Physician Call Center

For additional information, please visit Webley. 

The median wait time at U.S. emergency rooms is 2.6 hours. The average wait time is 4 hours. Experts are predicting that wait times will only get worse. If those statistics aren't enough reason to avoid unnecessary ER visits, then patients should try, when possible, to go to the same emergency room.

A report published in the Archives of Internal Medicine found that adults in Massachusetts who visited ER at different hospitals paid almost twice as much than adult patients who went to the same hospital. By visiting multiple hospitals, patients were exposed to a greater risk of medical errors, delays in treatment and duplicate tests. Provider to provider communication across organizations, is still poor.

USA Today recently published an article highlighting the popularity of retail clinics. There are about 1,250 retail clinics in the US. The largest, Minute Clinic, has 600 clinics in CVS stores. These retail clinics will continue to be popular because of their convenience and affordability. 

Patients can't wait to see family physicians, if they have them. Not all patients can wait weeks for the next open appointment. They may not be facing a life threatening condition, but they may be in considerable discomfort.

A growing number of people do not have primary care providers. Half of those who visit Minute Clinics fall in this category. With the shortage of primary care physicians, many are not accepting new patients.

Retail clinics have better technology, affordable pricing, and increased convenience. The longer hours and greater number of locations make retail clinics a good, convenient choice for many. Most retail clinics use EHRs while the EHR adoption rate for office based physicians just crossed 50% in 2010. The per cost visit (typically under $100) appeals to those without insurance. Many insurance companies reimburse retail clinic visits, so they appeal to those with insurance as well.  

While clinics can't provide the range of services of a family physician and they may see patients that otherwise would not have visited a family physician, they can handle routine acute conditions, as well as provide vaccinations and physicals. Urgent care facilities can take care of others, leaving complex, chronic conditions to family physicians. 

The following is an excerpt from a review posted on Insider Pages:

Busy signals, unanswered phones, and long hold times on the phone can seem like an inevitable part of calling a medical practice and its after hours live answering service. However, those phone related inconveniences can be avoided with the adoption of a virtual medical assistant.

A virtual medical assistant offers many of the same features of the live healthcare answering service. Some key features to look for when choosing a virtual medical assistant include:

New message notification. While it make take hours for the on-call physician to receive his/her messages, the virtual medical assistant sends out new message notifications go out immediately after the patient leaves a message. 

Custom greetings. Callers can still be greeted with a voice they know and trust by having your staff record the greeting message. 

Easy access to messages. Your staff can access messages from anywhere, either by calling in or via email. And these messages can easily be saved to patient's electronic files. 

Consistent, courteous handling of each call. Live agents can vary in their customer service skills. With a virtual medical assistant, you know that each call will be handled courteously.

For additional information, visit Webley.

Unified communications - it sounds desirable but what is it and what does it mean for healthcare? Unified communications allows an individual to manage messages across a variety of message mediums. A unified communication service typically assigns a personal mailbox to an individual. The user can access voicemail messages, email, faxes, text messages and more from that personal mailbox. The mailbox is accessible by multiple types of devices, including phone, computer, and so forth. Unified communications can improve communication and facilitate collaboration. 

For businesses and mobile individuals that experience high message volumes, unified communications can be an essential business tool. There are special challenges (e.g., more stringent privacy and security standards, legacy systems) to UC in healthcare. For a detailed discussion of these, I suggest reading the IT Business Edge article, Great Promise -- and Great Challenges of Unified Communication for Health Care.

Smaller practices are in a better position to adopt UC as they typically are not encumbered by expensive legacy systems. 

Automated answering services increase control over messages by offering a library of greetings, notification rules, voicemail boxes, call forwarding and so forth.  What's more, physicians are in control of when and how they receive their messages as well. They can pick up their messages as they arrive, not when a call center decides to send over their messages. 

When a patient calls in, there is no disgruntled, exhausted call center employee to take down her message. Instead, her call is immediately answered and a custom greeting created by the practice is played. She then is guided through a simple menu that helps determine the reason for the call and separate the messages that can wait till morning and the calls that require immediate attention.  She can even tag the message as urgent.  Calls that require immediate attention can be automatically forwarded to the on-call physician.  The on-call physician can answer or let it go to voicemail - or choose to have all calls go straight to voicemail. 

The physician can pick up his messages through his phone or online from his office computer.  He can consult medical references before responding. His response is on his terms. The recorded voice message can easily be replayed, shared and saved in the patient's file.

It's simple and efficient. 

The patient-practice communication gap
The typical medical practice is a busy place. In an effort to maximize the number of patients seen per day, physicians and their staff have little time to spend with patients. A study by Tai-Seale, McGuire, and Zhang (HSR 2007) examined how primary care physicians allocated their time based on 392 videotaped office visits. The authors found that the average length of a visit was 17.4 minutes, with 5 minutes spent discussing the major health issue and 1 minute on minor issues.

With just a few minutes spent discussing health issues, it's clear that medical practices could use some help with patient communications and proactive patient care.

The crisis with emergency rooms, where the average wait time is 4 hours, has spawned a new trend, making appointments for emergency room visits. The Los Angeles Times reports that 8 Southern California hospitals now offer ER appointments using a system called InQuickER. Patients pay $14.99 - $24.99 to make the ER appointment. They're guaranteed that if they show up at their assigned time, they will be seen in 15 minutes or get their money back. InQuickER says that 95% of these appointments have been kept. Hospitals may still ask that the appointment be made several hours in advance but the system reduces the amount of time spent in the waiting room.

Keeping with this week's topic, the future of small medical practices, I thought I would mention a 90 minute audioconference called Can Small Group Practices and Solo Doctors Survive in Today's Marketplace? What Are Your Options? The conference counts for 1.5 continuing education hours for the American Academy of Professional Coders (AAPC) and takes place tomorrow.

Conference description:

I'm taking a short break from Physicians Practice LIVE to remind everyone that the free virtual conference and tradeshow about practice management is going on right now (go to their website to register or login to the event). The event is sponsored by Physicians Practice and it features a tradeshow, auditorium for webinars, resource center (for copies of presentations, product information, etc. that you can save to your virtual briefcase), and networking lounge

The agenda is filled with interesting talks. If you miss any, you can replay the talk at your own convenience. But if you can make it today before the event ends at 7 PM Eastern, you can ask questions and network. For example, in the auditorium, they have a booth for asking a coding expert and another booth staffed by several experts. 

I've attended a few webinars and definitely feel they were worth my time. My favorites were the presentations on EMR selection by Dr. Jogi (he talks about his own practice's experience in choosing an EMR) and Stop Losing Money: The most common ways practices needlessly bloat their overhead and how to stop by MGMA's consultant, Rosemarie Nelson. Rosemarie recommends using automated patient appointment reminders to save money. She's supportive of using technology to simplify the workflow at the practice but also has other ideas on how to reduce costs, including staggering work schedules.

If you're thinking of selling your practice, you shouldn't miss the session called Hospital/Practice Integration. There are also sessions on employment contracts, health reform, patient collections and EHR incentives.

You can talk to other participants (from around the world), vendors, and experts. The archive of PP Live is available for 180 days. You need to register to access the archive but registration is free.

I highly recommend this event! I'm returning later today.

Increasing number of physicians are being compensated for on-call coverage at larger practices
Being compensated for on-call coverage isn't as uncommon as you might think. According to the Medical Group Management Association's 2010 Medical Directorship and On-Call Compensation Survey, 43.4% of primary care providers received additional compensation for on-call coverage, typically a daily or annual stipend. The amount of compensation varies greatly by specialty. And as more physicians are compensated for on-call coverage, more physicians expect to be compensated.

Hospitals faced with the difficulty of having an adequate number of on-call physicians are increasing on-call compensation, reducing service levels, using non-physician providers and relying on wireless telehealth. While telemedicine has its challenges, videoconferencing, patient monitoring systems and specialized equipment are helping overcome previous challenges, allowing physicians to "see" the patient from the comfort of their own homes. 

Smaller practices form call sharing groups
For smaller practices, on-call coverage may mean that the solo physician feels the need to provide on-call coverage 24/7. In these situations, physicians should consider forming or joining physician call-sharing groups. Ideally, members would belong to the same specialty. For advice on how to form and structure a call-sharing group, read the Physicians Practice article.

In addition to increasing the convenience and accessibility of care, technology makes patient information more accessible and easier to share with others. It can also make it easier for providers and practices to collaborate and share schedules. There are plenty of free online group scheduling tools, e.g., Google Calendar that can help. 

Technology increases accessibility of 24/7 care
Physicians may also want to consider offering e-mail consultation hours or finding other ways to make themselves more accessible, e.g., using a virtual office phone answering system or offering patient self-service tools, as these can reduce the number of after hours clinical calls. 

Just about everyone owns a cell phone and has an email address these days.  These new technologies have markedly changed how most people communicate today.  Patients expect greater convenience and they're used to self-service features such as ATMs, check in kiosks at airports, online banking and more.  It's certainly time to consider how your practice can start or enhance its use of technology to provide greater convenience and better service to your patients.

Just think about it.  Does your patient really want to spend more than 20 seconds on hold?  Moreover, do you want your patient spending more than 20 seconds on hold?  Do you want patients getting a busy signal when they phone your office? Is your staff too busy to spend much time with patients?  Technology makes it possible to avoid these situations.

As a patient, it is nice to be able to phone your doctor day or night and know that you will get a message to them.  Sure you could use a live answering service, but how confident are you that they'll treat your patients with the respect and compassion that they deserve on every call and that they'll get the message to your on-call physician in an accurate and timely manner?  A quick response to an urgent after hours call increases patient satisfaction and shows that you really care about your patient's health.

It may be time for you consider an automated healthcare call center because this type of service can:

1. screen calls
2. send new message notifications to an on-call doctor right away
3. let your practice quickly and easily change the on-call doctor without relying on someone at a live answering service to make the change
4. eliminates inaccurate transcription problems that you have with a live answering service
5. organize your messages by creating different voicemail boxes

You'd be surprised by how many patients love the automated answering service.  It's convenient and it can reduce hold times.  

A virtual office phone answering service also helps doctors make their patients feel safe and secure as the messages are recorded and conveyed correctly to the doctor. Technology enables automated answering services to provide greater convenience and reliability than live answering services and this technology is affordable for practices of all sizes. 

Using a virtual medical receptionist to answer calls to your practice will make the calling experience much more pleasant and convenient.  How?  With a virtual medical receptionist, callers never hear a busy signal.  There is nothing worse than calling an office and being put on hold for a long time and then being told you should be speaking to a different person.  This happens all the time and it's very frustrating for callers.

Callers are directed to the right person to speak to through the automated menu, so they're less likely to spend time waiting to be transferred and explaining their reason for calling multiple times.  Even if the person they need to isn't available at the time of the call, they can leave a message for the proper person. 

Unlike a live receptionist, the virtual medical receptionist continues to answer calls and help patients when the practice is closed for the day.

Calling the medical office after hours when not feeling well is uncomfortable enough and dealing with a live call center operator might not be reassuring for the patient.  Leaving a message with the virtual medical receptionist ensures that the caller's voice message reaches the on-call physician immediately. 

Call centers face some of the same issues your practice does.  That is, physicians and patients may call the live answering service only to find that the line is busy and they're unable to get through.  This would never happen with a virtual medical receptionist.  A virtual medical receptionist is the best solution for any busy practice.

Many medical practices simply accept the pains of after hours call coverage and live call centers because they're used to the suboptimal and don't realize that things can be better. Call centers can be rude or untrained at times, forward too many messages or not enough, and take hours to send important messages. Unfortunately, this means that the on-call physicians sometimes are the ones to take the heat from patients when they don't return calls in a timely manner, or the feel guilty when the situation has turned into an emergency and the message wasn't received in time.

The after hours experience doesn't have to be so horrific. Making a change for the better can be as easy as "A-B-C" when you use a virtual answering system to take care of your office phones.

Answer

When a patient calls in, there is no disgruntled, exhausted call center employee to take down her message. Instead, her call is immediately answered and a custom greeting created by the practice is played. She then is guided through a simple menu that helps determine the reason for the call and separate the messages that can wait till morning and the calls that require immediate attention.  She can even tag the message as urgent.  Calls that require immediate attention can be automatically forwarded to the on-call physician.  The on-call physician can answer or let it go to voicemail - or choose to have all calls go straight to voicemail. 

Beam

As soon as the patient successfully leaves her message, the virtual answering machine “beams” a message to the on-call phone number. The physician can pick up his messages through his phone or online from his office computer.  He can consult medical references before responding. His response is on his terms.

Complete

When the physician has gathered his thoughts and constructed an answer, he can complete the cycle by returning the patient's call in a timely manner.   The patient is satisfied that her message was received and responded to with the attention it deserved.

It's simple and efficient. Using a virtual office answering service to man your phones once your office is closed for the day will turn your nightmarish after hours service into a sweet dream. 

Automated answering services aren't free but they are worth far more than their cost because of the compelling benefits they provide to patients and physicians.

Benefits to patients
With live call centers, operators decide which calls to forward to the on-call physician and which messages can wait till morning.  Customer service skills can vary and the operator may not be the reassuring voice your patients need when they call after hours looking for clinical advice. 

An automated answering service basically mimics the phone answering, call forwarding and message taking abilities of a live operator, only it reduces the number of steps it takes before the message or call gets to the on-call physician.  And it handles each call courteously.  End result?  The patient feels "listened to" and reassured that he was able to leave a message that will go directly to the on-call physician. 

Benefits to physicians
Making the after hours experience less stressful for on-call physicians helps them enjoy their work more.  An automated answering service can weed out calls that can wait till morning from urgent calls that require the on-call physician's attention.  

If you use your own staff to handle after hours calls, it also makes their lives easier.  They can take evenings off rather than answer patient calls.  

Benefits to the bottom line
How much are you paying the call center you hired ten years ago? Has the price you originally signed on the contract gone up, and you weren't even aware of it? Do you get nickel and dimed?

It doesn't cost thousands to sign up for an automated answering service. It's much less than what you'd pay for a live call center. To find out more about automated after hours answering services, visit Webley.

For the typical medical practice with several physicians who share on-call responsibilities, after hours care on-call scheduling can be a challenge. On-call schedules can change at the last minute, and it may be the case that no one is ever sure who is on-call and who is not.  A study published in the Archives of Internal Medicine found that 14% of in-hospital pages were sent to an off-duty physician.  This confusion behind the scenes does nothing to promote your patient care. Relying on call center operators to change the physician on-call schedule adds an extra layer of complexity to the process. 

If you're thinking of automating the handling of your after hours calls, you can choose between a generic virtual PBX/ virtual receptionist or a medical virtual receptionist.

A generic virtual receptionist can answer your calls, take messages and send out message notifications but doesn't offer features tailored to the needs of medical practices.

A medical automated answering service offers features specifically created for medical practices.  For example, the physician can change his on-call status by phone rather than wait for the call center operator to make the change.  Your practice is also in charge of call handling and can create its own rules for new message notification.  Message notifications can be sent to a pager, any phone number (landline, cell phone, home, office, etc.), email address, etc.

Automated answering services increase control over messages by offering a library of greetings, notification rules, voicemail boxes, call forwarding and so forth.  What's more, physicians are in control of when they receive their messages as well. They can pick up their messages as they arrive, not when a call center decides to send over their messages. This control makes for a far less stressful on-call experience, as well as dramatically reforming customer service.

Our health is a highly personal matter.  Consequently, it can also be one of the most difficult subjects to discuss with others.  Anyone who deals with patients knows this to be true.  And yet many physicians think little of using a live answering service to handle after hours calls.   How many of the patients who call after hours enjoy talking to a stranger, a call center employee?  When the patient calls after hours looking for clinical advice, he wants reassurance.  He wants to hear a friendly, familiar voice.  He may feel awkward about describing his symptoms to a stranger.

If asked, your patient would probably prefer to have the on-call physician's home phone number and expect him to answer the phone when called.  But this would be too much to ask of physicians.  While many patients might respect the privilege of having the physician's phone number, a few could abuse the privilege.

An automated voice answering service can provide a good next best solution to having the doctor's home phone number.  First, the service may offer the ability to record your own custom greetings - so the voice of someone at your practice can greet after hours callers.  Second, a clear greeting that thanks the caller, stresses the importance of the call, asks the person to leave a message and gives the person who is calling for clinical advice a sense of how long it will take for the call to be returned can be extremely reassuring and satisfying to your patients.  New message notifications go immediately to the on-call physician and the physician can call in to hear the patient's message as well as have that audio file sent to an email address.

An automated voice answering service functions as a virtual office receptionist.  When you think about it, most after hours calls are about a handful of issues, so an automated answering service can easily take messages, organize messages and send out message notifications, while offering the convenience of reliable, courteous phone coverage no matter what time of night the patient calls. 

To learn more, visit Webley.

Your on-call physician might be thinking of each evening that she's on-call as a potential battle.  This on-call physician has to be ready at a moment's notice to deal with patient calls.  

And the opponent is...the live answering service that stands between the physician and the patient.

There are several ways the answering service can harm the physician and the patients.

1. Poor call screening.  Some services let almost all calls go through, even when they do not require the physician's immediate attention.  Proper training and detailed protocols can help if the operator follows those protocols.  But if the service isn't properly screening calls, ask yourself how much value they are providing?  An answering machine can easily record messages.  Perhaps even worse than lack of screening is the potential of the call center employee to not connect a patient who needs immediate attention to the on-call physician.  By the time the physician receives the message, it could already be too late for the patient in question.

2. Forgetfulness.  Human error is bound to occur when the message takers are human.  Messages can get lost for a variety of reasons.  The call center may forget to change the on-call schedule.  

3. Poor customer service.  While some call center operators may show patients the compassion they need when they are experiencing discomfort after hours, some might not.  And with high turnover rates, it's hard to be confident that your patients will be treated with respect on every call.

By using a call center, you place control in the hands of the call center.  They are the ones that have immediate access to your patients and their calls, and they can do with them what they please. 

You should seriously consider an inexpensive automated answering service to handle after hours calls. An automated phone answering system will provide your physicians the support they need and remove the middleman. 

General live answering services
Live answering services that aren't staffed by medical professionals are basically live message takers.  While these services may be able to send messages to you via SMS and e-mail, this does not change the fact that their basic service is low tech and uneconomical.  Because of the expense of hiring live operators, the live answering service will always be more expensive than an automated answering service.  

The typical live answering service can charge $10 to $25 per call.  For large call volumes, this can be extremely expensive.  Cheaper live answering services may not actually be cheaper when you consider extra fees such as holiday surcharges, message delivery, call patching, etc.  And they may suffer from high turnover and poor customer service.  Negative patient interactions with an answering service will reflect poorly on your practice.

Medical live answering services
While using a higher quality, more expensive healthcare call center can provide your patients with timely advice from qualified medical professionals, there is still uncertainty about the quality of the call center staff.  Your practice may be asked to provide detailed protocols or the service may have its own.

General automated answering services
With an automated answering service, the human variability is taken out of the equation.  Each caller is greeted promptly and courteously.  Some automated services allow practices to record their own greetings, so patients are greeted by a voice they recognize.  Messages are digitally recorded and reliably sent out.  These services usually come with advanced call management features, such as call routing, customizable find and follow me rules, call forwarding, etc.

Medical automated answering services
Medical automated answering services have the same features as a general automated answering service but also include features that were developed specifically for medical practices.  For example, an automated medical answering service may allow practices to easily manage on-call physician status.

To learn more about medical automated answering services, visit Webley.