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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

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. 

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.

Looking for free e-learning opportunities? I found several sites with free webinars for medical practices. 

HITECH Answers: The site is dedicated to the meaningful use of certified EHR technology. Membership is free for providers and includes access to live e-learning events and podcasts, whitepapers and more. 

American EHR: The webinars cover EHR topics such financing your EHR and meaningful use. Registration is free and required to access webinar recordings.

Sage Healthcare: Sage, an EHR vendor, offers several on-demand webinars that cover meaningful use readiness. Registration is required to view webinars. Registration is free.

Practice Dock: Practice Dock is an online marketing suite for medical practices. Free webinars cover different aspects of practice marketing, e.g., using Twitter as a marketing tool. Registration is free and required to access webinar recordings. 

Medical Group Management Association (MGMA): This is my favorite site for free webinars as it is independent and covers the widest range of topics. Topics include benchmarking, e-prescriptions, physician compensation, etc. Free registration.

If you know of other sites that I should include on this list, please let me know in the comments section of this post. 

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

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

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

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

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

Happy holidays from Webley MD and see you in 2012.

The other day I read an interesting blog post by Dr. Stephen Schimpff in which he presented some studies on how Merck's vaccine, Zostavax, reduced the incidence of shingles (herpes zoster) by 50%. He came to the conclusion that most adults over 60 should receive the zoster vaccine.

What did you think of our tactics for lowering your patient no show rate? Can you think of other ways that your practice has lowered its no show rate? Tell us about your experiences. We want to hear from you.

Webley MD's Community Stories Program 

Webley MD is looking for your stories about how your practice has made a change for the better. We’re looking for inspiring tales about how you successfully dealt with challenges like lowering no show rates, combatting rising operating costs, physician recruitment, going paperless (or in that direction), starting your own practice, and more. You should be proud of your accomplishments and we’d like to get your story out there. We're waiting to hear from you.

To share your story with us, visit our Community section.

Still looking for ideas to lower your no show rates? Try to do something different and see if it changes your no show rates.

Tactic 4: Send multi-channel appointment reminders
We've said it before and we'll say it again. Ask your patients how they'd like to receive their appointment reminders (cell phone, home phone, email, etc.) and listen. Chances are they are easiest to reach using the communication channel they say that they prefer. Multi-channel communications require more effort to manage but they increase your reach and the effectiveness of your communications.

Tactic 5: Don't just send one reminder, send multiple reminders
Patients might be annoyed by multiple reminders, but it can take more than one reminder to get their attention. Sending two reminders in advance of an important appointment is likely to be appreciated by the patient. Try sending one the week before and then a day before the appointment. 

Tactic 6: Ask patients to confirm their appointments
By asking the patient for a confirmation or cancellation with the option to rebook, you can be 99.9% certain that they have received the appointment reminder and understood the message. Asking for the confirmation conveys the importance of keeping the appointment to the patient. The interactivity of the message means that the message is more involving and more memorable. Some automated appointment reminder systems can capture appointment confirmations automatically. 
 
Be sure to read my previous two posts for additional ideas. 

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.