By Sue Altman

Data mining is an important tool used to measure the call center’s value as an information hub. How much more valuable can your call center be to your organization’s marketing and physician relations departments and the physicians you serve?

Let’s start with the obvious, analysis of consumer preferences. You may think of these attributes as “search criteria,” but in reality they are much more. The good news is that you already capture terrific data callers. They choose:

• Specialty
• Gender
• Preferred location – usually by zip code of work or home
• Insurance accepted
• Language

These elements are fairly straight-forward. So if we take our minds off the “match” process (what the staff are focused on during a call or Internet request), the information can then be seen as “consumer demand” information. You probably have a report that gives you these statistics, but is it in a format that other departments can use for decision-making?

If you don’t use them already, a zero match or partial match report is invaluable. What expectations could not be fulfilled or were only partially met? What percent of the time did the agent ask the caller to “settle” for a second best match?  This is great information for physician recruitment personnel. The call center cannot only support the category of need (what specialty), it can also quantify demand. You have the information to state, “If we have a female OBGYN in the Monte Vista area, we could send her 12 new patients per week.” This makes your information actionable. Get it to someone that can use it.

When generating this information, use your software to define “location” in a more meaningful way than zip code.  Most software products have a “service area” field that is underused. Group geocodes, zip codes, and school districts, labeling them with the terms that your callers use. This is far more useful than a zip code.

What can you tell physicians about appointment wait times? Your staff has a gut feeling regarding how long people will wait for first available appointment; a day or a few for primary care, weeks for a specialist, and so forth. Although we cringe when we have to say, “They are scheduling about three months out,” this information states an important case that your physicians, physician relations, and senior team need to know. Customers will seek other options – which may mean other health systems.

How do you quantify it? Use your “first available appointment” field (or a user defined field, if your software is lacking). The “wait time” report will subtract the first available appointment date (for that specific practice being contacted) from the date of the appointment request. Data mining enters the picture when you run this report by individual practice and by specialty. Analysis will show whether this is a practice that doesn’t need new patients (and perhaps shouldn’t be on your referral list) or whether there is a real need for additional options within that specialty. Again, don’t keep this information secret. Getting it into the right hands, in a format that clearly identifies the need, is a valuable service that the call center can offer.

This information can also be used to diffuse physician complaints. For instance, say that Dr. Smith thinks she does not get as many patients from the call center as Dr. Jones. If that’s true, you can produce the report that shows her first available appointment (three weeks) versus that of Dr. Jones (one week). This gives Dr. Smith a choice, manage her schedule to accommodate new patients, or continue to see that, given the choice, consumers choose to be seen in a more timely manner.

Saint Anthony Medical Center in St. Louis, MO recently re-positioned its call center in just this way. The re-introduction letter to physicians explained that the priority of referrals will be based upon

• Caller preferences
• First availability of appointments (‘same day’ given preference; then short wait; then longer wait)
• Timeliness and helpfulness of response from office

This seems so simple, it is almost a given.  For Saint Anthony Medical Center, it was an important message to shift perceptions of the call center’s role. They are going to be customer-centric. Practices that align with this strategy will be given priority; those that don’t will experience less new business.

This last topic should become a standard practice in your call center. “How heard,” or “lead source,” is a fundamental tool for tying call volume to specific marketing activities. Your staff may see this as a nuisance to track, but it’s essential data for your marketing managers. Few of their responsibilities have a definable return on investment. The call center is perhaps the most concrete vehicle for proving cause and effect. The best practices in this area go further than identifying “newspaper,” “yellow pages,” or “friend/family.” Build your tables to allow a drill down. Which newspaper? What article? This information, when paired with revenue reconciliation, allows a marketing executive to know the $1,500 ad placement for the new Endocrinologist resulted in 92 calls and 51 new patients through the diabetes center.

The analyses described above can be accomplished with a few brain-storming sessions. Consider inviting physician relations and marketing to participate. Be prepared to talk through call scenarios and what data you capture to get everyone on the same page. Contemplate the information that would be useful and what data must be pulled into accomplish it. As a last step, play with the report design and trial it with the audience that would benefit most.

[From the June/July 2006 issue of AnswerStat magazine]

By Sue Altman

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]

By Peter Dehnel, MD

Imagine the following four scenarios:

1. You are a physician in outstate Minnesota. It’s 2 PM on a Sunday afternoon and a confusing and concerning set of laboratory results just came back on one of your moderately ill patients; you really need to contact a kidney specialist that afternoon. You know of the hospital where the specialist works, but that’s it. You are not even quite sure of the name of the group in which he or she practices. What would your options be at that time?
2. You are the administrator for a referral hospital in a metropolitan area and you are seeing the referrals to your specialists decrease. When you survey the primary care providers who normally refer to you, their biggest dissatisfaction is difficulty in contacting the specialists they need at the time that they need them. They also report that competing hospital 30 miles away, “St. Elsewhere,” has an apparently seamless system to connect them with the specialist that they need. All that they need to know is a single toll free number and/or an email address that is monitored “around the clock.” What can you do to counter this change in preferences?
3. You are a GI specialist with a “brand identity crisis.” You have moved to a new location in a distant city to help fill a void identified by a leading hospital in that city. Because of the convoluted system of insurance networks present there, it has been difficult for primary care physicians to find a way to get referrals to you. This is in spite of the fact that you are in network and typically do a great job with the patients you see. It is just easier for the primary care providers to refer to the large and unresponsive Multi-Specialists, Inc. How can you work with the hospital to change this situation?
4. It is late in the evening on the Fourth of July. You are a consulting physician for a patient who has suddenly taken a turn for the worst and needs a surgical evaluation ASAP. The ideal solution would be to have a three-way conference call with the primary care provider and the surgeon, but how is that going to be set up at 9:45 PM on a holiday? Instead, you bite your lower lip and proceed to coordinate the flow of information between all interested parties over the next hour and a half. Fortunately, the patient gets well and is discharged a week later.

The solutions to each scenario can be boiled down to one key process, improving communications. The primary need in each of the above scenarios is an improved communications process to connect one medical provider to another – and sometimes multiple parties at once. That is well within the scope of a leading edge physician referral service. Providing updated information on providers, practice location, specialty information, and contacting the appropriate person at the time of need on a “24/7” basis is the foundation of a quality referral service. This in itself is an advancement in patient safety and quality of care. Added to these benefits are improvements in customer satisfaction and efficiencies in delivering a higher quality of care.

Going beyond this foundational level of service, referral services can act as “conduits and coordinators” of communication. Helping to facilitate the flow of patient information from one provider to the next is a key challenge in patient safety as well as quality of care. Many less than favorable outcomes have their origin in communications problems between a primary care physician and a specialist, or between a physician in the Emergency Department and the patient’s usual physician. Helping to bridge that gap is a natural function of an engaged and proactive referral service.

Finally, there is the opportunity to go beyond cell phones and faxes. Helping to bridge the technology gap is a function that a referral service can perform more effectively and efficiently than a single practice or even group of practices. Conveying the needed information at the time of need to the most appropriate provider is possible right now given the current state of technology. A service that works with both the hospital and physician practices – both primary care and specialty care – will have advantages that the hospital, acting on its own, can’t come close to matching. The biggest beneficiaries are ultimately the patients who are served by those practices and hospital.

All of this is not free, of course, and represent a sizable investment of time and capital resources. In the end, increased patient volume and growth of market share is what you have to prove to the sponsoring organization. That is not a hard job to do, as long as you are set up to track the appropriate information from the start of the program.

So, does all of this actually work, or does it just sound good in theory? Based on our experience, we know that the gains are very real and measurable. Our organization, Children’s Physician Referral (CPR), was established to connect outstate physicians with Children’s Hospitals and Clinics specialists and to facilitate the transfer of critically ill patients. In 2003, the Nurse Triage Service staff handled 1,902 physician referral interactions. Because CPR is contained within our Nurse Triage Service, the communications systems and information systems needed to perform this function are readily available. If needed, the ability to show the return on investment can be quickly shown to our sponsoring organization.

The next step for CPR is to enhance its functionality to include the transfer of information from provider to provider. As Children’s Hospitals and Clinics expands its electronic medical records and has that available to the community through a remote access function, the more information will be available to coordinate and communicate. When that becomes fully implemented, it will be exciting to see the future possibilities for a physician referral service.

Peter Dehnel, MD is the Medical Director at Children’s Physician Network Triage Service. Their Physician Referral is called Children’s Physician Referral (CPR).

[From the Spring 2004 issue of AnswerStat magazine]

By Paul Spiegelman

Teresa and her family have just moved to a new city. It’s 7:00 a.m., Tuesday, and Teresa’s little girl is running a fever. Where to turn? Teresa opens the yellow pages directory and finds that a local hospital nearby offers a physician referral service. Teresa dials the phone number looking for help.

Hospital-sponsored physician referral programs have existed for several decades. Early versions used manual processes to select appropriate physicians to whom referrals were sent. Documentation of the referral was via paper, pencil, and index cards. Today, physician referral programs are at the very core of hospitals’ patient acquisition and retention programs. They can represent an organization’s largest single marketing expense, sometimes representing a million dollars or more, and generating tens of millions of dollars in new revenue.

Objectives of Physician Referral Programs: There are two primary objectives that drive hospitals to develop and offer physician referral services to their communities: (1) endear physicians to the sponsoring hospital, and (2) provide great service to clients and prospects of the hospital.

Without physicians, hospitals would have no business. Virtually all services delivered by a hospital are provided only after an order from a physician has been written. Thus, hospitals need positive relationships with physicians in order to drive revenue-generating business.

Strategies that endear physicians to a hospital are funded by the hospital with little hesitation, and physician referral services have proven a very successful strategy. Why? Because they help grow physician practices by sending physicians qualified patients – patients the hospital is hoping will be referred back to the hospital by that physician for inpatient, outpatient, or emergency care.

Hospitals also frequently invest in another strategy to endear physicians to their organizations – telephone nurse triage. This service, when offered on an after hours basis for physicians, allows physicians an improved quality of life. Calls received in the physicians’ offices after hours are triaged by registered nurses. Whenever possible, the nurses provide callers comfort measures to follow until the patient can be seen by a physician. The nurses can direct callers to appropriate sources for care that are open at the hour of the call. When necessary, the nurses can forward the calls to the physician.

As in every business, there are multiple targets. For hospitals, physicians represent one target. Consumers represent another. Especially in today’s environment where consumer directed healthcare is growing in popularity, hospitals are focused on providing outstanding customer service to the public. Since the physician referral program is often the very first touch point for a consumer, hospitals are working harder than ever to ensure that every caller enjoys an exceptional customer experience. That requires specialized, ongoing training of call representatives and continuous quality improvement. This is where many hospital-based call centers fall short.

Hospitals Often Need Help: Obviously, operating a call center is far from the core competency of a hospital or hospital system. Because hospital-based call centers are often operating with 10 or fewer employees, the call centers have to make concessions.

Usually those concessions are in the form of limited hours of operation, limited recurrent training of call representatives, limited quality checks on calls, and limited improvement coaching with call representatives. The result is substandard customer service.

Skilled hospital marketers know that when consumers have to wait on hold or have to wait until the next morning to get help, the hospital is losing potential clients; every call means revenue to the hospital. A 2003 study by Solucient, the nation’s leading source for health care business intelligence, revealed that the average call center caller generates almost $14,000 in hospital charges within 12 months following a call versus a little more than $5,500 for patients overall. It also revealed that every call to the call center represents more than $4,000 in downstream charges within 12 months.

When hospital-based call centers make concessions, they also frequently include lackluster performance building relationships with affiliated physicians and physician office staffs. Hospitals’ physician referral programs must establish and maintain those relationships in order to gain and maintain physician’s loyalty to the hospital. Outsourcing has helped many hospitals avoid these pitfalls and minimize concessions.

Beyond Telephone-Based Physician Referral: Today, many hospitals nationwide outsource their physician referral programs to organizations that specialize in that service. By outsourcing, hospitals are able to access additional expertise and state-of-the-art human and technological resources. This gives the hospitals access to solutions that go beyond traditional telephone-based physician referral programs. In addition to physician referrals, strategically focused call centers also provide consumers referrals to hospital services, community services, hospital-sponsored seminars and classes and more – and not only by telephone.

Now consumers can get physician referrals via the Internet as well. They can sign up for hospital-sponsored seminars and classes both via live agent and online. While navigating a hospital’s website, a consumer can even ask that a call center representative to telephone the consumer at a particular time and on a particular day. Or the consumer can have an email conversation with a call center representative. During these interactions, the call center representative can “push” pages of requested or related information directly to the customer’s desktop. Consumers are better informed and more eager for information than ever before. Online resources help to provide those consumers the information they seek.

As you can see, the consumer can interact with a hospital’s call center in many ways. Call centers can reach out to consumers in traditional and new ways as well. Through Advanced Speech Recognition (ASR) technology, hospitals can deliver thousands of recorded messages all at the same time, personalized to each consumer. This automated outbound calling technology dials the consumer, speaks the consumer’s name, provides the consumer with important information, allows the consumer to answer questions in their own voice capturing all responses for future reporting to the hospital, and allows the consumer to opt out to a live call center representative whenever desired. This technology has far reaching applications for hospitals wanting help with appointment confirmations (physician appointments, pre-admissions, scheduled procedures, classes, screenings), notifications (new services, new facilities, watch for mailer), research (post-discharge satisfaction surveys, post-class evaluations, perception studies), and employee applicant screening.

A New View – Customer Interaction Centers: With the advent of the many live agent services, Web-based services, and automated services now available, call centers are evolving into “customer interaction centers” – centralized storehouses of information for and about consumers. Consumers have a variety of options for communicating with the hospital, and hospitals have a variety of options for communicating with the consumer.

Now that we know that each caller represents nearly $14,000 in future revenue to a hospital, we must refocus our thinking. We must realize that each call represents a transaction, a revenue-generating opportunity for the hospital. Continuing to develop relationships with the callers is crucial. Marketing efforts from television to direct mail need to focus on returning callers to the customer interaction center for further dialogue. That will result in more business, more revenue, and more profits for the hospital.

Way Beyond The Call: Even for hospitals that operate well-run call centers, few are utilizing the information they collect in their call centers to most effectively and cost-efficiently market their organizations. Imagine taking the tens, even hundreds of thousands of records your call center has collected, then segmenting those records into common groups each of which has predispositions to purchase certain goods or services. Now imagine producing a mailer to be sent to the group most predisposed to purchase cardiac services, each mailer featuring the recipient’s name in the headline, the recipient’s physician’s picture and signature, and an offer to attend a seminar in the recipient’s neighborhood with a map to the seminar location. The result? Reduced waste and increased response, revenue, and profit.

It’s not the future. It’s here today. Household view segmentation of any database helps hospitals understand what offers to send to which consumers. Variable digital printing allows for name personalization, different photos, different signatures, different offers, inclusion of maps and more within each mailer that is printed – each unique to the recipient.

This is the current state we’ve evolved to since the early days of physician referral. Not only does Teresa’s child get the care she needs, the hospital is gaining more loyal physicians and customers, and the hospital is reaping greater financial rewards.

Paul Spiegelman is co-founder and C.E.O. of Bedford, Texas-based The Beryl Companies. Beryl provides product information, physician/service referrals, health information, telephone nurse triage, and class/seminar registration to more than 15 million callers.

A Better Physician Referral Program

• Promote the availability and benefits of participating in the referral service to physicians and their office personnel.
• Create accurate profiles of every participating physician; update the information on a regular basis.
• Integrate the referral service with additional live agent and web-based services to provide customers more options for communicating with your organization.
• “Warm transfer” referred callers to the physician’s office to immediately schedule physician appointments.
• Capture and report the number of referrals made to each participating physician so each understands the value the physician referral service is bringing them.
• Use your data to market effectively and create more frequent dialogue with your customers.

[From the Spring 2004 issue of AnswerStat magazine]