appointments.” The truth about physician referral services and how often they result in kept appointments is demonstrated in research gathered in 2001 by Expert Knowledge Network:

Service Description                                           Percentage of Kept Appointments
Physician referral alone (caller was given names)                     18-20%
Appointment was scheduled at time of call                                52-65%
Appointment scheduled plus reminder call                                73-86%
(including rescheduling if needed)

So, it is obvious that evolving from referral-based services to appointment-setting is the faster track to achieving your goal of patient acquisition. Converting this number to a net revenue figure is even better!  The value of your service, often referred to as your value proposition, can be calculated in a variety of ways. These fall into three categories: direct revenues, indirect revenues, and savings. There are also less tangible measures that can also be tracked and reported, but they are generally of less interest to senior management.

Direct revenues are dollars that come directly to your call center, organization, or affiliate because of the services you provide. Indirect or “downstream” revenues are from subsequent actions to the initial appointment. Savings through automation also deserve mention, but the focus should center on the patients and revenues that new technology may attract. The following is a brief primer describing decision points that will help prove your contribution. Direct revenues can be realized by sales and kept appointments, as covered below:

Direct Revenues from Sales: If your call center sells the physician referral service for a fee, be sure the fee you charge is greater than your cost per call. You may also consider charging extra for scheduling appointments, since this step takes your staff additional time and delivers greater value to your customer.

Direct Revenues from Kept Appointments. Kept appointments equate to office visit revenues for physicians. If the practices are owned or affiliated with your organization, then this qualifies as direct revenue resulting from call center activity. Since kept appointments are always the goal, you should optimize the current activity so that “converting referrals to appointments” is a primary objective of your staff.

  • Create an easy-flowing script for referral representatives’ use that will encourage callers to allow your staff to schedule appointments more effectively.
  • Your marketing message must prepare callers to expect the complete service, matching them with a physician that meets their needs and references and a scheduled appointment. Consider stating “same day appointments,” “one call for an appointment,” or “one call does all,” as a benefit of the service.
  • Set up processes that enable easy scheduling, such as:
    • Direct access to schedules
    • Reserved “slots” in the physicians’ schedules for appointment-seeking callers.
    • Back door lines into the physician practices to reduce on-hold delays.

Quantifying the financial value of new patient visits can be done as follows:

  • Through the revenue reconciliation process, in the case that the owned physician practices use a common patient accounting system.
  • Through access to the scheduling software used by the office(s). If your call center has access to office scheduling software, you can obtain a report on appointments kept within a specified time range. Record the kept appointments and if possible, track the average revenue collected per new patient visit that is typical for that practice.
  • Manually, enlisting the help of the practice staff. This process requires you to send a list of callers who have either been referred to or scheduled for an appointment with the practice. The office staff must then cross-reference your list to their scheduling or billing system and indicate which of the callers did, in fact, keep appointments.
  • Manually, by following up with callers. This practice is time-consuming, but can yield valuable information about your callers’ (and physicians’) behaviors. Develop a process to follow-up with (physician referral) callers approximately two weeks after your referral, or one to two days after the appointment you scheduled for them. The critical information to obtain is whether they made and kept an appointment with (one of) the doctors to whom you referred them.

Indirect Revenues: Incremental Revenues: Incremental revenues to the hospital or health system may result from new patient referrals beyond physician office revenues. These are viewed as “indirect revenues” because the call center directs the caller to a physician, who then may order the patient to be admitted or to have ancillary or diagnostic testing (lab, radiology, and so forth). Tracking the financial value of these indirect services can be done through revenue reconciliation.

The revenue reconciliation process consists of matching patient accounting, demographic, and revenue data against registration data captured (from callers seeking a physician referral or appointment) in your call center software. You will also need to obtain a download (or extract) from your sponsoring organization’s patient accounting system. Your software vendor should be able to supply a list of the data elements needed for the match.

If callers have visited departments or facilities within the sponsoring organization or integrated delivery network that are on separate patient accounting systems, you will need to obtain an extract or download from each additional patient accounting system to analyze downstream revenues across your network.

Questions to consider include:

  • What definition of “incremental business” or “new business” is accepted by your CFO and senior managers?
  • What time parameter from the last call center contact to service utilization is acceptable to your CFO and senior managers?
  • Will you count the revenues of the first, last, or an aggregate of the services utilized within the time parameter specified?

Labor Savings via the Internet: Web applications can offload a volume of calls that would otherwise be performed by call center staff. This saves time, which can be converted into wage and benefit savings.

There is one caveat with this. If the Internet referral process requires staff to fulfill the request (via email), it does not save time. In fact, this can be a less efficient process than a live call. Time and cost-savings come from Internet products that fully integrate with your call center software. Ideally, your Internet product allows physician referral to be fully self-service and also provides the ability to track consumer match criteria, such as specialty, zip code, and gender.

As alluded to earlier, the Internet is not merely an alternative mode for processing referrals and appointments by the same consumers. A growing population segment is more comfortable seeking information on physicians and health issues via the web instead of, or prior to, making a more personal contact, by either phone or a visit. The time and effort you put into your Internet tools may be rewarded by an increase in kept appointments.

Sue Altman is Vice President, Consulting Services, for LVM Systems. Sue has focused on the healthcare call center industry for 16 years. She spent six years in call center operations and service line management with two Midwest hospitals. She has provided strategic and operational consulting to more than 100 medical call centers in North America and the Caribbean. Sue may be contacted at sue@lvmsystems.com.


Are the Physicians Meeting Your Needs?

Saint Barnabas Management Services (SBMS) has operated an Employee Assistance Program (EAP) for 18 years. To be awarded both regional and national contracts, they needed to establish both a vast provider network and a set of quality standards that could be guaranteed to participating members, regardless of location.

“Customers like Schering-Plough and the foundations on Wall Street demand the highest quality for their employees,” says Joe Ferrera, Chief Operating Officer of SBMS. “They want assurance that we know these providers and monitor them closely.”

Therefore, Saint Barnabas implemented a comprehensive tool to evaluate providers and the physical locations in which they deliver care. This assessment tool has been in place for the past five years.

In 2003, Saint Barnabas brought their physician referral and appointment services in house, developing a call center that now serves their nine-hospital network, spanning most of New Jersey. It is no surprise that they are applying this same standards-based approach to their physician referral network. Much work goes into maintaining and furthering their health system’s reputation of quality, extending to the physicians practicing there.

How do the physicians like being evaluated? “There were some issues at first. It was new; they weren’t used to it. But what they love is the feedback!” says Ferrara with a smile. Doctors are hungry for information on what is done at other offices such as the magazines, seating, or lighting and what patients say they like.

Saint Barnabas performs patient satisfaction calls after each new referral and appointment. The reports are given to the evaluation staff who share the details with the physicians. Therefore, the evaluation process becomes an exchange of information. Ferrera adds, “It’s not disciplining; it’s really a tool for education and marketing. That’s what it’s all about. And in turn, it helps Saint Barnabas sell the quality of their doctors.”

Customers feel more comfortable knowing what to expect at a when they visit a Saint Barnabas physician. This helps the call center convert an inquiry into a kept appointment. In addition, patient feedback is heeded. Listening and acting on what they learn helps the physicians of Saint Barnabas stand out from all the others.


Physicians Online: Directory or Referral System?

A first tier website initiative for many healthcare organizations is to establish a means to promote their affiliated physicians. Most deploy a ‘search by specialty’ function, but the resulting list is presented in alphabetical order. “Great!” as far as Dr. Anderson is concerned. “Of no value,” says Doctor Zimmerman. The bigger the organization, the less likely it is that Dr. Zimmerman’s notable talents are ever viewed online.

This describes an important difference between Physician Directories and what you should demand from an Online Physician Referral product – the power of equitable rotation!  When choosing physician referral software (for call center use), the selection and rotation capabilities are essential. Hospitals want to be able to rotate equitably by physician, solo, or group, and ensure that no participating doctor is underserved. It is important to remember that these concerns are just as valid on the web!

Look for products that provide equitable rotation to better serve your organization’s physicians. It should also track the consumer’s search criteria so you can report consumer preferences by specialty, location, gender, and other attributes.

One example of software that provides these benefits is LVM Systems’ Web3 product, which integrates with its call center software counterpart, E-Centaurus. The number of physicians presented to the consumer is your choice. If the consumer wants more physicians to choose from, they can simply select the “Show Me More” button.

Utilizing physician rotation software is a very practical solution for your online customers. They want a manageable number of physicians to view or contact and they may choose to request an appointment online.

[From the Spring 2004 issue of AnswerStat magazine]