Tag Archives: medical answering service articles

Pairing Nurse Triage with Medical Answering Service

By Ken Bleakley

After-hours telephone services for physicians must be able to address both administrative questions and clinical concerns from patients. Both physician and patient need to be confident that all inquiries will receive a prompt, caring, and authoritative response. This requires the deployment of two different skill sets: medical answering service and registered nurse triage.

Medical Answering Services: An efficient answering service can provide superior value to its clients by conveniently servicing callers through a compassionate and accurate response, including:

  • Answering and messaging services
  • Appointment calls
  • Conference calls
  • Client satisfaction surveys
  • Initial screening for clinical concerns

The staffs who provide these services need not be medical professionals, but they do require medical knowledge. Emphasis is on speed, efficiency, and accuracy in responding to a wide variety of situations using specialized operating systems.

Nurse Triage Services: When the caller requires clinical information or advice, licensed registered nurses using established guidelines and protocols become necessary. Using a dedicated operating system and their own clinical skills and experience, they triage, record, and document clinical calls from patients. Accreditation, insurance, and rigorous quality assurance programs add to the cost and complexity of these services, but provide dependability and confidence in the end result.

Integrated Services: As each of these types of services become more developed to support the medical practice, the need for a simpler, single service to provide the complete after-hours coverage for the busy physician become increasingly desirable. The ability to contract with one unified entity with single billing and a mutually compatible functioning becomes a valuable enhancement. The search and evaluation process are simplified. The service becomes the after-hours extension for each medical practice. On nights, weekends, or whenever physicians need a break, they are able to flip incoming calls to a single number and receive:

  • A compassionate response to patient needs, answered in the practice’s name
  • Committed medical answering services
  • Accredited medical advice and triage by registered nurses when required
  • Medical encounter reports immediately and aggregated reports monthly
  • One predicable monthly bill for services
  • A dedicated representative to address any concerns
  • Optional scheduling and referral services

Meeting the Need: Medical answering services and nurse triage services have responded to the challenge in different ways. Some simply provide parallel services to medical practices that contract them separately. Others offer informal pairing arrangements with different levels of integration. A few provide both services under a single company. While there are advantages to each model, there are also disadvantages.

Parallel service models provide maximum flexibility to medical practices and frequently combine local answering with nationally accredited medical call centers. However, the handoff from one service to the other and from one operating system to the other can be problematical, as can fixing responsibility for errors or delays. Separate billing complicates the task of practice administrators.

The combined service company is automatically equipped to provide a single number to connect the patient to an integrated answering/triage service with a single bill and to assume responsibility for outcomes. However, this model may generate an incentive for the answering service to refer patients to the company’s more expensive nurse triage, even when the call may not be truly of a clinical nature. As the two different functions may not even be in the same location, it does not necessarily assure a smooth handoff between them. In addition, a nurse triage service that is also competing for medical answering business will find it difficult to build cooperative relationships with medical answering services already providing answering services to their own clients.

Optimizing the Roles of Each Service: Once it becomes clear that neither the answering service nor the nurse triage service has any interest or desire to enter the substantially different business of the other, they become natural allies. They can concentrate on providing the one call/one service/one price model desired by medical practices and patients. They can concentrate on making their respective systems as compatible as possible, while enhancing the quality of their respective services. They can also develop joint sales programs focused on mutual specialized or local markets.

The result of these alliances is better and less costly service for the patient and physician alike. More physicians will be able to afford turning over their practices after-hours to reliable professionals. The pairing of local and national capabilities also helps to maintain the personal relationship between doctor and patient during the hours when medical practices are closed. Patients are able to schedule visits to their providers and avoid unnecessary visits to over-crowded emergency rooms.

Ken Bleakley is CEO of Fonemed, whose mission is to connect people by telephone and Internet to health information, services, and products. Fonemed provides nurse advice throughout North America and the Caribbean. For more information, call 800-366 3633.

[From the February/March 2007 issue of AnswerStat magazine]

Streamline Your Medical Answering Service

By Nina Fernandes

Some years ago, I called the telephone answering service for our medical practice. I was resigning as practice manager for a thriving internal medicine group and wanted to advise them of my replacement’s name. Speaking with a supervisor, I advised her of my pending resignation and the new manager’s name for their records. She asked where I was going and I responded that I hadn’t decided. I had several opportunities and would make up my mind in the coming weeks. To my surprise, she asked “Why don’t you come here? We need a good manager and I’m sure you would fit right in!” Taken aback, I politely declined and thanked her for the thought.

Little did I know that that brief conversation would be the beginning of a major career change. The owners of this answering service called the next day. Admittedly, the idea of having my own answering service to play with was entertaining.  After almost 20 years in healthcare, I couldn’t count the number of times I thought “Can’t the answering service get it right? How hard can this be? Answer the phone and follow the instructions. Sheesh!” After several preliminary conversations with the owners, we agreed to meet. Telling myself I was motivated by curiosity and contacts weren’t bad to have, I walked into the most amazing place. Modems firing, lights blinking, a room full of agents wearing headsets and typing like the wind as they moved from caller to caller – I was fascinated. Where were the boxes of Bonbons, women in curlers, slippers, and so forth? What a contrast this was with the image I had in my mind for all this time!  The frightening part was that I knew I wasn’t alone. Most healthcare managers have never seen an answering service and many share similar images. The answering service was often a topic in managers’ meetings or even over lunch.

On my way home I realized I was hooked. My mind was racing with the possibilities. The image of the answering service staff at work was vivid. Who knows about these people? Why didn’t I know about them? Is it a wonder “they can’t get it right” when we don’t know about them and they don’t know about us? Visions of growth and change, bridging the gap between the medical community and the answering service flooded my thoughts. There was so much to be done and someone had to do it.

That was more than 10 years ago. Since that day, I’ve been privileged to work with some of the most knowledgeable and innovative people in the industry sharing tips, tricks, and tools. This is a dynamic industry in constant motion, yet it is probably one of the most undervalued, unrecognized, and misunderstood of all the integral support services available to the clients we serve.

Misguided complaints and misunderstood comments are all too common. They include: “You’re just the answering service,” “You must be understaffed,” “I want you to answer our phone in one ring!” (How quickly does their own staff answer the phone?), “What’s wrong with you people?” and “You know that I don’t wear my pager to bed!  Are you stupid?”

If this sounds familiar, then change it or at least reduce the occurrence. An integrated plan to elevate the professional presentation, product quality, and profitability can change your medical answering service. Successfully done, not only can a medical telephone answering service become more profitable, but it can also open the door to securing a higher level staff with compensation comparable to skilled clerical employees in other industries. The cost savings for retaining versus replacing agents would provide a handsome savings. It is possible.

An aggressive approach to positive change involves tackling several focuses at once:

  • Improved individual agent performance via training and incentives.
  • Improved quality of message presentation (brevity and formatting).
  • Development of a cost-effective staffing model.
  • Review and transition all low or no profit accounts to an acceptable status.

The long term impact includes:

  • Increased professional presentation.
  • Higher service level with less staff.
  • Improved product.
  • Improved gross margin.

Performance may vary greatly among agents. Effective hiring, training, and the initiation of a performance incentive program will enhance individual performance. This will ultimately allow better traffic management and higher service levels.

Does your medical answering service have a “standard format” for messages? Is it followed? Have abbreviations been standardized? Defining message and abbreviation standards will provide an improved product and reduce agent errors while minimizing communication problems. Establishing norms for agent performance, aggressive implementation of call control techniques, and continued “customer care” training will enable your medical answering service to meet or exceed industry staffing and call volume standards. These changes will increase overall profitability.

Is your medical answering service operating in a reactive or proactive mode? “Putting out fires” too often becomes the mode at many medical answering services and results in decreased service levels and caller satisfaction. Operating in a response mode can negatively affect the ability to ensure adequate training and development of staff. Lack of available time and energy for effective training and monitoring of performance standards all but ensures ongoing service problems. Service issues generate complaints. Complaint resolution requires time and energy from key staff. Key staff is needed to ensure training and monitor performance. It’s necessary to break the cycle; start today.

[From the February/March 2006 issue of AnswerStat magazine]

Medical Answering Service Technology

By Robin L. Davis and Julie Deyett

In every medical practice and hospital, quick and accurate messaging is critical to physician and patient satisfaction. Making sure the right information is delivered to the right person at the right time can literally be the difference between life and death. With hundreds of calls coming in every day, physicians need a reliable way to manage a barrage of requests for matters including prescription renewals; making, canceling, or rescheduling appointments; referral needs; and X-ray or lab test results. It is also vital that in the event of emergency, physicians will be contacted in the fastest and most reliable method possible, yet not be unduly interrupted during their private time due because of outdated on-call schedules.

Equally important to the physician’s satisfaction is that of the patients. In order to retain patients, their calls must be handled quickly and with great attention to detail. In fact, recent studies indicate patients choose one doctor over another not for clinical reasons, but because of the experience they had at the doctor’s office. A busy signal, long hold-times, or incorrect transcription of their message could not only lead to frustration and prolonged aggravation, but could potentially jeopardize their health and lead them to seek alternative care.

In fact, having reliable message answering is recognized as being so important that it has become commonplace for medical facilities to outsource messaging responsibilities to an unaffiliated answering service. The upside to this approach is professional, prompt, and accurate message taking as well as delivery any time of day or night. The downside is lack of control and increased expenses in an industry facing tight budgetary constraints. In an attempt to manage expenses, it has become increasingly important for healthcare facilities to look towards technology rather than outsourcing or hiring additional staff for an affordable way to address messaging challenges.

Fortunately, with the advent of new and easy to use tools, medical facilities can integrate affordable technologies that allow medical offices to handle their answering service needs on site by helping operators and staff provide succinct, reliable, and efficient messaging. On a small scale, this technology can shave minutes off hold times, eliminate frustration, increase patient retention, and improve the overall experience for physicians, patients, and operators alike. On a large scale, this technology can save lives, diffuse emergencies, save money, and reduce costly errors.

When researching a solution for your in-house answering service needs, it is important to determine how robust of a system you will need. Choosing a single solution will keep costs to a minimum while still improving message taking and delivery. Layering multiple technologies will allow automated self-service and coverage for nights and weekends. With several systems on the market, consider prioritizing your needs in order to find the system that will work best for your environment. The following list outlines a few of the most helpful and important features available on the market today.

Professional and Personalized Greetings: Delivering exceptional customer service is an important goal of any medical facility. Today, voice saving technology helps enhance your customer service by delivering personalized greetings designed for a specific time of day, office location, or special event. Voice saving technology also ensures that every customer is treated with respect and each call is answered in a consistently professional and pleasant manner. By housing a host of predefined greetings, this technology not only cuts down on your call center noise, but literally saves the voice of your operators, particularly during lengthy shifts. Most importantly, this technology reinforces your facility’s image by guaranteeing that your patients are consistently greeted in a polite and professional manner.

Fully Customizable Message Templates: Fully customizable message templates provide operators with a tool that makes message taking simple and accurate. Flexible templates can be designed to meet the specific needs of an individual physician or healthcare environment and help control the delivery of clinical and non-clinical messages as well as information between patients, physicians, hospital, and office staff. Pre-selected delivery options and notes ensure messages are delivered according to the preferences of the recipient and guarantee quick, accurate, and convenient transactions for operator and physician alike. This allows each doctor in a practice or hospital to have a different set of protocols. For example, one doctor might wish to be paged for all calls, while another prefers to receive a page in only the most severe emergencies. The flexible templates dictate the information that should be included in each message as well as the proper delivery method, thus ensuring that operators gather the exact information necessary for individual doctors and are able to deliver that information in a timely manner.

Multiple Options for Message Delivery: A comprehensive message is useless if it isn’t delivered in a timely manner to the person who needs it. Today, state-of-the-art technology allows for various methods of message delivery, including pager or text messaging to mobile device, email to computer or mobile device, fax, and data download. Also important is a solution that allows for seamless integration with your on-call schedule, enabling messages to be delivered to both the on-call physician and the office. Doctors are able to dictate the best way to be reached and operators are easily able to comply, ensuring that patients’ needs are addressed as quickly as necessary.

Serial Calling: By allowing patients to reach multiple contacts with a single call, you automatically reduce frustration and streamline the calling and messaging process. For instance, if a patient needs to speak with a nurse regarding a prescription renewal and then wants to be directed to the lab, there is no need to hang up and redial. Using serial calling technology, your operators take advantage of a special transfer that will automatically return the caller to be transferred to a second or third destination where he can speak directly with a staff member or leave a message for the appropriate person.

Automated Emergency Processing: Automated emergency processing ensures that in moments of stress, when every minute is critical, your operators are able to launch messages to the right emergency teams quickly and accurately. By handling a host of predefined emergency procedures and instructions, automated emergency processing takes the guess work out of emergency procedures and promotes rapid and concise messaging and delivery.

Reports and Automatic Audit Trails: Finally, to ensure accountability, consider a solution that logs all messaging transactions. It is important that your solution allows for permanent message storage and provides powerful search tools that can pull up a message based on name or even keywords, months or even years after the message was taken. Transaction logs act as an insurance policy for staff and physicians alike, providing proof of all successful message transmissions and alerting operators if your system fails.

Choosing an Answering Service Technology that is Right for Your Facility: Careful consideration should be given to how you handle messaging in your medical facility. Before deciding to embark upon outsourcing your needs to a professional answering service, consider researching new technologies that provide your operators and staff with tools that make messaging easy, efficient, and accurate. Adding answering service technology to your in-house call center can be a cost-effective way to improve customer service and physician satisfaction. Ultimately, it can make an operator group a revenue-generating and relationship-building department for your facility.

Robin Davis is marketing manager and Julie Deyett is product implementation manager for SDC Solutions, Inc. with expertise in healthcare-specific telephony solutions, including PC-based consoles, speech auto attendants, and web and IP-based directories. They can be reached at 603-629-4242 or rdavis@sdcsolutions.com or jdeyett@sdcsolutions.com.

[From the February/March 2006 issue of AnswerStat magazine]

Telephone Answering Service Systems

By Peter Lyle DeHaan, Ph.D.

Peter DeHaan, Publisher and Editor of AnswerStat

Telephone answering services are by definition a subset of the call center industry. However, while the greater call center industry has a history spanning more than 30 years, telephone answering service has an 80-year history. In the 1920s, and the decades that followed, enterprising entrepreneurs began opening localized telephone answering services around the United States. In those days and until around 1980, calls were largely answered when an operator plugged into a ringing line, client data was in paper form, messages were handwritten, and calls were placed using a rotary dial telephone.

With the advent of affordable computer technology in the late 1970s, a new breed of entrepreneurs, the technologists, began harnessing the nascent microprocessor to automate, control, and organize portions of the call handling process. Thus was born the first-generation Computer Telephone Integration (CTI) systems. Although primitive and basic by today’s standards, they represented a fundamental shift in the call processing mindset. These systems allowed calls to be answered with a single keystroke and a basic repository of client data would be automatically displayed on a computer screen.

Second generation CTI systems allowed messages to be entered into the computer, giving way to a plethora of distribution methods, including alphanumeric paging, faxing, and eventually email. Today’s leading-edge answering service systems are third generation CTI platforms. These systems dominate the market, offering laborsaving automation, client conveniences, agent-assisting features, scripted call processing, integration with remote databases, and Internet access to web-based tools and information. “The evolution of CTI systems has helped the telemessaging industry grow into a sophisticated industry capable of much more than just answering the phone and taking a message,” stated Linda Osip, Executive Director of the Canadian Call Management Association. “We have so much information at our fingertips that we can now act as a true representation of our clients to their callers.”

Among the benefits afforded by these third generation CTI answering service systems, labor savings is a frequent and well appreciated result. Jim Geary, the owner of Complete Answering Service, in Jackson, TN, stated that with his Startel 5700, he “was able to handle the same amount of call traffic with over 50% staff reduction.” He also cited “a massive reduction in errors” as another important benefit.

Tom Gelbach, owner of Answer Connecticut, in Newington, CT concurs with the labor saving aspect. His center uses an Amtelco Infinity system. “We are barely scratching the surface of its capabilities,” he stated. “We have found that in our dispatching operation alone we have been able to reduce the time per call by 31 percent.”

Julie Barr, Call Center System Director at Banner Health, is equally enamored. “With the help of Amcom’s Smart Center, we’ve transformed operator services. By combining independent call centers into one centralized center, we’ve improved efficiency, reduced operational expense, and enhanced customer service.”

Call center managers of other telemessaging systems are also quick to applaud the features, efficiencies, and effectiveness of their respective call center technology.

Please refer to our updated listing of the major telemessaging system vendors in the industry.

Peter Lyle DeHaan, PhD, is the publisher and editor-in-chief of AnswerStat. He’s a passionate wordsmith whose goal is to change the world one word at a time.  Read more of his articles at PeterDeHaanPublishing.com.

[From the Summer 2004 issue of AnswerStat magazine]

Hospital-Based Telephone Answering Services

Karen Kiley of Allina Hospitals and Clinics in Minneapolis, MN had this to say when asked about how messaging is evolving in the medical field.

“More than twenty years ago I started a hospital-based doctors’ answering service. Back then, it was a big deal to have a digital pager. Several year’s later we thought it was a cutting edge technology to get a physician to use an alpha pager! Today we look at how call center technology can interface with the automated patient medical record systems. How can we attach messages from the call center to that record? How can our hospital call center push the medical information out to the community?

“I think, if they’re not already doing so, hospital’s today will be revisiting why they are in the after hours answering service business. This is due to operational expenses in providing a 24 x 7 staffing requirement and the rising cost of healthcare benefits for employees. I believe hospitals will come to the realization that commercial services can do it for less. You will more than likely see outsourcing of hospital answering services and partnerships between hospitals and private call center businesses.

“I see a new trend in hospital medical contact centers with the focus shifting towards looking at how they can best utilize the communications technology to support internal hospital departments via one call “hot lines” to their call centers. This includes providing online patient class registration, HEICS (Hospital Emergency Incident Command System), physician referral, nurse triage, appointment scheduling, patient placement, and call processing consolidation. This will result in reducing expenses by requiring less FTE’s (full time equivalents) across the organization and at the same time increasing productivity while improving customer service.

“Today’s leading-edge call center systems are innovative and allow each organization to be creative and customize special needs, while keeping things exciting and manageable for the users. They help create operator efficiency and reduce the opportunity for potential errors, which is critical in health care, and provides a powerful tool for today’s medical communication’s initiative.”

Allina Hospitals and Clinic uses the Amtelco Infinity system. For more information visit Amtelco at http://1call.com.

[From the Summer 2004 issue of AnswerStat magazine]

The Trouble with Medical Answering Service

By Joseph Sameh

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[From the Summer 2003 issue of AnswerStat magazine]

Hospital Answering Services Could Be Risky

By Mike Wilson, JD

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

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

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

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

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

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

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

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

[From the Summer 2003 issue of AnswerStat magazine]