Reduce phone calls in your medical practice

A physician approached me at the end of a talk on optimizing practice efficiency and improving service to patients and said, “I dream of an office with no phones.”

Do you have days where the phones are ringing off the hook? Or the phone message forms in your in-box seem to be reproducing? Maybe it’s been one of those days when you can never get your nurse’s help because she’s been on the phone every time you’ve looked for her.

We can all appreciate the feeling of frustration that the repeated interruptions of phone calls create for everyone in the office — you, your nurses, your receptionists, your lab tech, everyone!

The idea of not having any phones is a bit extreme, but let’s think about how you might function without one.

How would patients get an appointment, for instance? Answer: Your website would be the incoming line to your appointment schedules.

How? You’ve probably heard about patient portals that support requests for appointments.

The patient can select a provider, an appointment type or reason, and even specific days of the week or dates on the calendar in their request. The practice staff acts upon that request with a specific date-time slot and messages that information back to the patient for confirmation.

That eliminates the telephone exchange, but it is still means your staff is spending time interacting to provide the patient with an appointment.

Why not let the patient view available dates and times that fit their request criteria (provider and reason for the appointment) and select the preferred date and time?

You still effectively manage your schedule because the website will offer patients only those slots you have predetermined as available.

It is all self-service by the patient, so your staff can spend time interacting with the patients who are already in your office and facilitate the flow for the day. You get better use of staff time, and patients are happier being in control of their own destiny.

Try it with your flu shot clinic. Try it with back-to-school physicals. Try it with OB visits. Try it!

Why else do patients call into the office? Those prescription refills!

Again, you’ve heard about the patient portal features that allow patients to get online to request their medication reissues, but that process still requires additional staff time. Nurses must manage those portal requests and message providers to grant the request; even in the electronic world of e-prescribing and the EHR it means at least two sets of hands in the office are on the keyboard or mouse.

That particular inefficiency is self-inflicted!

You saw the patient, you wrote two orders — a prescription and a note for a follow-up visit. The duration for each of those should be the same!

For example, say your patient is well-controlled on a blood pressure medication and at his annual visit you write a prescription for 90 days and tell him you’ll see him next year unless he needs you for something sooner.

About three months later, that patient is going to need his blood pressure medication refilled, and that’s when the phone will ring in your office! Or, maybe it’s an incoming fax from the pharmacy. Someone in the practice has to deal with that.

That situation would never exist if you simply provided the patient with a prescription for a year’s supply of that medication during the visit.

It’s just that simple to reduce the incoming phone calls by 50% in your practice!

You’ll still have a phone, but imagine only half those rings buzzing every day … peace, quiet, and efficiency!

Rosemarie Nelson is a principal with the MGMA Health Care Consulting Group.

Originally published in MedPage Today. Visit MedPageToday.com for more practice management news.

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  • http://Www.Personalmedicine.com Natalie hodge

    The phone call “less” practice is one of our goals at personal medicine Kevin, it is not a fantasy, it is a reachable goal for docs in 2011 when you utilize the right technology tools, with careful implementation strategy in the RIGHT business model. Of the three, above considerations the business model is the most important. That is the most overlooked component. The reason that teledicine has not been more widely adopted by docs is simple. They got the business model for physicians wrong.

    Best, Natalie

    Www. Personalmedicine.com

  • Finn

    As you move in this direction (which would be terrific), keep in mind that there will always be a minority of patients who can’t use your website or patient portal: poor patients without internet access, visually impaired patients who can’t use a computer, elderly patients who do not have or are not comfortable using a computer. There will still be a small percentage of patients who will have to call the office because it’s the only technology they have or are able to use.

    • pcp

      I’m certainly computer literate, but I make all my appointments (doctor, dentist, lawyer, accountant) by phone: I can explain why I want the appointment and discuss the possible times for the appointment. It’s much MORE EFFICIENT to do this by phone than on the internet.

      What happens in situations like this is that the office goes from an all-phone system to part phone, part computer. Staff actually becomes less efficient and the posibility for error increases. We need to disabuse ourselves of this idea that doing a task on a computer is automatically better!

  • Dr. Z

    Biggest phone time suck up are the endless calls to with CMS and insurance companies to navigate the labyrinth of the progressive debate with GEDs, nurse techs, and then RNs layered so as to stonewall the billing and collecting for services provided their patients.

    Next highest time outlay is with pharmacies as we jointly navigate the payer’s formulary rules. The process is meant to be time consuming with the goal being to frustrate the physician and other clinicians into accepting less for the services rendered than it costs to perform… and to tie you up on the phone so you can’t see current patients and reduce future billables.

  • http://www.john-goodman-blog.com Devon M. Herrick, PhD.

    Rosemarie Nelson has some great ideas — but I would take it even further. Rather than try to eliminate all calls; I’d try to increase phone calls while reducing the wrong kind of calls.

    Start with a smaller waiting room and (for a fee) be willing to talk to your patients on the phone or by email as much as they want. Bill patients for increments of your time rather than for a visit. The notion that every patient needs to take time off from work, drive across town and have an in-office physician visit wastes both the patients’ time as well as doctors’ resources.

    • Dr. Z

      @”Doctor” Herrick… You are a health care economist. You aren’t a clinician. You are just pushing your ‘internet based medicine’ academic viewpoint. Patients aren’t the real problem taking up phone time… its the payers … driven by academics and economists.

  • http://www.john-goodman-blog.com Devon M. Herrick, PhD.

    @ Dr. Z… I’m not going to argue your point because I agree with it. I prefer a cash-based model with less third-party payment. Notice I suggested charging for increments of the physicians’ time over the phone (or in person). That is currently not something most insurers will reimburse for. But I am free to do so using my health savings account. This is a practice model used by Virginia-based DocTalker Family Medicine and one I wish my physicians espoused.

  • stargirl65

    Good in theory. I have been prescribing patients the amount of medicine they need to get them to the next appointment for over 10 years. We also try to get the patient to make the follow up appointment before they leave the office to make sure the times match up. Despite this we gets lots of calls/faxes/erequests for prescriptions.

    1. the pharmacy put them on file but didn’t look when the patient called, 2. the patient requested a refill with the automated number system but there are no refills by number since new rx written and has different number, 3. the pharmacy denies receiving them or loses them, 4. the mail away company loses them, misdirects them or otherwise, 5. the patient loses them, 6. they need preauthorization, 7. the patient has been taking it for years but NOW it is nonformulary due to insurance change or some other random event, etc, 8. the patient doesn’t want to come in as they just got a high deductible plan and don’t want to pay for the visit since it now costs more than $20

    The system is broken and creates more hurdles than clear pathways.

  • Dr D

    It’s more comlicated than this. My practice is mostly frail elderly, or multiple serious dianoses. We have to pace the schedule for the “bomb” of the morning-the lupus flare, the CHF after the xmas holidays, the tears. It doesn’t work in the mechanistic way you all suggest-if you give a damn about your patients. It’s not all about money. Or is it? And that decides how your practice works……..

  • Dr. Z

    @Dr. Herrick… I agree with you. One of the byproducts of changing the payment schema to a cash-based model will eliminate phone calls to/from CMS and insurance companies since we no longer would be doing business with them. We can also eliminate medical procedure coders from our practice overhead and focus more on the delivery of services to our customer the patient versus our artifical customer the payer.

    HSAs would be a great way to vest a cash-based model (why should our local dry cleaner and pet groomers have the luxury of a better way to get paid than doctors?). As a health care economist … what is your assessment of the impact of Obamacare on the utility and viability of HSAs given the orientation of our current SecHHS?

  • drjebj

    Consider analyzing and categorizing your calls for a week and then brainstorm with your staff about solutions. Implement solutions one at a time to evaluate the impact on your patients and practice. Then consider:

    1.) Use generics whenever possible.
    2.) Give your staff clear standing orders about refills ie no narcotics by phone, annual BP or semiannual DM visits required and 7 day refill permitted to come in for a visit.
    3.) Consider the reason for all those insurance company calls. It may be that your practice style tends to hit the insurance company radar more than it should.

  • Stephanie Trifoglio, MD

    well, Sure Scripts isn’t functioning…again. mandated by law and dysfunctional. IT is “working on it.” And, as a geriatrician, the vast majority of my patients are not online and cannot access a computer. Many have switched to me because a human being actually answers our phone. My telephone continues to ring.

  • http://www.physiciandispensingsolutions.com David Riethmiller

    An easy solution to reducing pharmacy calls is to dispense medication directly to your patients. The patients pay you for the medication and you spend less time on the phone for things like pharmacy corrections, refills & other miscellaneous activities.

    Patients are happy because they save a wasted trip to the pharmacy & the doctor’s office is happy because the issue is resolved & they’re compensated for their time.

    It’s called physician dispensing

  • Dr. Z

    Mr. Riethmiller … (noting your comml interest in physician dispensing … which doesn’t necessarily mean its a good idea or good business case)

    Taking on the pharmacy mission means you take on staffing including another physician to your staff … inventory … insurance … along with the accusation that you are prescribing to drive up your own revenues.

    How late does your practice pharmacy stay open in the evenings and on the weekends … while doubling your calls to/from insurance companies to resolve formulary issues?

    If this is a good idea … have one of your delighted physician practices come on here and tell us how great it is. Sounds like you are just selling your book.

  • http://www.physiciandispensingsolutions.com David Riethmiller

    Dr. Z

    I appreciate your feedback and people can take it or leave it, but there is another way of doing business. If you like you can visit my site and check out my testimonial section from practices that have chosen another path and are very happy.

    To answer your question regarding how late the pharmacy stays open, doubling your calls from pharmacies, adding another physician etc.. If you had experience with dispensing you would not ask those types of questions, because they don’t apply to dispensing. There is no need to do anything you’ve suggested that an office would have to do in order to dispense. I’m not suggesting that dispensing will eliminate the need to talk with pharmacies, but it will greatly reduce the amount of calls your office receives.

    A 1999 study by the Institute of Medicine estimated that every pharmacy call-back cost physicians practices $5-$7 to pull and review the chart and return the call. With the average physician writing 30 prescriptions a day and handling nearly another 30 requests for refills, the dollars add up quickly. Dispensing greatly reduces this cost & the amount of time a practice spends on the phone.

  • http://glenngoldbergskindr.com Karen

    I think the automated phone system sounds great, but what about all the Medicare patients who are not at all computer savvy, nor want to be. Does one still keep phone scheduling for them? This doesn’t seem possible. Any ideas there?