Virtual Office Answering

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. 

For additional information, please visit Webley. 

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.

For additional information on how medical office automation technology can help your practice, visit Webley.

* Source: 2009 MGMA cost survey

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.

Your practice's voice mail greetings can help or hurt your practice. These tips can help you create effective greetings for your voice answering service. 

1. Keep it short but informative. No one wants to listen to a message that's over a minute long. Try to keep yours to 30 seconds or less. 
2. Start by writing a script and practice until you feel comfortable with the script.
3. Identify your office first. The first thing callers should hear is the name of your practice. 
4. Include bypass directions that will take someone to the general mailbox or connect him/her to a live operator.
5. Vary your greeting depending on the circumstances. For example, someone who calls when your office is closed should hear a message with the hours of operation and instructions for what to do in case of a medical emergency. For smaller practices, you can help direct and pre-screen callers by listing the main departments and then allowing the caller to indicate which department he/she would either like to talk to or leave a message for.
6. Let callers know that you value their call and will return it soon.
7. Speak clearly, slowly and with minimal background noise. Your tone should be professional and upbeat.

For additional information on virtual medical receptionist services, please visit Webley.

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:

In San Francisco, signs for St. Mary's promise of an ER wait time will be 30 minutes or less plaster the side of buses and billboard signs. The campaign was launched in 2003 and it still runs 8 years later. Thinking back to the hours I've waited at the UCSF ER, I can see why the campaign has been a successful one. 

ER waits are the most stressful. You or your loved one is likely in pain or severe discomfort and so are the other wretched people around you. 

Looking back at that horrific UCSF experience, I realize now that my husband didn't need to go to the ER. I just didn't know where else to go. He didn't have a regular physician. He seemed to be extremely weak/ill with a high fever. I didn't know if he had caught something serious while we were abroad. 

Things would have been different if he had a regular physician with a clear after hours policy. 

The best way to provide after hours care to your patients and to keep them from making unnecessary emergency room visits is to use an automated after hours answering service or virtual office receptionist with call routing and message notification features.

The automated healthcare answering service puts the triage decisions back in the hands of the person best suited to make those decisions, the on-call physician, while saving the physician from dealing with callers who do not require clinical advice and whose needs can be met by the office staff the following day. The physician can screen each call, and decide to take the call or let the caller leave a voice message.

A good automated answering service can handle simultaneous calls, so each patient gets through without hearing a busy signal. It can also relay the message to the on-call physician immediately and the message can be repeated, saved to an electronic patient record or forwarded.

When patients need medical advice, you want them to think of your practice. It's important to make it clear that your practice can be reached after hours. Emphasizing after hours availability conveys the impression that your practice values their after hours calls. Post your after hours policy on your practice website if you have one. Let them know that your after hours calls are listened to and that they can expect a call back within a short period of time. Setting expectations will do much to alleviate your patient's anxiety.

I wanted to give a shout out to a blog that I found that seemed particularly helpful for medical practice managers. It's called Manage My Practice and the author is Mary Pat Whaley, a practice administrator in North Carolina. If you're a practice administrator, you're sure to identify with her and if you're not, you can learn what the life of a practice administrator is like. 

One recent blog post contained many helpful pointers for practices that are struggling with answering patient phone calls. Mary Pat writes: "The only answer to understaffing is technology. Use a patient portal to allow patients to request refills, schedule appointments and chat with billing staff or nurses. Replace paper charts with EMR. Use efaxing to eliminate paper faxes. Use the cloud to store information and collaborate."

The key themes are (1) centralizing your information to make it easily accessible to others at your practice, (2) reducing paper - it's eco-friendly, saves money and makes it less likely that something will get overlooked/lost, (3) increasing the accessibility of your staff to your patients - maybe this means that it's time to let your patients email your staff, (4) offering self-service features for patients.

Automated patient messaging systems, aka reminder call software, save time and money for your practice. They make it easier for the practice to communicate with patients, whether it's sending appointment reminders or telling patients that their lab test results are available. They make it easier for patients to confirm their appointments. And the system tracks patient responses, creating an electronic report that can be accessed from any computer with an Internet connection. 

Automated voice answering services answer the phone for your practice and direct your callers - connecting them to the right person or organizing messages when no one can answer the phone. By connecting the caller to the right department or person, messages are organized, saving response time and the potential for lost or incorrectly relayed messages.

The virtual office receptionist answers the phone during lunch, breaks and after hours.  The automated answering service can be easily turned on or off whenever the practice feels it is necessary or when everyone is away from the office.

It's a weekday morning. Your staff checks the answering machine for messages, scribbles the message on a notepad and distributes messages. 

Or maybe your routine starts with checking the fax machine for the answering service's report and distributing those messages.

Either way, checking one's messages is a slow process, riddled with time delays. Some of those calls were urgent and should have received immediate attention. 

Accessibility of care has a significant impact on patient satisfaction and patient loyalty. When patients need clinical advice after hours, they strongly prefer to speak to their physician rather than an answering service, nurse hotline, etc. 

The best way to ensure messages are delivered in a timely, accurate manner is to use an automated virtual office answering service. 

1. Immediately notify the on-call physician and offer the unmatched accuracy of hearing the patient’s recorded message
2. Let the on-call physician make the decision about which callers require immediate attention
3. Provide a consistent caller experience with no grumpy operators to contend with
4. Make it easy to save recording of call to patient’s electronic health record
5. Save money 

• Increased patient  safety & satisfaction 
• Improved communication with patients 
• Increased continuity of care 
• Assurance of never missing urgent messages 
• Elimination of inaccurate messages 
• No need to wait till the next day for after hours messages 

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.

The decline in the number of private practices has been dramatic and the trend shows every sign of continuing. "In 2005, two- thirds of all medical practices were physician-owned. Yet, by 2008, physician ownership decreased to less than 50 percent." There are many reasons for this, including a growing number of physicians who are joining group practices due to rising costs and lower reimbursements. These trends have hurt solo practitioners the most - a recent survey by Sermo found that 26% of solo physicians have either closed their practice or are considering closing. 

One-third of the nation's physicians are over the age of 65. And it's not just the older physicians that are moving to group practices. A greater number of younger physicians are opting to join hospitals and health systems. 

Physician owners cite lack of a business/practice management education as one of reasons for this trend. Owning a small business has always been a risky endeavor. It's estimated that 80% of small businesses fail within 5 years. And it can be difficult to know when it's time to sell a business. I found the following HCPLive article to be an interesting read as it covers many of the issues that should be considered when evaluating the viability of a private practice: Private Practice Is Fighting for Survival.

Practices that survive are the ones who can adapt to changes in the environment. Better performing practices are likely to be using technology such as automated appointment reminders and virtual office answering systems to increase the productivity of their staff, provided added convenience and accessibility to patients and reduce their operating costs. 

In a recent study published in the Canadian Medical Association Journal, researchers found that physician displays of empathy in clinical settings led to higher levels of patient satisfaction with the care received, higher motivation to follow treatment plans and fewer malpractice complaints.

Another study published in the July/August 2009 issue of the journal, Family Medicine, found that patients with colds whose physicians showed empathy towards them during an office visit got over their cold one day faster than a patients with physicians who took a just-the-facts approach.

What is 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. 

How do you display empathy in a clinical setting?

Understanding someone else's experience involves good communication skills, including asking the questions, listening to the patient, making the patient feel comfortable, communicating clearly and making sure that the message is understood. The empathetic physician shows care and compassion.

Empathy shouldn't stop with the physicians. The staff should show empathy as well. Has the patient had to wait longer than usual to be seen? Are you unable to see a patient right away because your schedule is full? Has the patient on the phone been unable to get through because the line is busy? Be empathetic and patients will be more understanding. Apologize for the delay. Offer alternatives if the patient can't be accommodated. Consider using an automated phone answering service (aka, automated virtual office receptionist) to field calls, eliminate busy signals, and direct callers to the right department.

* Canadian Medical Association Journal. "Showing empathy to patients can improve care." ScienceDaily 24 January 2011. 28 

It's well known that physicians have been slow to embrace email communication with patients. The reasons are numerous, including lack of compensation for email consultations, fear of liability, privacy and security concerns, and lack of time.

John Meyer of MaxMD brings up an excellent point. MaxMD's survey of their encrypted email users found "70% of secure electronic communications are initiated by office staff." While patients may be fixated by the idea of communicating via email with their physicians, both the front desk staff and patients stand to gain from communicating with each other via email.

While there haven't been large scale studies examining the impact of email communication on workload in the context of a medical practice, some studies report benefits to using email communication and provide insight into physician and patient attitudes towards email communication.

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. 

Looking for a way to offer greater convenience to your patients, increase their loyalty and make life easier for the medical office staff? If you haven't adopted patient self-service features yet, consider this:

A consumer survey commissioned by NCR Corp., conducted in March 2010, found that 79% said they were "more likely to choose a healthcare provider that allows them to manage various elements of the healthcare experience over the Internet, on a mobile device or at a self-service kiosk."

The message is clear. Patients are interested in self-service features. The good news is that there are many inexpensive ways to offer self-service features to your patients. 

Your practice website can range from simple (e.g., a place where patients can access forms and directions to complex (a patient portal).

Potential patient self-service web-based features:

• Bill pay
• Directions to the business
• Appointment requests
• Forms (e.g., medical history questionnaire)
• Directions and hours
• Lab test results
• Send and receive secure messages with your physician

Hiring a virtual office receptionist can transform your phone to a self-service tool. Many calls that a medical practice makes and receives can be handled by a good virtual office answering system. 

Potential patient self-service features for callers:

• Get directions to the practice and hours of operation
• Request an appointment or prescription refill
• Check lab test results
• Leave an urgent message
• Access information on insurance, eligibility, and benefits

Self-service kiosks are also growing in popularity but they're usually not economical for smaller medical practices. 

For additional information on virtual office phone answering systems, visit Webley.

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.