Brian Iriye, MD, is former president of the SMFM and president of Hera Women's Health, and Managing Physician of the High Risk Pregnancy Center.

Brian Iriye, MD

I once was dealing with the purchase of equipment from an ultrasound vendor. We had worked with our current vendor for over a decade and had purchased over $2 million worth of equipment. Their machines were tremendous and provided excellent images for our patients in our maternal-fetal medicine practice. However, for a fair number of devices, their salespeople offered us no significant pricing breaks. We had little communication on our imaging experience, sonographer education, and lack of shared goals. We felt our practice was not being valued.

We opened the bidding to 2 separate companies. This took precious time to participate in machine demonstrations and learn about this new and different equipment. However, as our practice was large, these 2 companies gave incredibly competitive pricing to open the door to our practice and build a relationship. We purchased equipment from both vendors and ended our long-standing relationship with our first and only ultrasound vendor.

We wanted to be treated like the customer they wanted, not the customer they had.

In many circumstances, this is 1 of the critical issues in losing a provider. We will wine and dine someone to come into our city and let them get to know other providers and staff. However, we will not take the provider and spouse out annually to show them an appreciation for their work, listen to concerns, address issues leading to burnout, and ask them about future goals to hope they stay. Unfortunately, this lack of strategic involvement is unwise. The cost of turnover is staggering, with the average cost ranging from $500,000 to $1 million per physician.

Engagement of the person is the key to retention. Systems hire recruiters, but why not professional staff engagement officers? Smaller practices should have owners take a chief role in engagement. For provider engagement, a plan is needed and should be documented and followed. (See sidebar).

The Coker group has put to gether a list of 12 dimensionsof physician engagement and a tool to measure the engagement, including the following

Coker’s tool for measuring physician engagement is a quantitative measurement of a qualitative experience and hence is limited in its application. Nonetheless, it is easy to garner feedback and upfront responses when administered, especially in an anonymous fashion.

Retention is important but recognizing burnout as a more insidious hazard in the workplace is critical. Professionally, burnout leads to decreased quality of care, increased medical errors, decreased productivity, and provider turnover.

Organizations should promote system-level solutions for retention and well-being. Mayo Clinic has announced

 organizational strategies for physician well-being.

Staff appreciate dialogue with their leadership, and it is critical that discussions are candid and heard. After that, routine measurement of physician well-being is essential to assess and act upon deficiencies.

Behaviors of leaders are critical to the well-being of the positions they lead. Leadership selection is crucial. Leaders must then be developed, prepared, and equipped for their roles. The effective leader recognizes the unique talents of the physician team. Evidence suggests that professionals working at least 20% of their time within their fields of strengths are at much lower risk for burnout.

Develop and implement targeted interventions.

Spreading these concepts out to your entire clinical team is important. Assemble a team for action and invite insight from physicians/providers. Form focus groups and have leaders steer facility change based upon the gathered information.

Peer support has always been critical in assisting physicians in navigating professional challenges. The support can come from various activities such as celebrating achievements or supporting each other through challenging experiences.

Pay based mainly or solely upon production may be unwisely guided. This eat-what-you-kill practice environment may shorten the time spent with patients, result in ordering more tests or procedures, or promote working longer hours. Instead, rewards such as work flexibility or protected time to pursue meaningful work may allow productive physicians other means to create professional fulfillment.

An organizational mission and vision must be kept at the forefront of interactions. Acting upon these values is critical to the organization to furnish provider guidance and later provider self-appraisal of living out the organizational values and hopefully
shared commitment.

Promote flexibility and work/life integration.

Physicians are almost twice as likely to be dissatisfied with work/life integration compared with workers in other fields in the United States. Providing physicians with options to reconstruct their work effort and tailor hours to meet personal and professional obligations may reduce and assist physicians in recovering from burnout.

Provide resources to promote resilience and self-care.

Providers should be given tools to encourage self-care, training, and skills that facilitate resilience. Resources should be customized to address personal well-being and work/life integration, financial health, and personal preventive health.

Facilitate and fund organizational science.

Larger institutions are responsible for funding research to develop metrics, establish benchmarks, and conduct trials and interventions leading to publications on physician retention and burnout. These efforts are critical to the viability of our nation’s health care system.

Regarding the new ultrasound systems, we ordered from the other 2 vendors. One company did not follow up on its system upgrade promises. The other vendor’s system had image issues resulting in diagnostic errors and our relegating the machine to be the ultrasound of last resort. After our recruitment, they quickly lost trust in communication, lacked accountability, and did not resolve conflicts—they had won our business, but it was clear we were 2 separate teams. Our original vendor came back with an unbelievable deal to upgrade all the equipment at an extensive discount. Everyone ended up losing, at least in some aspect. It would have been easier for all parties with a focused retention strategy. 

Greeter A, Harrison T. Physician engagement: a crucial component of a healthy organization. Coker Group. June 2018. Accessed August 10, 2022.

https://cokergroup.com/wp-content/uploads/2019/02/Physician_Engagement_-_A_Crucial_Component_of_a_Healthy_Organization_June_2018.pdf

Shanafelt TD, Noseworthy JH. Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout. 

. 2017;92(1):129-146. doi:10.1016/j.mayocp.2016.10.004

Shanafelt TD, West CP, Sloan JA, et al. Career fit and burnout among academic faculty. 

. 2009;169(10):990-995. doi:10.1001/archinternmed.2009.70

Articles

Retention beats recruitment

Those of us in management have come to recognize meetings as an inevitable part of our workday. The greater your administrative to clinical time, the greater the amount of time you will spend in meetings both as a meeting participant and as a leader. the increased number of remote meetings has had a negative impact as the threshold for creating a meeting decreased and the ease of inviting participants to meetings increased. The cost of meetings is rarely considered, but the next time you are at meeting, think about this: It is not unreasonable to estimate that an hourlong meeting of clinicians may cost close to $1000 in missed clinical revenue. It is imperative that meetings are managed as effectively as any common clinical scenario.

Whillans et al describe 6 pitfalls that lead to excessive meetings

1. Meeting FOMO (fear of missing out): What will our colleagues, or worse, our bosses think of us declining an invitation for a meeting of marginal necessity? this is rooted in the belief that just being present is being productive.

2. Selfish urgency: As leaders, not everything that we think is important justifies disrupting others’ days or adding an extra hour to the workday.

3. Meeting as a commitment device: using a meeting solely to establish a deadline is not a great use of time.

4. The mere urgency effect: This is where we feel better for completing a task, no matter what the value is. An example is low-value regular meetings. If we complete a series of meetings, we feel we have accomplished something, even if we have not.

5. Meeting amnesia: this is the meeting to review what was accomplished (or not) at the previous meeting. A much better tactic would be real-time debriefs or distribution of meeting summaries.

6. Pluralistic ignorance: Chances are we are not the only one who recognizes that a standing meeting is a waste of time. Open dialogue can remove a standing meeting from our calendars. Action plans and end goals are neededthere is a lot of science around effective meetings. 

A review of 100 articles on the subject came up with some tips

: Do you really need a meeting? Can a quick call or email suffice? Invite the smallest number of people required. This not only makes the meeting easier to manage and more effective but will greatly facilitate its scheduling in a timely manner. Build an agenda and stick to it. This seems so simple yet is probably the most common reason a meeting succeeds or fails. Everyone should know the end goal of the meeting. An agenda describes the process, but an end point will drive efficiency. It is a great tool for refocusing those who may be derailing the meeting. End with an action plan and a follow-up deadline for items on the agenda. this will effectively reduce the frequency of a second, less valuable meeting. Allow participants to leave a meeting if they feel that they are not contributing or that the meeting is not of value. After evaluating whether a meeting is necessary, deciding who needs to attend, and establishing an agenda and goals, the next decision point is the duration of the meeting. Meeting content seems to follow the laws of natural gas: It will expand to fill the available allotted time. scheduling your meetings for shorter periods of time will force discipline around roles and agendas and will free your teams up to be more productive in other spaces. 

Lucy Handley takes the 30-minute meeting 1 step further and promotes a 15-minute meeting.

 The purpose of the 15-minute meeting is 2-fold. The 15-minute meeting is not just about going more quickly. It is about prework. The foundation of this prework is asynchronous communication. A shorter meeting requires individuals to read materials sent prior to the meeting so they need not be reviewed. 

One highly creative approach is a brief video sent premeeting by the organizer. this shows that the organizer values the participants’ time and will lead to greater focus. Although the 15-minute meeting is not for every subject, it can be a great strategic tool. Make the most of online meetingsAlthough the foundation of meetings remained unchanged when they moved online via Zoom, Microsoft teams, etc, there still are special considerations. 

 discussed the potential for remote meetings to be draining rather than energizing to those working remotely, along with reasons and tactics for mitigating the risk of disengagement. Although the discomfort of constantly being on display and having to look at a screen of others throughout a meeting is something we can get used to, other issues such as multitasking during meetings will always hinder the productivity of a session. Although some have advocated mandatory “cameras on,” constantly being present on screen can increase the fatigue of a remote workday.

 Suggestions for improving appearance on remote video calls include both technical and physical strategies. Computers’ imbedded microphones and cameras rarely compare in quality to many inexpensive combined apparatuses, which are easy to install. Individuals should be aware of posture and facial expressions, watch out for lighting mishaps, and make sure they are well lit from the front. Unlike an add-on camera/microphone, which is essential, professional lighting is not something everyone needs. But it is important to ensure there is not an intense light source behind you, which can cause you to appear as a silhouette.

In a recent Harvard Business Reviewarticle,

 Rae Ringel wrote that “I’m going to give you 10 minutes of your life back” is a phrase to stop using. Ringel points out that if a meeting is run properly, one might be able to say, “Because everyone was so productive, we’re done 10 minutes early. Thank you so much for your presence and participation.” That’s the kind of meeting you should be aiming for.  

1. Whillans A, Feldman D, Wisniewski D. The psychology behind meeting overload. Harvard Business Review. November 12, 2021. Accessed June 29, 2022. https://hbr.org/2021/11/the-psychology-behind-meeting-overload

2. LePage E. Tips for effective meetings we learned from reading 100 articles. Unito. January 13, 2020. Accessed June 29, 2022. https://unito.io/blog/running-effective-meetings-tips/

3.Handley L. The rise of the 15-minute meeting —and how to run one. CNBC. January 25, 2022. Accessed June 29, 2022. https://www.cnbc.com/2022/01/25/the-rise-of-the-15-minute-meeting-and-how-to-run-one.html 

4.Discovery RSM. How to have effective zoom meetings—and make them less boring. Forbes. March 4, 2021. Accessed June 29, 2022. https://www.forbes.com/sites/rsmdiscovery/2021/03/04/how-to-have-effective-zoom-meetings-and-make-them-less-boring/

5.Gabriel AS, Robertson D, Shockley K. Research: cameras on or off? Harvard Business Review. October 26, 2021. Accessed June 29, 2022. https://hbr.org/2021/10/research-cameras-on-or-off

6.Ringel R. Please stop using these phrases in meetings. Harvard Business Review. January 11, 2022. Accessed June 29, 2022. https://hbr.org/2022/01/please-stop-using-these-phrases-in-meetings4 / 466%

Tips to avoid wasting time and optimize meetings you do need.


How much money are you losing in unnecessary meetings?

The financial health of a practice directly affects clinical performance. Optimal revenue cycle management (RCM) provides the financial assistance to competitively pay your top employees, purchase state-of-the-art equipment, and obtain continuing medical education for staff and physicians. 

Imagine a grocery store where you can buy an apple, take it home to eat, and receive a bill for it that you can pay 30, 60, or 90 days later. Then if the process of buying the apple was not ideally billed, you could refuse payment and ask for proper billing, ask if you really needed the apple, or ask for supporting reasoning on why the apple was required.

Of course, this is an outlandish example but it is iterative of the processes necessary in health care RCM. In this article on RCM, we will discuss some of the key performance indicators and benchmarks to pay observe. Future articles will look at factors that affect these benchmarks, management of accounts receivables, and the importance of payer mix.

Without measurement, there is often little management. Financial operations require assessment of performance to available metrics to understand the RCM process and enhance profitability.

Net collection rate (NCR) measures the efficiency of reimbursement collection dependent on the payer’s contractual obligations. 

NCR can be mathematically summarized as follows:

NCR in Percent = (Payments – Credits) ÷ (Charges – Contractual Adjustments) × 100

Measuring NCR allows a practice to examine revenue that should have been collected but instead was lost to untimely filing, lack of collection of deductibles and co-pays, bad debt, and other noncontractual factors. The NCR calculation should be based upon the date of service and visualized monthly over the last 12-month average.

Days in accounts receivable (AR) is the approximate number of days it takes claims from your practice to be paid. It is a key performance indicator of your practice’s financial health. The longer claims are in AR, the longer it takes for your practice to be paid. A more extended period is akin to authorizing credit for the extra days waiting to be delivered. A practice should perform this measurement monthly as well.

Days in AR = Gross Revenue ÷ Prior 3 Months’ Gross Charges per Day

If your gross AR is $1 million and your billed charges per day are $25,000, your days in AR are 40 days.

Usually, AR can be examined using an aged trial balance. The aged trial balance breaks out the AR in how much is outstanding over specific periods, generally categorized as 0 to 30 days, 31 to 60 days, 61 to 90 days, 91 to
120 days, and greater than 120 days. 

As revenue aging increases, it becomes more difficult to collect from patients and payers. The days in AR performance metric should be tracked overall and for specific payer groups. Measurement by payer may find a problem particular to the payer, such as abnormal denial patterns, a credentialing issue, or just poor payer performance. Measurement overall allows examination of overall practice performance.

Tracking this via a percentage of AR greater than

120 days to the total AR helps to benchmark:

Percentage of AR > 120 days = (AR > 120 days) ÷ (Total AR) × 100

Billing appropriately the first time ensures optimal speed in payments and reduces repeat work that increases the cost of the billing process by office or RCM personnel. The resubmission of claims usually involves researching the issues with the claim, appealing the claim, and then often submitting the claim again by paper and mail rather than electronically, which further slows down payments. 

To calculate the clean claim rate, use the following formula:

Clean Claim Rate = Number of Claims Appropriately Paid on First Submission ÷ Total Claims Submitted

Your clean claim rate may be increased through claim edit management systems that flag claims for corrections based on payer rule requirements or coding guidelines.

Probably the most overlooked component of the RCM process is the collection at the time of service. For the dollar that is not collected at time of service, estimates are that only 50% of the patient-owed payment will ever be collected. 

Collecting at time of service is probably the most critical part of RCM. It provides immediate reimbursement, reduces the cost of the future collections process, prevents surprise bills, and is informative for the patient when performed correctly. Amazingly, 36% of providers never discuss patient responsibility of payment or ability to pay before delivering care.

Medical practices should estimate the amount of payment at the time of service before the patient visit by knowing the procedures and evaluation and management code being performed at the time of service, assessing the patient’s benefits, co-pay, coinsurance, and deductible. 

Patients should be contacted regarding their expected payment at the time of service to increase their ability to pay and eliminate the uncomfortable discussion in the office regarding the payment responsibility at late notice.

You may not collect every dollar you are entitled to based on your work, but there are typical performance benchmarks many practices examine to understand RCM performance. These benchmarks may vary significantly with your specialty, subspecialty, and region. The Medical Group Management Association produces annual reports considered the gold standard for benchmarks among medical groups. The American Medical Association also has an excellent practice management section on its website.

Typical benchmarks for the performance indicators are:

•Days in AR should be less than
35 days, ideally less than 30.

•AR greater than 90 days:
less than 15%

•AR greater than 120 days:
less than 10%, ideally less than 5%

•Denial rate less than 3%, ideally less than 1% to 2%

Time of service collection rate: Sixty percent of patients (eliminate those without payments such as Medicaid or Medicare) have payment collected at time of service.

We hope that you utilize these indicators to get a feel for the essential performance of your revenue cycle management. In future articles, we will discuss more of the RCM process and how to optimize features to enhance your practice performance and increase the likelihood of better clinical performance. 

Brian K. Iriye, MD, is managing physician of the High Risk Pregnancy Center in Las Vegas, Nevada; president of Hera Women’s Health; past president of the Society for Maternal-Fetal Medicine (SMFM); and past president and current member of the SMFM Practice Management Division
Advisory Board.

James D. Keller, MD, is chief medical officer of Advocate Lutheran General Hospital in Park Ridge, Illinois; vice president of medical management at Advocate Children’s Hospital; and immediate past chair of the Society for Maternal-Fetal Medicine Practice Management Division Advisory Board.

1. Optimizing revenue. Solving healthcare’s revenue cycle challenges using technology-enabled communications. West. 2017. Accessed March 20, 2022. https://cdn2.hubspot.net/hubfs/402746/Assets/West%20Assets/Optimizing%20Revenue%20Report/Reports%20and%20Handouts/WEST-Optimizing%20Revenue%20Report%20final.pdf?t=150393870059

Key financial metrics detail your practice’s economic health

Get a grip on revenue cycle management

Consumer is not a negative term when it comes to the provision of health care resources. It never was meant to marginalize the important clinical impact of the provision of care.

Consumerism in health care has been evolving for close to a century from the demand for employer-supported health insurance to autonomy in selection of time and location of care.

The COVID-19 pandemic has accelerated the health care consumerism movement.

Consumerism in health care is best defined as individuals proactively using trustworthy, relevant information and appropriate technology to make better-informed decisions about their health care options in the broadest sense, both within and outside the clinical setting.

Health care consumerism recognizes the importance of a patient or a family member in the continuum of the health care journey. As what becomes important to the patient becomes more evident, the concept continues to evolve.

The origins of consumerism can be tied to the push for health care insurance in the 1930s, with the patient having input into how their care would be paid for. The protest over provision of care for those with HIV/AIDS in the 1980s showed that patients, not government or payers, should drive how health care is provided to a population.

This article examines what is driving the current consumerism movement and explores evolution in the provision of health care and the health care system as a platform for how a practice can thrive. No discussion of health care consumerism would be complete without addressing legitimate concerns over the use of the term, both in possibly marginalizing the concept of the 

 as well as placing the burden of the health system’s shortfalls on the patient rather than the system.

What drives health care consumerism today?

A consumer-focused system needs to address cost and experience.

 When systems, practices, or individual providers try to address what is important for the patient or consumer, the foundational assumption—even if flawed—is that the quality of care will not differ among providers and that, with quality being a fixed variable, value is mostly cost dependent. 

Markets and consumers have always been focused on the cost of goods and services in places such as grocery stores and restaurants because the responsibility for payment rested solely on the consumer. 

For years, health care consumers have had little or no responsibility for payment as generous employer- or government-supplied insurance products covered most of the cost of care.

As the cost of these insurance programs became unsustainable, cost of care shifted toward the patient. When patients became sensitive to cost, they predictably became consumers in the traditional sense. 

Some consumers choose high-deductible health plans where lower premiums are balanced by higher co-pays or deductibles. These plans drive consumerism in 2 ways. Ostensibly they can promote personal responsibility for care. 

Making better lifestyle decisions and using preventive care would hopefully decrease not only overall health care spending but also out-of-pocket costs. Unfortunately, it often means that the overall health care spending is unchanged, but the consumer pays more of the health care costs. 

Data from 2018 showed that patient financial responsibility increased 11% in 2017. The impact of this increased spending has led to more than 10% of patients struggling with this financial responsibility.

Value-based care, the essence of consumerism, is more than just cost control. Although traditionally value has been related to only 2 variables—quality and cost—the definition of value is now in line with the Institute for 

Healthcare Improvement’s Triple Aim. This improves health while lowering per capita cost and also places value on the patient experience.

 The Washington Health Alliance defines the element of patient experience at each step of the health care journey from insurance product enrollment to before, during, and after each visit.5 Value, the cornerstone of consumerism, has a different formula.

Practitioners would be well served to understand the dynamic environment of consumerism and health care at this time, as well as anticipated changes, and how they will share responsibility and also benefit from the changes.

Although today’s health care system is characterized as a high-cost system with quality and safety performance less than what would be expected at the price, it has identified and is acting on several opportunities both at the payer and provider level.

Responsibility for cost should shift back to the health care system and by proxy to the provider. Despite introductions in payment reform, much of the nation’s health care dollar is still spent on volume as opposed to value. An acceleration to value-based programs that pay at either an episode (bundle) or population (accountable care organization) is inevitable. 

Physicians will need to learn that these modern systems thrive not when an individual tries to manage the complexity of care, but when well-crafted teams design programs that promote healing (surgery) as well as prevention and wellness. 

For physicians to succeed in this paradigm, they need to be prepared to lead teams and share the financial risks and gains that would occur with well-coordinated care.

Providers must rapidly embrace
evidence-based care and discontinue reliance on unproven expensive technology. In addition to financially incentivizing evidence-based care, incentives for low-value, volume-based care must be removed.

It is no longer enough to worry about the other health care systems or practices in your market. The most formidable competition will come from those who have already succeeded in a consumer-based world, such as companies that have proved facile in technology-driven service and artificial intelligence to guide effective marketing and targeting. 

These strategies are not only an opportunity for revenue generation but also a key part of disease prevention and management, especially of costly chronic conditions, pushing these entities toward success in a risk-based environment. 

For example, Best Buy, known for being more resilient than most retail electronic giants, is active in patient monitoring, a key component of the hospital-at-home movement that is a favorable space with respect to cost
and engagement.

The COVID-19 pandemic quickly changed the way consumers think about health and health care. A team from management consulting firm McKinsey & Company lists 5 areas that are important to consumers.

 Let’s look at these 5 through the lens of pregnancy care:

We screen for depression and domestic violence. Can we do better about evaluating environmental factors such as food security and toxic exposures?

2. Enabling consumers to make better decisions

Quality data are hard to come by in obstetrics, which makes consumer choice a more blinded process. Items such as readmissions might not carry the same negative connotation as they do on the medical/surgical side. This makes a clinician focus on the patient experience.

3. Personalizing and enhancing engagement

This is critical in obstetrics as most patients are experiencing a normal life cycle process, so the engagement process needs to be altered based upon the needs of the patient as pregnancy and health status progresses.

4. Delivering seamless customer experience across health care journeys

Can your patients access care quickly? Does your office have a way of handling tests such as carrier and aneuploidy screening that are sent to third-party laboratories? More importantly, are patients who develop complications such as gestational diabetes or hypertension given appropriate referral for follow-up?

5. Integrating in-person and virtual health care solutions

This is the area that COVID-19 most quickly accelerated. Although many visits were transitioned to a telehealth platform, now is the time to establish the appropriate cadence for in-person and virtual visits. It also is important to expand the option of asynchronous care for patients whose lives are most disrupted by half-day, low-value visits to a provider.

Patients often do not have a choice in their current episode of care (eg, an ambulance transport to the emergency department). But remember: They may have a choice in their next. Consumerism must give patients a voice in how their health care dollars are spent, but it should not be an excuse to accelerate cost shifting or move the responsibility of lowering the cost of care to the patient. Patients deserve the same—if not more—attention to value that other consumers have grown to expect.

Carman K, Lawrence W, Siegel J. The ‘new’ health care consumerism. Health Affairs. March 5, 2019. Accessed February 28, 2022. 

https://www.healthaffairs.org/do/10.1377/forefront.20190304.69786/full/

Wyke A. Can patients drive the future of health care? Harvard Business Review. July 1, 1997. Accessed February 28, 2022. 

https://hbr.org/1997/07/can-patients-drive-the-future-of-health-care

Heath S. Breaking down the basics of health care consumerism. Patient Engagement Hit. November 24, 2020. Accessed February 28, 2022. https://patientengagementhit.com/news/breaking-down-the-basics-of-healthcare-consumerism

The IHI triple aim. Institute for Healthcare Improvement. Accessed February 28, 2022. http://www.ihi.org:80/Engage/Initiatives/TripleAim/Pages/default.aspx

Getting the high-value care you deserve. Washington Health Alliance. Accessed February 28, 2022. 

https://wahealthalliance.org/getting-the-high-value-care-you-deserve/

Mirror, mirror 2021: reflecting poorly-health care in the U.S. compared to other high-income countries. The Commonwealth Fund. August 3, 2021. Accessed February 28, 2022. 

https://www.commonwealthfund.org/publications/fund-reports/2021/aug/mirror-mirror-2021-reflecting-poorly

Zimlichman E, Nicklin W, Aggarwal R, Bates DW. Health care 2030: the coming transformation. NEJM Catalyst. March 3, 2021. Accessed February 28, 2022. 

https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0569

Cordina J, Levin E, Ramish A, Seshan N. How COVID-19 has changed the way consumers think about health care. McKinsey and Company. June 4, 2021. Accessed February 28, 2022. 

https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/how-covid-19-has-changed-the-way-us-consumers-think-about-healthcare

Patients’ ability to choose can affect your practice.

Consumerism has a voice in health care 

Medical care is the ultimate customer service profession; however, physicians or medical systems, rather than the patient, engineer the business. Physicians and administrators often ignore one of the most critical pieces of customer service–related technology in the office—the phone.

The 2 pieces of technology that probably affect every person seen within an office are the electronic health record (EHR) and the phone. The EHR is often the biggest issue for the provider, whereas telephone and poor service are often the most prominent issue for the patient and should rank high on the list of priorities for most practices. A Press Ganey report from 2011 stated that difficulties with ease of appointment scheduling, assistance from staff, and promptness of return phone calls lead to patient frustration.

 More recently, a 2021 Press Ganey report showed that 84% of patients report that the difficulty in contacting an office is the No. 1 reason for not booking an appointment.

Stopping the loss of 1 or 2 patients due to phone service will pay for infrastructure upgrades. Addressing the telephone system and providing exemplary service, the first impression for most patients, will allow a practice to stand out and be remarkable.

For starters, a physician should call their own office on the general line or have a friend or relative call and simulate making an appointment. 

How many rings were there before the call was answered?

Is there a phone tree (automated routing service) or live call answering?

How long is the list of phone tree options, and how long does it take to get to the last item?

When a live person is reached, does the person answering provide their name?

Does the call go to voice mail? If a message is left, how long does it take for it to be returned?

Is there an early option in a phone tree for a hospital or referring provider?

This secret shopping technique should be used for multiple areas in a practice, such as billing and collections and front office check-in, and is an exceedingly simple means to assess phone service.

Understanding call volume is key to providing optimal phone service. Having a central phone line with multiple lines that rollover to provide relief from a volume that prevents busy signals is imperative. 

The proper number of phone lines can be calculated as follows

1 to 99 calls per day: 1 main line and 2 rollover lines

100 to 199 calls per day: 1 main line and 3 rollover lines

1 extra rollover line for every 100 calls per day

Larger practices should invest in a private branch exchange system, which allows switching calls between office users on local lines and sharing external phone lines. They also may want to consider a phone call recording system to assess customer service and make improvements. These systems must provide adequate security, with encryption, use of robust passwords, and third-party Health Insurance Portability and Accountability Act agreements.

Creating an initial phone tree for large or busy offices might increase efficiency for the patient and office personnel, yet phone trees have a horrible reputation because of businesses that use them to reduce personnel and costs. To callers, phone trees seem impersonal and inefficient. Most offices that use a phone tree should have only 3 or 4 options: (1) referring providers, (2) scheduling, (3) billing department, and (4) other or stay on the line. Remember, the phone tree should mainly assist the caller in accessing the proper live person most quickly. The response should not transfer to a voice mail.

Members of a phone team should show enthusiasm for the practice’s mission, empathy for callers, and patience and professionalism under difficult customer service conditions. Day-to-day emotions cannot be controlled, but attitudes with phone service are entirely manageable. Personnel that use the phone often should be coached to smile when making calls. Smiling changes the tone of voice to be more friendly and empathic. Hence, the call center mantra of “smile then dial.”

A team member should answer the call in 3 or 4 rings to prevent patient-initiated hang-ups. Before placing a caller on hold, personnel should ask permission to do so. A system with call parking avoids accidental hang-ups and can be set to notify when someone is left on hold too long.

Personnel should have headsets that free users’ hands to input information into computer systems, provide a clearer voice into calls, and prevent work-related neck injury. Using call parking with a recall feature will help avoid accidental hang-ups and unintentional errors when transferring patient calls.

Offering guidance for challenging scenarios will help your team.

 Examples of scenarios include the following:

New patients desire kindness, qualified practice, and prompt appointments. The answering team should provide warmth and empathy, reflecting the practice mission, as they work toward booking the patient and collecting demographics. They should ask for
the caller’s name and number in case of disconnection.

Existing patients who are rescheduling with suboptimal reasons

Team members should understand that rescheduling can be costly to a practice as the slots become non–revenue generating. They should advise the caller of the need to adhere to a prescribed treatment plan, express the provider’s concern and investment in the patient’s care and treatment, and point out the difficulty of finding an opening in the busy schedule.

The caller’s concerns must be listened to and acknowledged without interruption. If the situation is especially problematic, the team should tell the patient the concern will be researched and called back later in the day. This allows the patient to decompress and reset while the practice thoroughly investigates concerns and make changes when possible.

The interactions between technology, staff, and service bridge how patients evaluate their care. The phone is often the most overlooked piece of technology in a practice. Improving phone service will improve patient satisfaction, avoid financial loss from patient frustration, and enhance care. 

Whaley MP. The 2011 Press Ganey pulse report: medical practices must personalize their interactions with every patient. Manage My Practice. February 7, 2012. Accessed January 6, 2022. https://managemypractice.com/the-2011-press-ganey-pulse-report-medical-practices-must-personalize-their-interactions-with-every-patient/

Press Ganey. Consumer experience trends in healthcare 2021. Accessed January 6, 2022. 

https://www.pressganey.com/sites/default/files/2021-11/Press%20Ganey%20Consumer%20Trends%20Report%202021.pdf

Own the Phone: Proven Ways of Handling Calls, Securing Appointments, and Growing Your Healthcare Practice.

 American Association for Physician Leadership; 2015.

Take steps to ensure a positive first and lasting impression.

How to provide excellent phone service

The mean salary for an ob-gyn in the United States, according to the Bureau of Labor Statistics, is $239,120 annually.¹ The question is; if every physician were paid this amount as a flat salary, would access be equal across the board? Would quality? Would there be resentment among those who feel they are generating more revenue for their group or health care system or performing better than their peers making the same salary? 

Distributing revenue to physicians to drive productivity and thus patient access and better health outcomes is the foundation of physician compensation plans.

Physician compensation plans have certainly evolved over the years, especially as more physicians pursue employment arrangements. 

However, 2 foundations have not changed. First, compensation plans must be created to provide successful physician recruitment, engagement, and retention, while supporting the sustainability of the practice or health system and its mission. Second, the makeup of the compensation plan should address the following:

Teaching and administration, and call stipend if appropriate

Although much attention is placed on the development of a compensation plan, the plan is best thought of as a live document designed to be modified based upon market changes and challenges. For example, a plan that emphasizes productivity may have worked well in a fee-for-service world but would not be sustainable in a highly capitated environment where care management may be more valuable to the health care system or practice than unbridled clinical activity.

Knowing the relative value and risk of each component is critical. Best practices will increase the likelihood of the compensation plan achieving its intended goals for both the physician and the organization. In a highly functioning organization, those goals should be aligned.

An article written for the Healthcare Financial Management Association (HFMA) describes a process aimed at large medical groups but which that can also be applied to smaller groups trying to apportion revenue.

Benchmarks, although a very sound recommendation, must be evaluated with caution. They are often developed with unvalidated data. Salary requirements are often set by region; however, those that are necessary for a particular service to be provided may differ based upon urban or rural environments. Sometimes, these environments are in the same region. Benchmark salaries may also be in a range that is inconsistent with the group practice’s viability. Benchmarks can also differ from specialty to specialty within a group, which could lead to intragroup conflicts.

In a small group it would not be unreasonable for all members to discuss the elements of the compensation plan. Elements that will be reviewed mainly revolve around the “value” portion of a compensation plan, such as quality metrics and citizenship. In a large multispecialty group practice, a balance must be weighed between sufficient representation and a group too large to effectively develop a plan. As an ob-gyn, you need to ensure your specialty is represented; this is because of the complex nature of the field, which encompasses primary, specialty, imaging, and surgical services.

Five principles can be adapted to any compensation development plan:

Ensure the plan  is financially sustainable

This step addresses the reality that 1 plan will not fit all. It is important to keep the elements of the plan defined (ie, productivity, value components) and define how each element will be apportioned in any plan. This will reduce the risk of individuals potentially defining new values above of the compensation plan.

Reliable compensation plans are imperative as health care becomes more complex. Hear from the experts in our new Practice Management column.