Reminder Call

Why patient collections are a concern for most practices

While workers are asked to pay more and share in healthcare costs, employers are still facing rising healthcare costs. A PricewaterhouseCoopers (PwC) report issued in June 2010 found that "for the first time, a majority of U.S. workers are expected to have health insurance deductibles of $400 or more as more employers return to pre-managed care “indemnity style” cost sharing by raising out-of-pocket limits, replacing flat-dollar co-pays with percentage-based co-insurance, and adding high-deductible health plans."

At the same time, Medicare is reducing reimbursement rates, so an increasing percentage of revenue will be coming from self-pay patients and patients with health savings accounts and high-deductible plans. This requires practices to be better at collecting directly from patients. 

How automating account balance notifications can improve patient collections

Long thought to be primarily a means to reduce infectious diseases, the role of vaccines has expanded to include the prevention of non-infectious diseases. Expect to see an increased use of vaccines as a way to prevent or treat conditions such as cancer, Alzheimer's, type 1 diabetes, etc.

Continuing with the theme of the last post, we're taking a closer look at one of the main challenges faced by medical practices according to the 2011 MGMA member survey. For the past few years, operating costs have been rising faster than revenues for the average medical practice and this trend is expected to continue. 

Back in June 2011, the Medical Group Management Association (MGMA) released the results of its member survey. Members indicated that the top challenges they faced were:

• Changing reimbursement models that place a greater share of financial risk on practices 
• EHR issues - selecting and implementing the EHR system and participating in the Centers for Medicare & Medicaid Services' EHR Meaningful Use incentive program
• Rising operating costs
• Implementing and/or optimizing an accountable care organization

Financial, technological and compliance issues were clearly the main challenges. At the same time that practices plan on dealing with adopting a complex new system (EHR) that will require major changes in workflow, they also need to deal with managing potentially lower reimbursements and rising costs.

Ideally, the EHR will reduce administrative complexity, increase efficiency and lower operating costs but that takes time. Adopting an EHR has many other benefits for patient practice communication. Once patient records are digitized, they can be more easily shared with other systems, including a host of inexpensive, on demand web-based services. These services include automated appointment reminders, appointment scheduling, automated account balance notifications, patient surveys, and more. Such services can easily improve patient-practice communication and they also (1) save staff a considerable amount of time, (2) improve documentation and possibly reduce potential for legal action against the practice, (3) increase patient satisfaction.

Automating appointment reminders is a step that benefits the majority of practices. These types of calls typically are routine and the essential information can easily be conveyed by a quality appointment reminder service. Typically the practice only needs to generate a file with patients to be called and transmit that file to the telephone reminder service. This process can take just a few minutes. Appointment confirmations can be automatically tracked. 

For additional information, please visit Webley.

For additional information, please visit Webley. 

Pay for performance (P4P) isn't going away and 2012 is the year that many practices that have yet to ready themselves for the days of P4P will need to take on the challenge. Notably, Medicare will include patient experience measures on the Medicare Physician Care website by Jan. 1, 2013 and experts are predicting that patient experience will be incorporated in the pay formula for physicians by 2015.

It's a new year and the time we typically reflect on lessons learned in the previous year. Here at Webley MD, we deal with helping our clients with their patient no show problem every day. We've compiled a list of best practices that can help medical practices manage their patient no shows. 

Webley MD is looking for medical practices who could benefit from automating their answering service and patient notifications. Help us get the word out and you'll earn $100 for every qualified referral. It's called Refer & Earn and here are the details:

• Adults in the U.S. and Canada
• Need not be a Webley MD Customer
• No self-referrals please

In my last post, I provided one quick and easy change you can make to (possibly) improve the effectiveness of your appointment reminder calls and lower your no show rates. Changing your reminder strategy can help with no show rates but so can other tactics. Not all will work for all practices, so pick and choose a few, see if they help and if not, try other tactics.

Tactic 1: Book more appointments to reduce waiting time.
Generally speaking, the further out the appointment is, the greater likelihood that the patient will forget and schedule something else (e.g., vacation) that prevents him/her from making it to your appointment.

Tactic 2: Implement a penalty for no shows.
People typically think of a missed appointment fee but it could also be a points system. If using a points system, you can terminate the relationship with a patient after they reach a certain number of points. Be very clear about your no show policy and make sure your staff understands the importance of adhering to that policy.

Tactic 3: Follow up with your missed appointments.
Call within a week, ask the patient why he/she missed the appointment and reschedule. The patient will likely feel guilty about missing the appointment and be willing to reschedule. Emphasize the importance of the appointment to your patient's health.

Maximizing the effectiveness of your appointment reminder calls isn't an easy task. There can be seasonal variations in no show rates, not to mention the ever present element of randomness. However, some elements are under your control. When you see your no show rate grow or you're unhappy with the current rate, try sending the reminders out at a different time, that is change the number of days between the reminder and the appointment. It's easy to make the change and you should be able to see results quickly. Anything longer than a week is likely to be ineffective unless you send another reminder closer to the appointment date. 

We've generally found that making reminder calls 2 days before the appointment works best because (1) it gives patients time to listen to the message if a message is left, (2) there is still time to confirm or cancel the appointment and possibly find another person to take the slot. However, what works best for your practice may differ and it can change over time. If the appointment requires preparation, it may make sense to send a reminder several days before the appointment. Most practices send reminders 1 to 3 days in advance of the appointment.

An automated patient messaging service can be just what your staff needs, if you find that understaffing and/or inefficiency are plaguing your practice. By automating time consuming, routine tasks such as appointment reminder calls, lab test results notifications, and account balance due notifications, reminder call software offers the following key benefits to your staff:

Reliability and tracking. The service automatically tracks when messages were sent and message outcomes (e.g., someone answered the phone, message was left on an answering machine). Because of this tracking, your staff will know with certainty whether the reminders and other messages were sent. 

Time savings. Your staff can save hours a day by using this service and reducing the number of calls that they need to make. This is time that they can spend on other tasks, such as greeting patients.

Improved communication with patients. Your messaging service can use multiple communication channels (phone, email, text) to reach patients according to their communication preferences and it can do this when your practice is closed. Your staff will appreciate the ease and effectiveness of automating routine patient messaging. 

Your staff may have some concern that automating calls will reduce their usefulness and possibly their job security. While this is a natural concern, a good manager will find better uses for his/her employees and since this should improve the overall health of the practice, this benefits all employees. 

A common concern that medical practices have when considering automated reminder calls is their patients' reaction. The staff may believe that patients prefer a call from someone they know at the practice and that these calls are more effective than automated reminder calls. While some patients will prefer the personal call from your practice, you shouldn't assume that they represent the majority of your patients.

Many patients appreciate the automated reminder call service for the following reasons.

1. Greater efficiency. The calls use custom scripts and provide useful, personalized information to patients. Patients may be able to interact and respond to the message by pressing a button to confirm or cancel an appointment. Patients with more complex needs still have the option to call your practice.
2. Greater convenience. The telephone reminder service isn't limited to office hours. The service can call patients in the evening and on weekends, when they are more likely to be home.
3. Personalized and customizable experience. Automated calls can easily be replayed or offer options such as delivering the message in another language.

Pre-recorded reminder voice messages are not necessarily more impersonal than a call from your staff practice. Your staff often reaches someone's answering machine or voicemail so there isn't much difference between the automated reminder call using a pre-recorded message and the call from a staff member. 

Some phone reminder systems send pre-recorded voice messages. These are human voice messages. Sound quality and the clarity of the speaker may still vary but high quality pre-recorded appointment reminder messages are recorded with professional voice talent in a controlled studio environment. 

If you're concerned about patient acceptance of automated calls, ask your patients for feedback on your service. If most hate it, you'll know that you either need to find a better automated reminder service or find another solution.

For additional information on automated reminder calls, please visit Webley.

The medical provider industry is moving towards the digitization of all patient information. With the electronic storage of patient information comes improved accessibility and the ease of automating certain routine processes. With ease and accessiblity come speed; patients will have access to bills, lab results and so forth faster than ever. Physicians can pull up a patients' history and lab results, easily access codes, and benefit from evidence-based medicine. 

The era of fully automated medical practices is not yet upon us, but most medical practices are able to take advantage of an extremely useful, low cost form of automation, automating patient communications. By taking your call reminders to automated and unlimited heights, your practice's efficiency, staff morale, and customer service will soar. Automated patient reminders can help your practice:

Unlimited messages

Automated call reminder systems are not limited by office hours or employee fatigue. It only takes a few minutes to set up a broadcast messaging campaign that can go out to as many patients as you'd like. The results are automatically tracked in helpful electronic reports.

Unlimited applications

Automated messaging systems are not just for appointment reminders. You can use them to send patient account balance due reminders, health screening reminders, and other important announcements. 

For additional information, please visit Webley.

A Sermo survey found that 26% of solo physicians (single physician practices) have either closed their practice or are considering closing. Many have turned to practice management companies for assistance. Cash flow concerns are such that a delay in reimbursement can jeopardize the practice, so some solo physicians are switching to a cash-only model and/or becoming a non-participating provider.

Wait times are a key source of patient dissatisfaction. Press Ganey, a health industry survey firm, looked at hospital satisfaction scores and found that keeping patients informed of delays can increase patient satisfaction.  They also found patients were equally dissatisfied with wait time in the exam room vs. the waiting room. You can boost patient satisfaction by making a few changes that reduce wait times.

Phone wait times


Practices that have adopted patient check-in technologies (e.g., electronic check in using a kiosk or tablet PC) have dramatically reduced check in times. For example, Vanguard Urological Institute in Houston, TX, a 4 member practice, adopted a check-in kiosk - the average wait time at Vanguard in 2010 was 2.44 minutes while the national average is 21.3 minutes. 

Offering forms on your practice website that patients can print out and fill out ahead of time is convenient for patients, inexpensive for the practice and effective at reducing office wait times. 

While few patients like wait times, sometimes they are inevitable.  The best way of dealing with long wait times when they occur is to keep the patient informed and apologize for the delay. Also make sure you have a wide variety of current magazines in your waiting room to help pass the time.

With medical practices facing increasing competition from retail clinics, it's time for practices that are looking to boost demand for their services to develop strategies to attract and retain patients. 

The retail clinic advantage: Accessibility

Retail clinics are attractive because they are more accessible (e.g., open longer hours, no appointment needed). Remember to remain accessible after hours as well. Sell your after hours availability by instructing patients to call your practice after hours. This may save many from an unnecessary, expensive visit to an emergency room. A virtual medical receptionist may be very helpful to your after hours callers.

It may make sense for your practice to stay open longer hours and leave some unscheduled slots for drop-in patients. This is a common practice that should be fairly easy to implement.

Play to your practice's strengths 

"Your patients are already getting and using health information online – shouldn't they be getting more from you? The report suggests providing patients with online health tools such as reminders, instructions and educational information about their diagnosis and treatments."

The quote comes from a recent article in Healthcare IT News entitled "Top 10 ways to engage patients with IT." I particularly liked how the article talked about how patients trust their physicians/healthcare providers and how they online social media should be thought of as a valuable opportunity to engage and educate patients, while building your own brand, managing your own online reputation, and strengthening the provider-patient relationship.

It's easy to continue to communicate to patients the way you always have and call it a day, but if you want your practice to continue to be successful in the future, you need to be responsive to changes in the environment.


Patient communication preferences have changed and many of them are highly engaged online. Opening a Facebook or Twitter account is free though it takes time to contribute content. Blogs can be created for free as well, on sites such as blogger.com and wordpress.com

I recently read a Fierce Practice Management article called Master the three A's of staff retention. The article identifies three non-financial reasons for staff satisfaction: (1) autonomy (empowering staff to make decisions), (2) action (feeling that they have helped a patient), (3) assessment (feedback on their performance but also allowing them to assess their managers). These three A's relate to having a sense of authority and competence and feeling valued by one's organization. 

What it leaves out is the importance of the relationship with one's manager.

Surveys have shown that 39% of employees leave their organization because of their poor relationship with their supervisor. "What staff want in a leader is approachability; to work "shoulder to shoulder"; tools and equipment to do their jobs well; appreciation; efficient systems; and opportunities for professional development."

Managers have a responsibility to increase the efficiency of the organization.

Automated patient appointment reminders have been effective at (1) reducing no show rates, (2) decreasing the amount of time the staff needs to spend on making manual reminder calls - possibly saving hours a day, (3) increasing the reliability of reminder calls.  

Automated answering services offer many of the same features of a healthcare answering service, including new message notification and call screening. Automated answering services have the important benefit of eliminating the middleman, so that the on-call physician can receive messages immediately.

Avaya conducted a survey of healthcare IT professionals at HIMSS11 (2011) and asked respondents to rank the importance of issues facing their healthcare organizations in the next three years. The #1 issue was "communication and workflow integration into healthcare information systems." Respondents felt automated patient communications and collaborative tools were important issues to address. 

The survey highlights the importance of communication within the organization and with its patients. Respondents expressed concern about poor communication and not enough time for patient care. 

Did you know that 77% of patients would like an email reminder?

Now guess how many actually receive email reminders. The answer is 4%, according to a Wall Street Journal Online/Harris Interactive poll.

I'm astounded by the huge gap between what patients want and what they're currently getting from their healthcare providers. Perhaps many providers don't know what patient preferences are...or they don't think that being more patient friendly will make that much of a difference, so there isn't a compelling reason to change their current practices. 

Email patient reminders are not only easy but they save the practice time, effort and money.

Affordable automated patient reminder services can use existing information from your appointment files and customize reminder messages. The results of campaigns can be easily tracked. Some services let patients click to confirm or cancel an upcoming appointment. 

You can manage your email volume by sending a "do not reply" email reminder. For patients that require additional assistance, the email body can provide instructions to call your practice. 

Emails are seen as convenient and accessible to patients and practices should think of them in the same way. Patients do care. Multiple polls have shown that the majority said that having electronic access to physicians would influence their choice of providers. Offering email reminders can enhance the satisfaction of current patients and attract new patients.