Improving Front Desk Operations With Next Gen

NOW PRESENTING…

Presenter(s): James MuirTopic: Improving Front Desk Operations with NextGenLevel: 100Level: 100

SESSION GUIDELINES

• Turn off all cell phones & pagers.• Questions will be addressed at

the end of the presentation. • Refrain from personal discussion.• Refrain from personal discussion.

Warning!Too much content alert!

Warning!Too much content alert!Too much content alert!Too much content alert!

Efficiency AreasEfficiency Areas

• Phones

• Appointment Scheduling• Appointment Scheduling

• Registration & Check-in

• Miscellaneous

PhonesPhonesManaging telephones and

call demand can be one of

the most fruitful areas for the most fruitful areas for

improving operations at

the front desk (and entire

clinic).

Strategies for Improving Phone EfficiencyStrategies for Improving Phone Efficiency

• Measure• Measure

• Right-Staff for Call Demand

• Reduce Call Demand

• Be More Efficient on Each Call

Measure Twice. Cut OnceMeasure Twice. Cut Once• Before you make changes, measure where you are now.

– Phone System Reports

– Manual Tracking

• Things to Look for:– # of incoming calls

• Established Patients

• New Patients• New Patients

– Call volume over a week period

– Inbound call by topic• Prescriptions, Scheduling, Billing, Referrals, Test Results, Nurse/Physician, Other

• Repeat calls– Target areas with high repeat call volume first

– Outbound call volume• Use EMR reporting

– If possible:• Time on hold

• # of calls dropped to voice mail– Low-tech method – count

• # of abandoned calls

– Do mystery shopper calls & review results

Phone Statistics & Staffing for Call DemandPhone Statistics & Staffing for Call Demand

• Call Volume– Primary Care – 100-200 calls per physician per day

– Specialists – 75-100 call per physician per day

• Mondays & Fridays are the days with the highest call-in volume

• After-lunch call demand is high• After-lunch call demand is high– Solutions – take calls during lunch, stagger lunches

• 65% of calls occur between 9am and noon.

• Abandoned calls are most likely to occur between 12:15 and 2:00 pm.– Because of too much demand

• Calls that drop to voice mail require on average an additional 1.5 minutes to address– Better to handle the call the first time

• Check-in times peak between 10:30 am and noon. An then again between 2:00 pm and 2:30 pm.– How does this relate to phones?

• These are the same peak times for phone calls.

• Solution – front desk staff should not answer phone. Have dedicated phone staff

Reducing Call DemandReducing Call Demand

• Look at other options before adding moreresources to solve telephone problems.

• You may be unintentionally causing many of • You may be unintentionally causing many of your current telephone challenges.

• Consider changing how you manage– Scheduling

– Prescription Renewals

– Referrals

– You website

– Etc.

Reducing Call Demand (cont)Reducing Call Demand (cont)

• Set a callback policy. (Example: 2 hours or less)– This will eliminate repeated call backs

• Train triage staff to make appointments– This eliminate transfers

• Schedule follow-up visits at checkout• Schedule follow-up visits at checkout– Eliminates inbound calls caused by open-ended follow-up practices

– Avoid “Call us back and…”

• Set up your scheduling templates 3+ months out– Ask physicians to stick to schedules

– Limit rescheduling to just emergencies

• Use an appointment reminder system– Eliminates inbound calls & reduces no-show and late arrivals as well

– TeleVox

– PhoneTree

– QSI Service (Worklog)


• Teach patients to call the pharmacy for med refills & do ePrescribing

– Eliminates interruptions & time fielding med refill calls

– Nothing is faster than ePrescribing refills

• Consider a voice mailbox for prescription renewals & be diligent about handling

those requeststhose requests

– Eliminates interruptions & time fielding med refill calls

– Allows you to incorporate refill requests more efficiently into your workflow

• Ask patients about med refills on the intake form & have providers ask about

refills at the end of each encounter

– “Refills I need to discuss with my doctor today:”

– Eliminates calls after the visit about medication refills that could have been handled during the visit

• Ask Patient about refills when they are roomed

– “Do you need any prescriptions refilled today?”

– Eliminates calls after the visit about medication refills that could have been handled during the visit


• For Surgical Practices – Proactively Call patient 1-2 days after

service.

– Review medical instructions, evaluate the patient’s improvement, adjust meds

if appropriate & reinforce discharge instructions

– Prevents calls from the patient for the same things– Prevents calls from the patient for the same things

– Also improves customer service & improves marketing

• Consider an automated test results retrieval system

– Eliminates call time addressing test results

• NextMD

• PhoneTree, TeleVox, etc.

• Letter

• Set patient expectations about test results timing during encounter

– Prevents the patient from calling for results too soon


• Studies show that up to half of calls half of calls a medical practice receives about clinical

matters come from patient that were just seen in the office.just seen in the office.

• Provide education about:• Medications

• Test results

• Procedures

• Appropriate health topics (diseases, exercises, etc.)

• Payment

•• Provide a Patient NoteProvide a Patient Note

• Anticipate questions & answer them in advance• Website

• Patient education

• Maps

• Locations, hospitals, lab, etc.

• Welcome Packets

• Use the phone template for incoming calls.

– Track & report on the reasons for the call and the questions asked.

– Then devise ways to answer these questions in advance.


Communicate

with patients

using alternate

means such as

NextMD.NextMD.– Eliminates calls in

favor of secure

email

– Allows you to

incorporate

responses more

efficiently into your

workflow

Be More Efficient on Each CallBe More Efficient on Each Call

• Get the patient to the right person & empower your staff to solve the problem– Avoid “pass the caller”

• If you use an auto attendant– List no more than 5 options. Example:– List no more than 5 options. Example:

1. Schedule an Appointment

2. Speak with a Nurse

3. Discuss your Bill

4. Refill a Prescription

5. Speak with an operator

– If you make “operator” an option make you actually have an operator available

• Make the most of the EMR Phone Template

• Coming – integrated Workflow & Worklog tasking

Appointment SchedulingAppointment Scheduling

• Template Design & Physician Preferences

– Check-in times and patient loads

– Simple preferences vs. complex preferences

• Hover Tooltip

• Use Event Definitions to Improve Efficiency

– Simpler vs. More Complex

• Use Appointment Book Tabs

• Search Ahead vs. Manual Searching

How to check access

with Search Ahead

How to check access

with Search Ahead

• Assess Your Access

– Time to Next Available New Patient Appointment

• NG Search ahead feature

– Time to Next Available Established Patient Appointment

• NG Search ahead features• NG Search ahead features

– Appointment No-show rate

• Statistical Analysis of Appointments Report

– Appointment “Bump” rate

• % of appointments that physician bumps

• How to do this in NG?

– Cancelation Conversion Rate

• % of cancelation slots that are filled after a cancelation

• Avoid scheduling follow-ups on Mondays.

– Open/Advanced Access will require more slots to be available on Monday.

No ShowsNo Shows

• 15 minutes or so is spent taking all the steps for a

visit even if the patient does not show upeven if the patient does not show upvisit even if the patient does not show upeven if the patient does not show up

• The cost of that 15 minutes ranges from $4-$7.

• Experiencing just 10 no-shows a day will cost a cost a

clinic between $10,000 and $19,000clinic between $10,000 and $19,000 a year not

counting opportunity cost.

Strategies to Reduce

No-shows


No-shows• Improve your relationship with patients

• Create stronger nurse-patient relationships

Provide good access• Provide good access

– The average time a patient must wait to see a physician is 9.5

days (Source – AMA)

• Consider Open/Advanced Access Scheduling

• Do internal monitoring

– Statistical Analysis of Appointments


No-Shows


No-Shows

• Establish a policy for repeat no-shows

• Remind Patients– Recalls– Recalls

– Services

– Interfaces

• Ask for a call back to confirm for procedures

• Don’t schedule too far in advance

• Charge patient for no-shows?– Remember the goal is reducing no-shows not collecting $

Registration & Check-inRegistration & Check-in

• Scanning Insurance Cards

• Required Fields

• AutoFlow for Check-in

• NextMD

• Instant Medical History

• Capturing the Patient’s Picture– Drivers License

– Photo

– Allows calling the patient back without announcing

their name in the waiting room

Registration & Check-in (cont)Registration & Check-in (cont)

• Right & Wrong Ways to Ask for Patient Registration Information

Info NeededInfo Needed Right WayRight Way Wrong WayWrong Way

Current Phone # Please confirm your home phone

numbers for me.

Are your phone numbers the

same?numbers for me. same?

Current Address Are you still living at 123 Banner Drive? Is your address the same?

Employer Are you still employed by the City of

Nashville?

Have you changed jobs?

Insurance Is Aetna Preferred still your primary

insurance?

Do you have the same

insurance?

Insurance Do you have secondary insurance

coverage with United Healthcare?

What secondary insurance do you have?

Not asking.

Insurance Is this visit due to a worker’s

compensation or auto injury?

Not asking.

Registration & Check-in (cont)Registration & Check-in (cont)

• Make staff accountable with Worklog

• Printer location– Printer Preferences

• Insurance card scanner

• Eligibility

• Search for insurance by address

• Registration detail via phone or at check-in?

• Possible Pre-registration staff– Scheduling -> Pre-registration staff

• NextMD

• Waiting room kiosk

Registration Methods

Pros & Cons

Registration Methods

Pros & ConsMethodMethod ProsPros ConsCons

Register on Appointment Call -Timely Information

-Advanced Verification Possible

-Patient’s may not have all needed

information handy

-Staff spends more time on phone

Transfer patient to “Pre-

registration” unit immediately after

they schedule

-Pre-registration is more efficient


-Requires sufficient staff & phone

system

-Patients will hang up if forced on

hold for long times & less info is they schedule

hold for long times & less info is

gathered

Call Patients Back -Allows practice to control workflow

of callbacks


-May be difficult to track down

patients

-Patient’s may not have all needed

information handy

-Patient’s may view callbacks as

inconvenient

Register Patients via NextMD - Convenient for patients and practice -Not accessible to all patients

-Will not capture 100% of

registrations

Register via Kiosk at Practice -Keeps registration separate from

check-in so lower staffing costs

-Patients must be directed to Kiosk &

may need instruction to use it

-May require early arrival

Pre-RegistrationPre-Registration

“Although the pre-registration process itself is

optional, collecting the information is not.

Doing as much of it as possible before Doing as much of it as possible before

patients walk in the door will make their flow

through the practice smoother and reduce

administrative burdens on front and back

office staff.”

- Elizabeth Woodcock, MBA, FACMPE

Signature PadSignature Pad

• Assignment of Benefits

• Medical Records Release

• Insurance Coverage Waiver• Insurance Coverage Waiver

• Financial Policy

• Advance Beneficiary Notice (ABN)

• Notice of Privacy Release

CollectionsCollections

• Define your collection policy & goals

• Develop & Train Scripts for Collecting

– Co-pays– Co-pays

– Privately owed money

• Roll-play with staff

• Make staff accountable

GeneralGeneral

• Start the day on time

• Policy / Instruction Manuals

• The Importance of Staffing• The Importance of Staffing

• Using Worklog

– Referring Physician

• Edits -> registration errors – feedback loop

• Reporting

General (cont)General (cont)

• Workflow

– Status & Color

• RTS• RTS

– Eligibility Checking

• Demand

• Batch

• Background Business Processor

• For just New Patients & Procedures?

Selected Best

Practices

Selected Best

Practices• Scan Insurance Cards

• Have dedicated staff for reception and scheduling

• Provide telephone coverage during lunch hours

• Change provider scheduling templates to stagger new • Change provider scheduling templates to stagger new patients

• Prepare staff for phone & collections by employing scripts

• Consider open or advanced access scheduling

• Reduce missed appointments. Consider a call reminder system.

• Reduce Call Demand (various ways)

• Use new tools to speed check-in (Instant Medical History, NextMD)

Thank you!Thank you!

Documents

Improving Front Desk Operations With Next Gen