Tag Archives: Healthcare Call Center Articles

Three Major Benefits of a Medical Call Center Partnership



A Medical Call Center Partnership Contributes to Organizational Efficiency

By Karen Brown

Organizational efficiency is the ability to implement plans using the smallest possible expenditure of resources. It’s an important factor in organizational effectiveness and vital to the healthcare industry, which continues to experience increased operating costs and smaller bottom lines.

Medicare expansion and the ACA (Affordable Care Act) have contributed to significant increases in patient populations that are expensive to treat and provide minimal financial return. This strains an organization seeking to provide adequate post-discharge care, which can result in costly avoidable readmissions.

As patient loads and associated risks increase and reimbursement decreases, the ability to achieve organizational efficiency becomes more challenging. However, providing the highest possible quality patient care at the lowest possible operating expense can be possible with the assistance of a medical call center. By partnering with a call center’s team of registered nurses specially trained in telephone triage, organizations can save a significant amount of time and cost associated with adding staff while reducing the risk of unnecessary readmissions and inappropriate utilization of care.Partnering with a medical call center provides access to high quality care at the lowest cost possible. Click To Tweet

Telehealth and Related Services Are a Large Part of a Bright Future

It’s no secret that telehealth services and telemedicine are becoming increasingly popular due to the financial benefits they provide. Combined with federal policy changes (MACRA and MIPS) that address care planning and risk assessment—significantly effecting reimbursement in the process—telemedicine is poised to drive more revenue from virtual care directly to hospitals and healthcare organizations. And this is just the beginning. According to a recent report from Grand View Research, the telemedicine market should top $113 billion by 2025.

While telehealth currently focuses on a range of primary care services, the rising occurrences of chronic conditions as well as the increasing demand for self-care and remote monitoring are significant factors driving telehealth growth. Healthcare organizations that add new primary care options will reduce costs and create new services while remotely offering existing ones to more of their patient populations.

Partnering with a medical call center provides a healthcare organization with access to established chronic care, self-care, and remote monitoring programs. This eliminates significant labor costs. It’s vital to find a call center with outbound service offerings that include a variety of chronic care and follow-up, post-discharge call programs, including prescription/medicine reconciliation, self-care plan adherence, and follow-up appointment scheduling.

Quality of Care: Patient Satisfaction

In today’s world, people have a multitude of choices when it comes to their care. Because of this, it’s vital for healthcare organizations and providers to get every aspect of the patient experience right. Providing the correct medical care isn’t the only factor contributing to a positive experience. From the initial appointment-setting call to the final communication between a patient and provider, every experience contributes to the overall satisfaction and quality of care a patient receives.

One of the largest factors contributing to patient satisfaction is access to care. We live in a 24/7 world, and having access to definitive medical care at all times is a standard patient expectation. Providing that level of access is challenging and often costly. Not providing that level of access leaves patients feeling less empowered and engaged, which in turn can lead to poor experiences and even poorer satisfaction scores. A partnership with a medical call center gives patients access to definitive medical care 24/7/365 at much lower costs.

Another factor contributing to patient satisfaction is the quality of relationship with their caregivers. Patients expect to be engaged in decisions involving their care. This includes open communication with nurses and providers involved in that care. If patients do not feel their concerns have been heard and taken seriously, they feel less confident in the care they receive, resulting in a negative experience—even if the outcome is positive.

It isn’t uncommon for providers to become overwhelmed with consistently increasing workloads in a 24/7 environment. This can lead to frustration and burnout, which is often evident in their interactions with patients. Using a medical call center to cover all after-hours calls removes the 24/7 access from the provider’s core responsibilities. This is a powerful physician recruitment and retention game changer. In short, happy providers have more positive interactions with their patients, which results in higher patient engagement and satisfaction.

While no healthcare organization wants a patient to have a negative experience for any reason, there is a new factor regarding patient satisfaction that demands attention. Since the inception of value-based purchasing, the definition of a successful patient experience has been redefined. Now 30 percent of the overall quality of care is attributed to patient satisfaction.

This means that patient satisfaction survey scores directly impact an organization’s bottom line. The shift to pay-for-performance also means that reimbursements are tied to the quality of care. Hospitals that provide a higher quality of care than their peers will receive reimbursement incentives, while hospitals that provide a lower quality of care will incur penalties.

This is perhaps the most beneficial aspect of partnering with a medical call center. Providing positive experiences for both patient and provider can drastically improve overall patient satisfaction and outcomes, leading to a higher overall quality of care and the related financial rewards.

Ultimately the provision of appropriate, quality care to achieve positive outcomes is the goal of all healthcare organizations. Making that a possibility—while also considering organizational needs, government regulations, and patient experience—can be difficult and costly. Partnering with a medical call center provides access to high quality care at the lowest cost possible.

Karen Brown, RN, is vice president, business development, with TeamHealth Medical Call Center, a premier provider of medical call center solutions, providing services to more than 10,000 providers, health plans, home health and hospice organizations, employers, and universities across the United States.

The Healthcare Call Center’s Role in Reducing Hospital Readmissions



By Traci Haynes

Reducing hospital readmissions has been a focus of the healthcare environment for many years. Steven Jencks, MD, dubbed by many as the father of readmission research, along with Mark Williams, MD, and Eric Coleman, MD, analyzed medical claims data from 2003–2004 to describe the patterns of rehospitalization.

Readmissions Rates

Almost one-fifth (19.6 percent) of the 11,855,702 Medicare beneficiaries who had been discharged from a hospital were rehospitalized within thirty days. In 2007 the Medicare Payment Advisory Commission (MedPAC) reported to Congress that 13 percent of patients rehospitalized within thirty days of discharge in 2005 were for preventable reasons. These readmissions accounted for $12 billion in Medicare spending.

As a result, the Patient Protection and Affordable Care Act (PPACA) of 2010 mandated that the Centers for Medicare and Medicaid Services (CMS) implement a program in which hospitals with higher-than-expected readmission rates for certain designated conditions experience reductions (that is, penalties) in their Medicare payments.

Beginning in October 2012, the hospital readmission reduction program (HRRP) began adjusting hospital payments based on excess readmissions within thirty days of Medicare patients following myocardial infarction (MI), heart failure (HF), and pneumonia hospitalizations. The maximum penalty at that time was 1 percent of a hospital’s base Medicare reimbursement rate per discharged patient.

A year later the penalty increased to 2 percent and then to 3 percent in 2014. The first year more than 2,200 hospitals received penalties for failing to meet standards, with 8 percent incurring the maximum penalty. In addition readmission penalties now include elective knee and hip replacements and chronic obstructive pulmonary disease (COPD). Utilizing the call center to identify and implement communication strategies adds value to the organization and better outcomes for their patients. Click To Tweet

Reasons for Readmission

According to Bisognano and Boutwell, the primary reasons for readmission were no physician follow-up visit, medication discrepancies, and communication failure during transitions of care.

Coleman and others identified poor information transfer, poor patient and caregiver preparation, and limited empowerment to assert preferences as the primary reasons for readmission. Contributing factors include nurses not having time to thoroughly address the needs of both the patients and caregivers upon discharge, the hospital setting not being conducive to education to drive behavior change before discharge, and the care continuum breakdown between hospital discharge and the handoff to primary care.

The impact of the penalties has been a significant concern for hospitals that care for a larger number of low-income patients. They claim it is more difficult for their patients to adhere to post-hospital instructions, including payment for medications, dietary modifications, and transportation to follow-up appointments.

To address these challenges, some hospitals have implemented measures including discharging patients with medications, home visits, and follow-up calls. Other interventions include hiring specialty care coordinators and transition coaches to offer follow-up care for patients with multiple comorbidities, providing patients with extensive teach-back for multiple days prior to discharge so they’ll better know what to do after discharge. In addition many include comprehensive medication reviews with a clinical pharmacist.

Call Centers Help Reduce Readmissions

The healthcare call center can help reduce avoidable readmissions by enhancing the quality of care in the hospital-to-home transition through the combined capabilities of technology and human interaction. Discharge planning should begin upon admission to the hospital. This includes arranging for durable medical equipment (DME), transfer to step-down as appropriate, home healthcare, transportation needs, and communication with primary care providers (PCPs). Discussions with caregivers, the extended care team (which includes the PCP, caregivers, and pharmacist), and other members of the interdisciplinary team can be greatly improved by the services of the call center in helping to comprehensively coordinate the patient’s care.

The patient and their caregivers will also benefit from the reinforcement of information provided, teach-back, appointment reminders, and coordination of services including transportation, as well as medication reconciliation and symptom assessment resulting in earlier interventions and improved outcomes. Extending contact beyond the thirty-day penalty period will bring even greater benefits to patients and their caregivers, which may prolong readmissions indefinitely.

Some healthcare call centers make one post-discharge call to review the patient’s diagnosis, instructions, medications, and education materials. They also ensure that the patient has scheduled their follow-up appointment. Others make several outbound calls to the discharged patient including a call within the first twenty-four to forty-eight hours.

In addition, the call center staff or care coordinator may reach out to the patient again after their first appointment. Ideally this should occur within seven days post-discharge. This call typically reviews follow-up appointment instructions or changes in medications, assists in referrals and scheduling with additional providers or resources, and communicates to the interdisciplinary team as appropriate. During this contact, biometric monitoring may also be tracked through technology or as self-reported by patients or their caregivers.

Whatever level of service provided, it’s a win for the patients, their caregivers, and the healthcare organization. Utilizing the call center to identify and implement communication strategies that effectively engage the patient and their caregivers adds value to the organization and the opportunity of better outcomes for their patients.

Traci Haynes, MSN, RN, BA, CEN, is the director of clinical services at LVM Systems, Inc.

References:

  • Bisognano, M., Boutwell, A. (2009). Improving Transition to Reduce Readmissions. Frontiers of Health Services Management 25(3), 3-10.
  • Coleman, E.A., Parry, C., Chalmers, S., & Sung-joon, M. (2006). Care Transitions Intervention. Arch Intern Medicine 166(17) 1822-1828.

Jencks, S.F., Williams, M.V., & Coleman, E.A. (2011). “Rehospitalization Among Patients in the Medicare Fee-For-Service Program,” New England Journal of Medicine 364:1582.

The Call Center Can Save Healthcare



With a shortage of practitioners and a downward push on costs, the call center is poised to come to the rescue

By Peter Lyle DeHaan, PhD

Peter DeHaan, Publisher and Editor of Connections MagazineIt’s a bold statement to claim that call centers are the future solution to healthcare’s present problems. But it’s what I believe. And more and more people in the healthcare industry are believing it every day too. Here’s why:

Contain Costs

The healthcare industry is under extreme pressure to hold costs down. One way to do this is to outsource calls to professional communicators at healthcare call centers. Let healthcare practitioners and staff do what they do best, and let call centers handle their calls for them. It saves money and frees healthcare staff to focus on patients and providing care.

Counter Staff Shortages

We currently have a shortage of doctors, and projections indicate the shortage will increase. Also, some geographic areas suffer from a shortage of nurses, and no one expects this to get better either. Given these shortages of key personnel, it makes sense to keep them off the phones and outsource as much telephone work as possible to healthcare call centers, with agents who can do the work faster and more economically.The medical answering service makes medical practices, clinics, and hospitals available to patients around-the-clock, 24/7. Click To Tweet

Increase Availability

The medical answering service has long been a cost-effective way to extend patient availability past normal office hours. It makes medical practices, clinics, and hospitals available to patients around-the-clock, 24/7. More recently, telephone triage operations have also made healthcare support available by telephone anytime of the day or night. Though this isn’t currently available to all people in all places, it will change. It must.

Retain Patients

Patients increasingly have a consumer mind-set when it comes to healthcare. Loyalty to their providers is no longer as strong as it once was. They’ll switch caregivers over the smallest of slights, which often occurs when they can’t get the assistance they want, when they want it. That’s why 24/7 phone coverage is essential to retain patients in today’s marketplace. The healthcare call center is primed to accomplish this.

Serve More People

Telehealth is another exciting healthcare development in the call center industry. With telehealth—of which telephone triage serves as the entry point—remote populations can now receive cost-effective service. No longer will people in rural areas need to drive long distances to access the healthcare system. Instead they’ll start with their phone. And if they have a smartphone, they can do a video chat, which aids remotely located practitioners in making more informed recommendations.

Let Specialists Specialize

In medicine we have many types of specialists. These highly trained individuals focus on one area, which allows them to serve a niche market better and faster than a general practitioner. Let’s expand this thought to the healthcare call center. The healthcare call center stands as the communication specialist for the healthcare industry. Just as there are benefits of going with a medical specialist, so too there are benefits of going with a healthcare communications specialist.

Conclusion

These exciting opportunities and the compelling outcomes they can provide show us how important healthcare call centers are to the healthcare industry. This applies both now and in the future. And while the demand for these healthcare call center specialists is great now, it will be even greater in the future.

Peter Lyle DeHaan, PhD, is the publisher and editor-in-chief of Connections Magazine. He’s a passionate wordsmith whose goal is to change the world one word at a time.

Three Options for Setting up a Nurse Advice Line

By Charu Raheja, PhD



Managing patient calls effectively is critical to ensure high-quality, well-coordinated care for every patient. Make sure the people answering your phones triage patients efficiently and effectively. Establish a consistent nurse triage system to improve the way you manage patient calls, improve patient satisfaction, and decrease unnecessary medical expenses. Triage nurses can direct patients to the appropriate care for their symptoms and give patients peace of mind by addressing their concerns.

The benefits of nurse triage are better patient access, coordinated care, and cost savings. In addition, nurse triage gives patients better access to providers even if they aren’t seeking emergency care. This improves patient satisfaction, prevents future complications, and allows providers to educate patients.

With technology advances, several cost-effective opportunities are available to provide nurse triage services. Here are three key options to set up a nurse advice line:Each patient encounter starts with a phone call. Make sure your nurse triage service,is a seamless experience for your patients. Click To Tweet

1. Do It Yourself: Start Your Own Call Center

Opening your own call center involves setting up the call center infrastructure. The requirements depend on the scale and number of calls received. For daytime calls, many practices choose to have their own staff nurses take calls using daytime triage protocols.

These protocols are available in book form or in electronic format. For night calls, the requirements include hiring an experienced call center manager, purchasing triage software for nighttime protocols, and hiring clinical and nonclinical staff to handle patient calls.

Pro: Having your own system gives your staff the flexibility to perform multiple tasks in addition to triage, such as physician referrals, scheduling, disease management, class registration, and surveys.

Con: Setting up a call center requires a high investment. It is labor intensive for the nursing department, and it requires human resources and IT involvement. Moreover, there are significant differences in terms of hardware requirements and capabilities with various software programs, so it’s important to do your research and speak with a variety of vendors. This is a long-term project with a slow return on investment.

The organizations most likely to succeed with this approach are larger facilities with high call volumes who expect to handle over 50,000 triage calls a year. These companies are ideal because they likely already have some call center infrastructure in place and just need to add to it. The high call volume also allows the center to use nurses’ time efficiently.

2. Outsource to a Nurse Triage Center

If setting up your own call center seems daunting, you could use an outside vendor for nurse triage calls.

Pro: This option has a low start-up cost. You don’t need to train triage nurses. And there’s no human resources or IT component. Since the vendor is already taking calls, start-up is quick, and there’s an immediate return on investment. In addition, vendors may have more expertise in the niche area of triage, resulting in better care for patients.

Con: When outsourcing patient calls, you have less direct control over the nurses. Also, some nurse triage vendors can’t integrate with electronic medical records (EMR).

For the best outcome, be careful when interviewing vendors and make sure you’re comfortable with them. Be aware that costs vary depending on the vendor. While you “get what you pay for,” you get less from some than others. Assuming you’ve done your homework, outsourcing is a good option for small- to medium-size practices.

3. Use a Combination of In-House and Outsourced Services

In this model a healthcare organization uses its own nurse triage software and nurses during high call volumes and outsources the triage to a service during low call volumes. Call center technology, integration engines, and communication platforms can accomplish this seamlessly.

Pro: A combined model can expand services and decrease costs. Most triage centers lose money when the call volume is low because nurses sit idle waiting for phone calls. By outsourcing calls during low traffic times, the call center can provide service at a reduced cost.

Your organization can continue to provide the same level or increased levels of service and at the same time decrease operating costs. This also allows organizations to keep their current infrastructure and resources.

Con: Just as with the previous option, it’s critical to find the right partner who has the technology and service-level knowledge to implement a combined model. If their system doesn’t align with yours, an interruption in patient care will result.

This option works best for organizations that have some existing nurse triage infrastructure. Again, it’s crucial to select your call center partner carefully. Discuss your software and services with your partner before making a commitment.

Each patient encounter starts with a phone call. Make sure your nurse triage service, whether in-house, outsourced, or a combination, is a seamless experience for your patients.

It’s important to explore options for managing patient calls to find the solution and product that aligns with your needs.

Charu Raheja, PhD, is the CEO of TriageLogic, a leading provider of quality, affordable triage solutions, including after-hours medical call center software, daytime triage protocol software, and nurse triage on call.

The Ten Critical Steps of Taking a Triage Call



By Marci Lawing

The goal of every triage call is to make patients feel comfortable and heard, while at the same time collect critical information from them and get them to the appropriate level of care based on their symptoms.

Step 1: Introduce Yourself. Use your first name, title, and the practice or physician you represent. It’s imperative for you to clearly identify yourself and state your credentials as a nurse employee of the practice for which you work. When you introduce yourself, you create a relationship.

Step 2: Collect Demographic Information. Before you are ready to hear your patient’s concerns, you will need to know some basic information. Age, gender, and other data will affect your triage protocols, so be sure to collect all the necessary demographic information. This information is needed so it can be put in the appropriate chart and followed up.

Step 3: Gather Medical History. Get a brief medical history so you do not miss any important surgeries, medications, or relevant medical information from the recent months or years. You’ll want to know your patient’s medical history before he or she details the current issue.

Step 4: Let the Patient Talk. Now that you’ve armed yourself with all the necessary information you need to proceed, let the patient speak freely about current concerns. Be an active listener. That means that you don’t just listen; you participate in the conversation by asking any probing questions needed to ascertain a full description of the patient’s complaint.

Step 5: Document the Assessment. Once you’ve listened carefully to the patient, document your assessment carefully with the necessary details.

Step 6: Choose the Right Protocol. With the right triage protocol, this step can be fast and efficient. Be sure to document the answer to each question and make any additional notes needed.

Step 7: Get the Patient to the Right Level of Care. Now that you’ve followed the protocols and completed the assessment, you’re ready to recommend the level of care your patient needs. Be sure to speak clearly and at a pace the patient can follow while you detail every step he or she needs to take.

Step 8: Give Relevant Care Advice. Provide solutions based on the patient’s symptoms in order to help identify the best path to care.

Step 9: Make Sure Your Patient Knows When to Call Back. Confirm that the patient fully understands your triage advice and knows when and who to follow up with. Triage tip: Make sure your patient is able and willing to follow the plan you discussed. Click To Tweet

Step 10: Offer Reassurance. Make sure your patient is able and willing to follow the plan you discussed. It is important, especially with serious symptoms, that the patient follows your triage advice. If told to go to the ER, verify with the patient that he or she has access to safe transportation.

You can’t underestimate the power of empathy. Over 80 percent of patients who call their physician’s office may not need urgent care, but they all urgently need empathy, someone to listen, and someone to care. That’s the role of the triage nurse. In addition to being a good clinician, a critical thinker, and making sure everyone stays safe, you are also there to provide empathy and care advice to patients.

These ten critical steps will help you stay on track and ensure that patients get the quality care they deserve.

Marci Lawing, RN BSN, is the clinical nurse manager at TriageLogic LLC. TriageLogic’s online learning center is available free of charge to telephone triage nurses and teams as an educational resource and practical training guide. Along with course videos, coursework includes class notes, related articles, and learning materials. You will receive a TriageLogic Telephone Nurse Triage Certification for each completed course. Managers can also set up teams and check their individual nurses’ progress in the course.

The Patient Experience Contact Center



By Richard D. Stier

Patient experience failure, the incentivized reduction of avoidable readmissions, increasing rates of physician burnout, and the escalating priority of revenue cycle management, have all combined to incubate an unexpected solution: Exit the call center; discontinue generic transactions.

Instead the patient experience contact center is born. Enter the era of thoughtfully deployed patient experiences, beginning with the first point of contact. In contrast to yesterday’s call centers, which processed physician referrals and class enrollments, today’s patient experience contact centers are a health network’s communications nerve center. They deliver intentionally memorable experiences that strengthen preferences, mitigate risk, reduce unnecessary readmissions, serve as physician practice extenders, and solidify patient loyalty.

Patient Experience Failure: Currently healthcare has a 29 percent patient experience failure rate, according to research by Hospital Compare. Only 71 percent of inpatient patients receiving care report that they received the “Best Possible Care.”

In what universe is a 29 percent failure rate acceptable? Could we miss revenue projections by 29 percent? Be over budget by 29 percent? Would it ever be acceptable to miss quality standards by 29 percent? “We only dropped 29 percent of newborns, so we met the standard.” Seriously?

“Best Possible Care” experiences begin before a patient receives care and continues after the patient returns home. Healthcare contact centers are uniquely positioned. They serve as the virtual front door for personalized support and referrals before using a clinical service and for individualized follow-up and coaching after discharge.

With the launch of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) program by CMS in 2006, hospitals have dedicated significant time and resources to improving the results of CAHPS surveys. The shift from a transaction-focused call center to an experience-driven contact center is an investment to improve the experience of care—beginning with the first touchpoint when someone new to the community calls to request a referral to a primary care physician (PCP) and continuing after discharge when a contact center navigator calls to confirm a follow-up visit with that PCP.

That first touchpoint is critical. According to SHSMD (2012), the first three seconds of that initial interaction influences hospital selection and preference. Whether on the phone or online, healthcare contact centers can intentionally deliver a transformative first patient experience.

Incentivized Reduction of Avoidable Readmissions: One-half of all hospitals in the United States (2,597) will be penalized by the Centers for Medicare & Medicaid Services (CMS) for unnecessary readmissions in FY 2017. Those penalties will total $528 million, over $100 million more than in FY 2016. During 2016 forty-nine hospitals received the maximum penalty of 3 percent withholding from Medicare funding. A total of 1,621 hospitals have been fined over each of the five years (source: HealthStream SUMMIT 2016).

Preventable readmissions represent a substantial portion of unnecessary medical spending. According to data from the Center for Health Information and Analysis (CHIA), the estimated annual cost of this problem for Medicare is $26 billion annually, $17 billion of which is considered avoidable (source: Provider Advisor 2016 Volume 2, Issue 2, p. 4).

It’s about to get even harder. For FY 2017, CMS is adding open-heart surgery—a more complex, longer-stay procedure—to the list of clinical conditions monitored for avoidable readmissions.

Increasing Physician Burnout: Nine out of ten physicians discourage others from joining the profession. Currently about 300 physicians commit suicide every year (source: Daniela Drake, The Daily Beast, 2014).

As many as one in three physicians is suffering from burnout, which is linked to a list of pervasively negative consequences, including lower patient satisfaction and care quality, higher medical error rates, greater malpractice risk, higher physician turnover, physician alcohol and drug abuse and addiction, and physician suicide (source: Dike Drummond, MD, Stop Physician Burnout).

Physicians face increasing burdens, including the complexities of ICD-10 coding; new billing models; responding to new government regulations; dealing with a changing landscape of health plans; sharing information across the network; inefficiencies of credentialing, provider enrollment, and onboarding; documenting quality; cybersecurity; loss of autonomy; threats from alternative providers; and the “retailization” of primary care.

And, here comes the value-based reimbursement plan for physicians: MACRA (Medicare Access and CHIP Reauthorization Act). Beginning in 2019 physicians will be reimbursed on various performance metrics such as quality, advancing care quality, resource use, and clinical practice improvement. According to Deloitte, “Providers are in for a notable awakening when the law takes place in 2017.”

On top of this avalanche of stressors, physicians must keep up-to-date clinically, build practice volume, and improve their patients’ experiences. Are you exhausted yet?

Growing Focus on Revenue Cycle Management: The Affordable Care Act (ACA) and Medicaid expansion has created an influx of previously uninsured patients that has left healthcare organizations scrambling to accommodate increased demand while simultaneously experiencing lower margins. Because consumers are assuming greater financial responsibility for their own healthcare, healthcare delivery networks must shift from a wholesale to a retail environment where they interact directly with patients on issues such as pricing, billing, and payment. Unfortunately, hospitals and health networks are experiencing a strong correlation between the use of high-deductible plans and the amount of bad debt they are incurring (source: HealthCare Finance, 2016).

Concurrently, few healthcare organizations have taken the steps necessary to integrate the many information systems that support revenue cycle management. Systems are incompatible across service lines, locations, and functionality. Different software solutions are frequently employed to support disparate functions such as registration, clinical documentation, and billing.

Even worse, some of these functions may be done manually or are only partially automated, making data analysis incomplete or impossible. As the industry migrates toward value-based care, healthcare organizations are entering new collaborations, taking on risk contracts, exploring alternative sources of revenue, and being pressured to document outcomes. Patient experience contact centers address a myriad of healthcare industry pressures. Click To Tweet

Summary: Patient experience contact centers are a timely response to a myriad of industry pressures. Redeploying a legacy transaction-focused call center as a patient experience contact center can strengthen preference for your organization, mitigate risk, reduce unnecessary readmissions, serve as a physician practice extender, and solidify patient loyalty.

Richard D. Stier, MBA, is vice president of marketing for Echo, a HealthStream Company. He is a passionate and results-proven proponent of delivering transformative patient experiences.

Moving from “Sick Care” to “Health Care”



By Mark Dwyer

In 2012 our government enacted legislature that mandated U.S. hospitals to reduce readmissions by emergency departments (ED) admits for the first thirty days post-discharge. To force this change in behavior rather than wait for hospitals to choose to proactively address the overall health of their communities, the government began penalizing hospitals who had higher than average readmission rates through a deduction in their reimbursed Medicare payments.

This was a radical change in American healthcare; it put the onus of keeping patients well on the hospitals and providers who treated them. No longer could hospitals simply wait for individuals to require hospital care; instead it became their responsibility to proactively manage ED-admitted patients for at least the first thirty days post-discharge. If they were unsuccessful in providing the patient with the tools and help needed to keep them from readmitting, they bore the weight of a financial penalty.

Initially, the penalty amounted to 1 percent of the hospital’s total annual Medicare reimbursement. It was tied to three specific DRGs (diagnosis related groups): acute myocardial infarction (AMI), heart failure (HF), and pneumonia. Each hospital was scored against its neighboring hospitals to determine which ones had readmission rates in the highest twenty-fifth percentile of the surrounding hospitals. If a patient who had been admitted via the ED due to one of these three DRGs required readmission within thirty days post-discharge, and the hospital’s readmission rate was in the highest twenty-fifth percentile of hospitals in the area, the hospital’s overall annual Medicare reimbursement was reduced by 1 percent. Although 1 percent may not seem like a lot, when applied against the hospital’s entire Medicare reimbursement dollars, it was significant—especially for hospitals operating with only 2 to 3 percent profit margins.

But the government didn’t stop there. In year two of the program, the percentage of Medicare reduction was increased to 2 percent of the hospital’s total annual Medicare reimbursement amount. In year three, not only was the percentage again increased to 3 percent of the hospital’s overall Medicare reimbursement, but three additional DRGs were added: elective knee replacement, elective hip replacement, and chronic obstructive pulmonary disease (COPD). Healthcare software vendors have programs to educate and manage patients post-discharge. Click To Tweet

At this point many hospitals began paying attention, especially when over 2,200 U.S. hospitals were penalized for failing to reduce their readmission rates. To address this ever-increasing reimbursement reduction, hospitals had to implement programs to manage Medicare patients post-discharge for at least the first thirty days. To do so, many homegrown programs were introduced with varying success.

A number of healthcare software vendors began developing and marketing programs to help educate and manage the patients post-discharge. Some of these programs involved on-site care management visits, phone calls, reminder texts, and emails. Some also involved extensive motivational programs designed to not only assist patients in remaining proactive about their care but also the patient’s caregiver. Too often the Medicare patient’s primary caregiver is an elderly spouse who is also battling a litany of health issues. Assisting them and other familial caregivers was determined to play a critical role in the process.

But what about the many patients who suffer from more than one chronic disease? Some vendors realized that many Medicare patients suffer from comorbidities. It is not unlikely for an individual with diabetes to also be obese, or someone with HF to have been admitted with an AMI DRG. Initially, since these various disease states were defined as separate care plans, patients suffering from comorbidities experienced multiple interactions post-discharge in order to manage all conditions that could possibly result in a costly readmission.

To motivate patients and their caregivers to follow post-discharge instructions regarding medications, to make and attend post-discharge provider appointments, and to integrate with the hospital’s care management or medical call centers, vendors have begun collaborating with leading content developers. By adding patient educational and motivational training content to their software programs, post-discharge programs can enable nurses or care coordinators conducting follow-up calls to select the specific information needed to address each patient’s multiple issues. This comorbidity program approach eliminates the need for redundant calls to address each of the patient’s healthcare issues. Instead it enables the nurse or care coordinator to select the content, surveys, motivational scripts, and other resources needed to meet all of the patient’s unique needs across a wide array of health conditions.

Future-thinking hospitals and providers who see the need for follow-up beyond the initial thirty days post-discharge are beginning to take a stand for long-term health management by using customizable comorbidity programs. This is a real step in the direction of healthcare management. Imagine a future where healthcare generates greater revenues from having empty beds, keeping area residents healthy and at home.

Mark Dwyer is the COO of LVM Systems, Inc. For more information about LVM’s Comorbidity Care Management Program (CCMP), contact LVM Systems sales at 480-633-8200 x223 or info@lvmsystems.com.

Interoperability in the Healthcare Call Center


Amtelco


By Matt Everly

The call center in a healthcare organization preforms a variety of important functions. One is serving as a virtual lobby when processing internal and external calls. It may be the initial touchpoint a patient has with the organization, so the experience must be positive. As the saying goes, “You only have one opportunity to make a first impression.” The call center also serves as the nerve center for ongoing communications.

Modern healthcare call centers need to handle all types of calls quickly and efficiently. To ensure that the virtual lobby experience is positive, the call center agents need immediate access to accurate data. To accomplish this, information systems need to share, pass, and store usable data from system to system. Interoperability is a term used in healthcare to describe the idea of different technologies and systems communicating to share data.

To handle calls effectively, the call center system needs to use data that may reside in external databases on other systems. As an example, if a caller wants to talk to an admitted patient, the agent needs to know which room to send the call to. Most patient admission, discharge, and transfer (ADT) information resides in a database that is external to the call center system.

Without interoperability, the agent would have to bring up a second screen to view the ADT information, go back to the call center system screen, manually enter the room extension, and transfer the call. With interoperability, the call center system can automatically download the ADT information from the external database and present it to the agent on the call center screen, thus eliminating several steps and decreasing the chance of error. Interoperability works behind the scenes to automate data exchanges and sharing.

Making sure the hospital call center is interoperable with other systems is the safe way to make sure call center agents communicate with callers in a timely and effective manner. A few of the important IT systems and technologies that should be interoperable within the healthcare call center system include:

  • Electronic health records (EHR)
  • Messaging applications (paging and secure messaging apps)
  • Alarms and monitoring systems
  • Nurse call systems
  • Scheduling systems

Many healthcare call centers routinely use outdated technology. Binders with paper call schedules, non-PC-based PBX consoles, fax machines, data access terminals, and sticky notes are used by agents to access the information they need to handle calls. These makeshift solutions lead to inefficiency and mistakes. Using interoperability, data can be combined to form a master record for a particular patient. Click To Tweet

Interoperability Works Both Ways: Hospital call center systems store information as administrators and agents input data or create schedules. This information may be valuable to other departments or used to augment an external document.

As an example, when an agent takes a message from a patient for a clinician, that message can be automatically sent to the EHR system and be posted to that patient’s individual electronic health record. By using interoperability, information from numerous databases can be combined in one area to form a master record for a particular patient.

Not All Systems Allow Interoperability: Legacy systems and technologies were not designed with data exchange in mind. There are several ways to connect IT systems to the healthcare organization’s larger digital ecosystem, but these can be costly and potentially unreliable.

Health Level Seven (HL7) is a set of standards used to transfer clinical and administrative data between software applications. Many present-day IT developers design products with HL7 in mind, helping organizations move toward interoperability throughout the enterprise. The healthcare call center can use HL7 to populate patient, clinician, and employee directories for agents. HL7 also can be used as a way to post information from the call center system to a patient’s EHR.

Reducing Costs: Interoperability will make your call center agents more efficient, eliminate mistakes, and reduce costs by automating processes that are currently handled manually. As healthcare providers look to reduce expenses, interoperability in the call center is a natural solution.

Matt Everly is the marketing director for Amtelco’s 1Call healthcare division. Matt has worked at Amtelco for over twenty years and has held numerous positions, including southeast regional sales manager, executive suite market development, and marketing manager.

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Medical Call Centers Rise to Meet Healthcare’s Pressing Needs



By Gina Tabone

Medical call centers have finally gained recognition and credibility in the healthcare marketplace. Centralized medical call centers are rapidly emerging as the backbone of health systems because they are integral in achieving better patient outcomes. They offer a proven solution for reaching the three goals of the triple aim: improving the patient experience of care, improving population health, and reducing the per capita cost of healthcare.

Improving patient experience requires open access so patients receive the most appropriate level of care needed, in a time best determined by specially trained nurses guided by evidence-based tools. The patient learns to expect reliable advice, taking into account their current health state and consistently available day or night. Gaps in care are eliminated and delays are avoided, leading to favorable patient outcomes and higher reimbursements in a fee-for-value model. When patients’ well-being is enhanced, everyone gains, especially the patients. Medical call centers can stake a claim for making that happen.

Labor costs consume up to 70 percent of many call centers’ operating budgets. Outside partners can assume the responsibilities with greater efficiency and better outcomes for a lower cost. The choice to retain, outsource, or develop a hybrid pursuit is a multifaceted decision that organizations must thoroughly evaluate to determine which solution best aligns with their mission, future vision, and strategic plans.

Medical call centers are taking on a variety of responsibilities that are well suited to be conducted remotely and reliant on state-of-the-art technology and a dedicated workforce. Appointment scheduling is the most common task in many medical call centers and often happens in tandem with the strategy of centralization. Electronic medical records (EMR) products now have customized templates embedded with providers’ schedules used for office visits, imaging, or procedural appointments. Outbound calling campaigns are often conducted in conjunction with scheduling for appointment reminders.

Additionally, centralizing medication refill requests is emerging as a successful addition to many medical call centers. Call center technology such as CRM (customer relationship management) allows requests to be tracked, acted upon, and measured to ensure that established targets are met in a timely manner. Patients expect a standard process for their medication needs and a defined time for responses or resolution. Medication management and compliance is critical for optimal outcomes, so implementing a process that fosters this is a good idea. Patients stratified as high risk garner the most advantages, which contribute to maximum reimbursements for medical treatments.

Medical call centers have taken on the significant task of not only caring for the acute needs of primary care patients but also the chronic needs of vulnerable, high-risk patients as well. Successful coordinating and transitioning care is central to every health system’s strategy. Nurses are the clinicians assigned to figure out how to morph from case management to transitional care coordinators.

Training nurses in the fundamentals of remote patient care is imperative and is based on the standards of care used by telephone triage nurses. The practice of triaging acute symptoms will serve as the starting point for nurses involved in coordinating care. We must proclaim the unlimited value of a medical call center to the healthcare industry. Click To Tweet

We must continue to proclaim the unlimited value of a medical call center to the healthcare industry. In many healthcare organizations, more than 10 percent of employees spend the majority of their day doing their job on the telephone. The benefits of centralizing and consolidating the work they do are undeniable.

The task at hand is capturing the limited attention of decision-makers and educating them on the role medical call centers play in a fee-for-value system and the distinct results that are possible. The political future of healthcare may be uncertain, but there remains a need for products, services, and expertise that bring the call center to the forefront of patient care.

Gina Tabone, MSN, RNC-TNP, is the vice president of strategic clinical solutions at TeamHealth Medical Call Center. Prior to joining TeamHealth, she served as the administrator of Cleveland Clinic’s Nurse on Call 24/7 nurse triage program.

Finding the Right Medical Call Center Consultant

By Gina Tabone, MSN, RNC-TNP

In terms of delivering high quality, cost-effective healthcare, most people would agree that this year is going to be very complicated, and many organizations are going to rely on consultants to help them be successful. Every day dozens of potential solutions are offered for overcoming healthcare delivery challenges, and one solution repeatedly suggested is that of a medical call center. Many organizations do not possess the internal expertise to effectively implement and operate this type of access to care.

A successfully operated medical call center can meet the need to provide access, continuity of care, optimal resource utilization, and better outcomes for more patients. Many healthcare organizations have already established their own call centers, others outsource to nationally recognized organizations, and some are still exploring the best options for their patients and organizations. Often the expertise of a medical call center consultant is engaged to define the best goals to work toward and to map out strategies for achieving those goals.

If you’re considering working with a medical call center consultant, you should be happy that your organization acknowledges the value of a medical call center and is willing to seek out and pay for industry expertise. As a responsible leader, you want to select a call center consultant who can meet your needs, direct your efforts, and ensure success for your call center, your organization, and yourself. Remember, your reputation is on the line.

Your best interests are served by selecting a consulting group with established roots in providing telehealth. When you’re looking for advice about a specific subject, there’s an inherent intelligence that only comes with someone who has experience in that subject. Hands-on medical call center expertise is invaluable when you’re hiring a consultant for help with a start-up or making your existing operation more efficient.

Empathy is the icing on the cake. Look for a consultant who can identify with you and understand the emotional roller coaster that a leader of a 24/7 call center faces. An empathetic consultant understands what motivates you and what keeps you up at night and can see the current situation from your perspective. Consultants with a history of successful call center leadership can focus on experiences similar to yours, respect the uniqueness of your organization, and customize proven strategies to ensure that your call center meets and overcomes the challenges that healthcare may face in the months ahead.

Gina Tabone, MSN, RNC-TNP, is director of clinical solutions at TeamHealth Medical Call Center. Prior to joining TeamHealth, she served as the administrator of Cleveland Clinic’s NURSE on CALL 24/7 nurse triage program. Under her direction, ED utilization declined, continuous care coordination improved, performance metric targets dropped from 33 percent ABD to less than 5 percent, URAC accreditation was achieved, and the call center grew from covering 350 physicians to the integration of more than 1,500 employed and affiliated providers.

[From Connection MagazineMarch/April 2016]