By Mark Dwyer

Video-based doctor visits (e-visits) have received renewed interest to address the shortages of primary care physicians nationwide, especially in rural areas. The healthcare industry is ripe for a strategy to address what many believe to be one of the greatest challenges of the Affordable Care Act (ACA)—providing government subsidized insurance coverage to thirty million Americans while struggling with a major shortage of primary care physicians throughout much of the country.

Providing insurance to uninsured individuals was seen by many as a vital component of a successful ACA. Unfortunately, most individuals initially receiving government subsidized healthcare were without a primary care provider. These early enrollees were also those with serious health issues related to the costliest health conditions. Consequently, the already over-crowded emergency departments across the country became even more congested only now with newly insured individuals who had nowhere else to go to receive the healthcare they needed.

The demand for healthcare has further increased due to our aging population, along with a declining supply of primary care physicians. According to the Association of American Medical Colleges, by 2030, the United States will have a shortage of as many as 43,100 primary care physicians.

What does this have to do with call centers?

Since their inception, healthcare call centers’ mantra has been to get patients “the right care—at the right time—at the right place.” Video-based doctor visits are a logical source for patients to be served as an extension of the call center. The most successful organizations that offer healthcare triage call center services may be those who devise a strategy to integrate video-based physician visits as a triage end-point for immediate, real-time appointments. 

According to the American Telemedicine Association, “as the US healthcare environment continues to evolve due to changes in reimbursement, legal issues, and shrinking healthcare resources, the expanding role of telehealth nurses will continue to evolve.” In distant, rural, small, and sparsely populated areas, telephone triage nursing can remove time and distance barriers between providers and patients. Video-based doctor visits are a prime example of how patients can connect with providers to make better use of shrinking healthcare resources.

It is clear there are not enough primary care physicians to handle patients physically able to be seen in the office setting. But that is not the only concern resulting from the shortage. There are an estimated two to four million people who need doctors, nurses, and healthcare providers to make house calls. Unfortunately, the number of physicians and health practitioners who make house calls has also greatly decreased over the years.

In an August 8, 2017 article by Elizabeth Whitman titled “When patients need house calls, there may be no doctors nearby,” the author referenced a study by Aaron Yao, an assistant professor at the University of Virginia School of Medicine. Yao’s study cited findings that showed more than half of Americans live over thirty miles away from full-time providers of home-based medical care. These centers limit how far they send doctors, nurses, physician assistants, or other primary care providers. Consequently, the healthcare system needs to expand ways to get care to these homebound patients, many of whom suffer from chronic diseases.

“These are the high-cost, high-need people,” Yao said. “We live longer, but we also suffer for longer years,” he added, noting that if doctors can get to patients’ homes and manage their symptoms, they could help prevent emergency room visits and hospitalizations.

Despite the study’s limitations, Yao said his findings drove home crucial points about the need for more, and more widely available, home-based medical care providers in the US. That said, Yao admits, “It’s not a high-paying job,” and comes with related challenges making it less appealing to many healthcare providers. This challenge also lends itself to the use of video-based doctor visits.

So how do e-visits work in conjunction with triage call centers? First, it is important to understand that not all e-visit programs are the same. Like any system that uses patient data, e-visit programs need to be HIPAA compliant. Strong e-visit programs are designed around optimal provider workflows with simple to navigate virtual waiting rooms. E-visit technology allows a physician to connect with a patient via secure, high-resolution video. These connections can be used for a remote visit, to share medical images, to send text messages or online chats in real-time, and to submit prescriptions to the patient’s pharmacy. E-visits help keep patient flow moving with flexible, on-demand virtual visits. When the triage disposition calls for an urgent care referral or to see one’s doctor immediately, patients can get quick “walk-in” care without leaving their house, eliminating long wait times at the urgent care facility.

In addition, a strong e-visit program can increase patient satisfaction by quickly addressing patients’ needs. With e-visits, you can quickly offer patients 24/7 care without the commute or long wait at the clinic. Access to high-quality, convenient care keeps patients happy. According to survey data, 37 percent of parents would choose a virtual care option for their child in the event of a minor illness. That percentage more than doubles for parents in rural areas with minimal access to pediatric specialty care.

How does one monetize the e-visit? Many insurance companies now allow reimbursement for telemedicine services, especially remote visits done via two-way video. As of January 2017 Cigna, Aetna, United Healthcare, and thirty other payors put telemedicine in plans nationwide. In order to be reimbursed, each telemedicine visit needs to be well-documented. Whether stored in the call center software’s triage transaction notes or in the patient’s EHR, everything must be saved in one place and be up-to-date. Some e-visit programs may also integrate with an EHR system for seamless record-keeping. The top telemedicine software solutions allow healthcare providers to easily document the patient encounter and then submit the record for reimbursement.

In addition, through use of e-visit programs, unbilled work also gets reimbursed. From refilling a prescription to treating an illness, some e-visit programs can collect payment from patients and provide a detailed medical chart to submit for reimbursement. E-visits also help to reduce costly no-shows. Missed appointments can cost a provider’s practice thousands in lost revenue. When the visit is real-time via an e-visit program, the service is paid for at the time of care. This creates a more profitable practice further aligning the provider to the facility hosting the call center to which the e-visit program is associated.

Telemedicine solutions come in various configurations. The sophistication of the technology, equipment, training, set-up, and number of users required will all affect the cost of a telemedicine service. Healthcare providers should evaluate their budget for an e-visit program and make sure they consider how much training and staff resources they will need to implement the telemedicine software. Since telemedicine providers offer solutions for single-provider practices all the way to huge health systems, it is imperative to do your homework.

E-visit solutions have the power to change the way we provide and receive healthcare for the better.

Mark Dwyer is a thirty-year veteran of the healthcare call center industry and the COO at LVM Systems, which provides healthcare call center software.

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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.

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.

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

References:

• Bisognano, M., Boutwell, A. (2009). Improving Transition to Reduce Readmissions. Frontiers of Health Services Management 25(3), 3-10.
• Coleman, E.A., Parry, C., Chalmers, S., & Sung-joon, M. (2006). Care Transitions Intervention. Arch Intern Medicine 166(17) 1822-1828.
• Jencks, S.F., Williams, M.V., & Coleman, E.A. (2011). Rehospitalization Among Patients in the Medicare Fee-For-Service Program. New England Journal of Medicine 364:1582.

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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]

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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 10 a.m. 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 8 a.m. or 9 a.m. 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.

In addition, 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.”

Conclusion

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]

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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]

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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.

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