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Reimbursement and Practice Management

Incoming Phone Call Volume

Many practices complain about the volume of incoming telephone calls and how much time their employees spend handling them. Instead of continually adding more employees to handle more calls, smart practices are determining ways to reduce the volume of telephone calls.


In this article, you will learn how to:

  • Design telephone protocols that allow staff to answer more questions from patients
  • Utilize technology, including online patient portals, to deflect – and more quickly resolve – many patient inquiries
  • Implement and track response times to questions that patients ask by telephone

Many practices complain about the volume of incoming telephone calls and how much time their employees spend handling them. Instead of continually adding more employees to handle more calls, smart practices are determining ways to reduce the volume of telephone calls. They are accomplishing their objectives by using telephones more strategically and by opening alternative channels for patients to reach clinicians and get answers. These solutions come about by implementing new information technologies, making better use of existing systems, and getting back to basics in staff training.

If your employees do a better job of handling messages, patients get faster responses and are less apt to call back to see if anyone has addressed their question yet. A prompt response also makes it more likely that patients follow their medical care plans; it can even reduce liability risks.

Consider these ideas to improve communication with patients while reducing the volume of telephone calls.

Take better messages. Look at how well messages are–or are not–being handled. Establish parameters for how to take a message. Offer staff sample scripts to assure that they ask the right questions when taking a message. Patient name and an accompanying identifier (e.g., date of birth), physician, two (or more) contact numbers, and a brief description of the problem are crucial points of information. However, don’t take it for granted that everyone knows to get this information for every call.

Establish a turnaround time. Set realistic expectations for callers but, first, determine the timeframe in which you can return calls. Make sure the promised response time is one that you can always beat–if you tell callers they’ll hear back within two hours, expect them to call if they haven’t heard from you within that timeframe.

Don’t confuse response time with “answer” time. Simply telling the patient that you’ve received their message and are working to get an answer will appease the majority. Most callers are simply anxious about whether anyone even received their message. At minimum, respond to every patient who has left a message by the end of the day–anything short of that creates anxiety–and, quite likely, an after-hours communication that has to be handled by the physician on call.

Track turnaround times to make sure you and your staff really are living up to the promised response time. Electronic health records often have an integrated messaging system that facilitates tracking response time; paper messages should be audited to ensure that the expectations for turnaround time are being met.

Eliminate unnecessary telephone messages. Too often, physicians spend time handling simple questions that staff cannot, or are not allowed to, answer. Non-physician staff cannot be expected to know everything, but a procedure that prevents them from saying anything of substance delays the response to patients’ questions. An “always-ask-the-doctor” protocol also puts more pressure on employees: taking, maintaining and following up on dozens of additional messages each day consumes precious time.

To empower staff appropriately, determine your patients' most frequently asked questions (FAQs). Ask nurses, medical assistants and other clinical workers to list the questions they hear most often from patients. Physicians in the practice can then write brief responses to the questions and indicate which questions should always go to the physician, and which questions can (and how) be answered by employees. For example, many questions about basic post-operative wound care can be handled by informed staff, but those same employees should recognize the signs of an infection or increased pain in order to steer the patient to a nurse or physician.

Train staff. In addition to guidelines and FAQs, teach your staff how to put a positive twist in their responses to questions that truly need a physician’s response. Instead of saying, “I don’t know. I’ll ask the physician,” instruct employees to respond: "That is a very important question, and I know that Dr. Smith would like to hear it. I'd like to run it by him, and get back to you.”

This response positions the staff differently – and much more positively. This same reply acknowledges the importance of the patient's question, while communicating to them that Dr. Smith does want to hear about the problem. With response, the employee has taken ownership of solving the problem for the patient who, in turn, may be more willing to wait for a response, instead of calling back repeatedly. This tactic also positions the employee as an advocate for the patient, which can ultimately increase patient loyalty to the practice.

Create forms and guidelines. To improve the quality of messages, physicians can help by listing the additional information they want to receive along with each patient’s questions. Consider developing a form or an electronic template to encourage consistency, accuracy and comprehensiveness.

Next, agree upon an alert system for emergent messages: a red tag or a certain in-box for handwritten messages, and a specific task folder or internal e-mail box if you are taking the electronic approach. Message-taking protocols also should provide clear guidance about which questions should be referred to a physician or nurse immediately and which ones could wait for a response later in the day.

Manage outgoing calls. Instruct your employees to include their names when leaving messages for patients or other practices. If they just say, “this is Dr. Jones’ office calling. Please call us back,” both your operator and the recipient are a pickle. With few clues to go on, your operator must try to figure out who in the practice left the message. The result, frequently, is delay and irritation for everyone involved, including the patient. In sum, provide instructions about how to handle a message–and how to deliver one.

Deliver information efficiently. Playing phone tag with patients wastes time and usually initiates a new series of callbacks. Request several call-back phone numbers from every caller. Then, when making the return call, aim to get to a live person. Leave a message only after you’ve exhausted multiple numbers.

Sure, it takes a little extra time to call those additional phone numbers, but the time savings of getting the message taken care of – and avoiding the merry-go-round of return call-phone tag –most certainly makes up for the extra efforts on the front end. Ask patients if they will give you permission to leave messages on their voice mail, but be sure to get a signed permission, such as through a statement you can integrate into your registration forms.

Create an online patient portal. Online access helps patients answer many types of questions and perform numerous functions. Patients are experienced at self-service, from shopping to banking – even the government has gotten into the act by offering license renewals and other services online. For a practice, an online patient portal can head off many of the telephone calls that consume significant portions of employees’ time. Examples of portal functions, in addition to office hours and driving directions, are:

  • Registration;
  • Normal test results;
  • Prescription renewals;
  • Referrals; and
  • Payments and account information.

Solving telephone call overload isn’t easy and, even with many other channels open to communicate, this century-old technology remains the most popular “front door” to your practice. Be wary of locking this door by forcing patients to leave their messages in voice mail boxes. Very little time is saved once you factor in the effort spent to retrieve voice mail messages, then route them to the appropriate staff for answers and, finally, make the time-consuming return calls to try and reconnect with the patient. In the long run, relying on voice mail tends to increase, not lessen, the work load for staff.

In addition to getting more control over the daily workload of your staff, committing to better telephone management reduces the risk that a message–or a reply to one–gets lost in the shuffle.

While telephones are such an integral part of medical practices that it hardly seems necessary to design protocols around handling them, a carefully designed management plan may be just the action you need to take to avoid the frustrations that telephones can create for patients, practice staff, and physicians.

Pearl 11/15/13

Portals of Care
Patient portals can reduce practice operations costs. In contrast to a telephone conversation, an online patient portal can provide the patient with self-selected information and services. When patients using a portal do make requests that require staff action, the response often entails information gathering and a reply. (Many portals can automatically document the patients’ request and the reply in the patients’ record. Before investing in a portal, evaluate the product to make sure this type of functionality is included.) Unlike the telephone, your response need not occur in real time. In this way, the portal enhances the efficiency of your staff as well as physicians.

Pearl 11/8/13

Greetings
Design a specific telephone greeting, like “Hello; [your practice’s name]. This is [employee’s name]. How may I help you?” Include your complete practice name, avoiding quick-but-inappropriate greetings like: “Doctor.” It’s also important to have a consistent closing that shows your appreciation to the patient: “Thank you for choosing us for your medical care.”

Pearl 11/1/13

Mirror, Mirror on the Wall
Consider putting mirrors at employees’ workstations. It reminds employees of the powerful influence of a smile, which tends to make a voice sound more pleasant and helpful when heard over the telephone.

United States