Multi-Channel Electronic Communication Solutions

It's highly likely that the number of medical practices will continue to shrink this year as fewer physicians open new practices and an increasing number of existing small practices become affiliates of larger practices.

* Fewer medical school graduates are opening their own practices and a greater number of graduates are joining hospital-based practices.

There are several factors driving this move to join larger practices. Experts speculate that medical school graduates are seeking a work-life balance and desire to pay off their student loans. The average student loan debt of 2010 medical school graduates was $157,944. Joining a larger practice provides a lower risk, less time intensive position.

Consistent with this trend, the number of part-time provider positions at larger medical organizations has increased. An American Medical Group Association (AMGA) survey of AMGA member groups in 2006 found that 20% of the groups' staff were part-timers, compared to 13% in 2005.


The benefits of owning one's own practice have declined with falling reimbursements, increased administrative complexity, and rising malpractice insurance and IT costs. 

With fewer new practices and the selling of existing practices, continued provider consolidation is assured. 

Christmas is just a few days away and many Americans will be receiving new smartphones. Nielsen estimated that half of the U.S. population would have smartphones by the end of Christmas 2010. Three out of 4 physicians owned a smartphone by the end of 2011.

These trends are important to businesses because they show how communication is changing over time. Multi-channel electronic communication solutions are more relevant than ever.

Mobile health apps have the potential to change patient and physician behavior. Pharma companies have taken note and are building smartphone apps to improve drug adherence. Marketing is shifting from outbound to inbound as marketers try to engage consumers and provide relevant content. The online world makes it easier to tailor and target content to customer segments and to track the results.

Businesses, including medical practices, that can establish a strong online social media presence and manage their online reputations will have an advantage. It's easy to put off the task of developing an online social media presence but the time is right. I'm including a link to a helpful post that I found on KevinMD.com: Should all health care professionals have a social media presence. It's a good starting point.

Happy holidays from Webley MD and see you in 2012.

Intuit Health's Annual Health Care Check Up Survey of 1,000 American adults in January 2011 found that 59% of Gen Y respondents and 29% of Baby Boomers would switch doctors for one with better online access. 

Rosemarie Nelson, a self-proclaimed “healthcare technology guru” and management consultant, weighs in: “In a recent Harris Interactive poll, 77 percent of the adults surveyed indicated they would appreciate email reminders from their physicians when they are due for a visit or follow-up care,” she says. The poll also revealed, in concurrence with other studies, that many patients will choose a new doctor based on whether they use modernized forms of communication.

The message is clear. Modernize the way you send appointment reminders to please your patients and improve communication. Adding email communications and/or a practice website is the easy way to attract new patients and retain the ones you already serve. 

A good automated reminders service sends interactive high quality messages that allow patients to easily confirm (or cancel) the upcoming appointment, whether that message is sent by e-mail or by phone.

Using multi-channel electronic communication solutions to one's advantage will not only determine the practice's growth, but its survival against other competitors. 

Experts estimate that by 2012, direct payments from patients will account for 30% of providers' revenues. With such a large percentage of direct patient payments and record levels of healthcare bad debt, providers are challenged to become better at collections. 

The medical billing and collections process is currently a labor intensive one. But there are things you can do to make it easier for your patients to pay you and make it more likely that you will be paid. Good communication is the key to maximizing the amount collected.

Prompt billing and clear statements, along with consistent reminders and a clear payment policy are the basics that each practice should aspire to offer.

Be flexible and accept additional forms of payment. Being able to accept credit cards at the point of care is a good first step to take. Accepting online payments is the next logical step to consider. The smallest businesses accept online payments today - there is little excuse for medical practices to not offer this convenience. Before you grumble about credit card transaction fees, ask yourself if you want to get paid.

Automate your account balance notification reminders. You can save money and time on postage and labor by using an automated patient notification service to handle your account balance notifications. These automated reminders can take the form of a phone call, email, text message, etc. Phone calls tend to work best when it comes to collections. Telephone reminder services have the ability to call in the evening, when patients are most likely to be home. Multi-channel electronic communication solutions allow for greater reach and better effectiveness than single channel solutions.

For additional information, visit Webley.

I recently blogged about how higher levels of physician empathy are positively correlated with higher levels of patient satisfaction and improved patient health outcomes. I recommended that empathy be shown by practice staff as well. 

Lack of empathy (and possibly other factors such as lack of experience) could also explain a recent study published in the Journal of General Internal Medicine. The study was based on a survey of 750 adult visitors to an internal medicine walk-in clinic and their physicians. Physicians rated 18% of patients as "difficult" but the rates varied dramatically. Physicians with fewer than 10 years of experience rated almost 1 in 4 patient visits as difficult whereas those with 20 or more years of experience rated 2% as difficult.  Physicians with better, more open communication skills also reported far fewer difficult patients.  

A difficult patient is one that "had more symptoms, worse functional status, used the clinic more frequently and were more likely to have an underlying psychiatric disorder than non-difficult patients." 

Recall the definition of empathy.  "Empathy is the ability to understand another's experience, to communicate and confirm that understanding with the other person and to then act in a helpful manner," writes Dr. Robert Buckman,  of Princess Margaret Hospital and the Faculty of Medicine, University of Toronto." Good communication skills are an essential part of empathy. 

It's unlikely that inexperienced physicians and those with poor communication skills see a disproportionately higher number of difficult patients, so the more plausible explanations are that a physician with better communication skills is able to gain patient cooperativeness and that patient leaves the encounter more satisfied and/or the empathetic physician perceives patients differently (less like a problem than a person in need of their assistance). It would be interesting to study the relationship between years of physician experience and empathy levels. 

The importance of communication skills cannot be overemphasized. It's also important to remember that not all patient-provider interactions occur at the practice. Patients may call the practice, visit the practice website, e-mail, etc. Clear, empathetic communication should be a goal for every patient encounter. Multi-channel electronic communication solutions such as a virtual office receptionist can help a busy practice manage and respond to messages across multiple channels. 

Reference 

1. Hinchey SA & Jackson J (2011). A cohort study assessing difficult patient encounters in a walk-in primary care clinic; predictors and outcomes. Journal of General Internal Medicine; DOI 10.1007/s11606-010-1620-6 

My article on multi-channel electronic communication solutions is fresh off the presses at EzineArticles: "Using Broadcast Messaging to Close the Patient-Provider Communication Gap": http://tinyurl.com/2aawc5k

Here's the article summary:
The communication gap is increasing as practices are forced to see more patients per day just to make ends meet. Physicians and staff members are understandably busy seeing a full patient load and juggling other tasks. Heavy reliance on one-to-one communication methods makes it difficult to close the communication gap. This article describes how new communication technologies can help close the communication gap.

 

Today there are many more ways to send and receive messages thanks to advances in communication technology. Each can be used to remind your patients of their appointments... but which one is best? Let's have a look at each of them to find out.

Verbally over the phone
Calling each patient individually is almost as ridiculous as knocking on their doors. Why? Because you have to manually dial each number, speak to each individual person, or more likely, leave messages on each machine. This process may only take five minutes, but it can quickly add up to hours of phone calls.  Every once in awhile, you'll run into the patient who has other questions for you just because he/she has you on the phone.

Printed and sent to the patient's home 
Hopefully your practice phased out printing patient messages a long time ago. This is the most expensive option and it's also time consuming to address those reminders.  

Automated multi-channel electronic communications solutions
"Basically, e-mail is better for transmitting clear and detailed information than a verbal exchange,” says Eric Knight, M.D., of the Elliot Physician Network in Londonderry, N.H. “Some patients love it and will change to — or stay with — a particular physician just to be able to use it.”  Emails are inexpensive, can reach many patients and provide a written record of the upcoming appointment. This information can easily be shared with others and/or transferred to an electronic calendar.

Voice broadcasting takes over the time consuming task of making reminder calls and reliably delivers clear pre-recorded messages with the necessary appointment information.  The automated reminder system can easily personalize and deliver voice and email messages, as well as track responses. 

Automated multi-channel communications services offer the easiest, most reliable and lowest cost method of delivering patient appointment reminders.

For many providers, having staff make reminder calls is their only method of reminding patients of upcoming appointments, but how many have stopped to think whether a phone reminder call the best way of reducing missed appointments?  These days, patients are available through any number of channels including phone calls, e-mail, and even text messaging.  Most patients have multiple phone numbers, including work numbers, home numbers and mobile numbers.  The best way to reach your patient is the way the patient prefers.

One study showed that 14.8 million adults would prefer to have web access to their doctor's office, and that 11.9 million would switch to a doctor who communicated via e-mail. By relying only on staff appointment reminders, many doctors offices are missing the chance to communicate with their patients in a way that is cost effective and that many patient actually prefer.

Keep in mind that phone calls aren't the only way to communicate with patients. Studies show that communicating by more than one method will significantly decrease no-show rates over using just one method of communication. Having an automated reminder system that combines e-mail with phone reminders can decrease your no-show rates and increase your patient satisfaction at very little cost.

Manual appointment calls are time consuming and contact with the patient isn't always successful. Setting up automated messages to contact the patient's preferred number and calling at a preferred time can increase your contact rate. Adding e-mail messaging services can increase that rate even further.

Appointment reminders aren't the only service that a healthcare call center can provide. Messages can be sent out to remind patients about immunizations, preventative care, and even public health warnings. Utilizing a healthcare call center with a multi-channel electronic communication solution can improve your bottom line and improve your patients' health as well.

Of course after I wrote my first blog post, my dentist called with an appointment reminder.  I missed the call.

I didn't want to call back during office hours because it's effortful and time consuming to speak to a live person.  I prefer to call after hours and leave a message on the answering machine.  

What irks me is that the practice never asked me how I prefer to be contacted and it contacts everyone the same way - by having someone at the practice call during the day. Perhaps my expectations are too high.  A Forrester Research survey conducted in late 2008 found that many marketers are not capturing and catering to consumer communication preferences, leading to consumer annoyance and less effective messaging.  

So what does this mean for practices?

1. No single method of communication works best for all patients.  If you don't want to adopt multi-channel electronic communication solutions, you're likely alienating patients - but consider your patient base to get a sense of whether automated communication solutions might be well-received.  Better yet, ask your patients.  You might be surprised by what they say.
2. Start small, by automating routine tasks.  Many practices are sending automated phone reminders and finding that these reminders are effectively reducing no show rates and saving support staff from tedious, time consuming calls.  
3. Measure the results of automation.  How does your staff feel about automation? Monitor patient comments or capture comments by using a patient satisfaction survey. Weigh the results and ask how you can achieve better results in the future.  Set realistic goals and devise a plan to achieve your goals.