Virtual Office Receptionist

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. 

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.

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.

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 

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 

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.

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.

More than any other business, it is vital that a medical office has 24/7 phone coverage.  Good phone coverage after hours is as important as phone coverage during business hours.  Patients do not decide when they will become ill and they need to know that their physician's office is responsive to their needs at any time.  All medical practices can benefit from an automated answering system.

With phone coverage around the clock, you can save money, improve customer service, speed up response times (and reduce wait times), and communicate more effectively.

An automated answering service handles incoming calls

An automated answering service works like a virtual office receptionist.  When there is no one available to answer the call, the answering system will pick up and lead the patient through a menu that your practice has customized to its own needs.  So for example, many practices will set up a phone tree that connects patients to billing, appointments, insurance, etc. 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.

Your staff can now leave for lunch without worrying about phone coverage.  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.

When you use an automated medical answering service to handle after hours calls, the on-call physician receives the message quickly and is able to listen to the patient's message, think of a response and call back.  Patients who call after hours looking for clinical advice are usual anxious and waiting hours for a return sends the signal that their call is not valued.  Don't let your patients think your practice doesn't care.

An automated patient messaging service calls your patients for you

There are other ways to improve your phone coverage.  You can reduce the number of incoming calls and outgoing calls by using an automated patient messaging service.  For example, rather than have anxious patients calling in for their lab results, you can use an automated messaging service to send lab results to patients.  Appointment reminder calls can take hours a day if they're made by your staff, but an automated messaging service can deliver these messages for you.  Some services can even automatically retrieve your patient appointment information, so all your staff would need to do is to view reports to see how many patients were reached, how many confirmed their appointments and how many cancelled their appointments.  

When you use automated patient messaging, you free up phone lines so patients who need to speak to a live operator are more likely to get through.  It's incredibly frustrating for a busy patient to be put on hold or not be able to get through when calling - and it creates a bad impression.  They now feel that it's inconvenient and difficult to reach their practice.  

Automated medical communication technologies make it easy to provide comprehensive, round the clock phone coverage. 

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.

Physician pay increased 3.8% in 2009 for primary care specialties according to the most recent American Medical Group Association (AMGA) physician compensation survey.  The MGMA compensation survey reported that physician compensation for primary care specialties rose 2.9% in 2009, but all other specialties experienced a 4% drop.
 
What can account for the discrepancy?  Tommy Bonhannon, Vice President of Merritt Hawkins, a physician recruitment and consulting firm, speculates that larger groups are more efficient thanks to adopting computerized business operations.  He states, "Their coding is more accurate, they're better at billing and collections."  The average group size of AMGA is 295 physicians compared to 23 full-time physicians for the average MGMA member.  

Smaller practices may not realize that it's easy to computerize some business operations and doing so saves money.  Take for example, appointment reminders.  Larger practices rarely rely on their own staff to make routine appointment reminder calls.  Instead, they rely on an automated patient notification service to make the calls and track the outcomes.  This not only saves staff time, but results in more reliable and effective appointment reminders.

The same patient notification service can save money and increase operational effectiveness in other ways.  Automated account balance notification calls combined with mailed EOB statements are an easy way to boost the success of collections.  

Automation can also help after the office is closed for the day. An automated answering service can serve as an effective virtual medical receptionist to guide callers through the after hours experience, take messages, and relay important messages to on-call physicians 

To learn more about how much your practice can save, visit Webley.