Manage My Practice

Here’s a companion piece to my recent list “50 Ways to Attract New Patients to Your Practice.” Once a patient makes an appointment to see your provider, be sure to keep them coming back by wowing them with your customer service.

FRIENDLY

1. Introduce yourself to patients. “Hi, I’m Jane and I am Dr. Smith’s assistant and I’ll be working with you today.”
2. Wear a visible and readable name tag with your first name in large letters.
3. Smile and speak to all patients, family members, and vendors in the practice. If anyone has a question mark on their face or is hesitating, be sure and ask “May I help you?”
4. Always smile while speaking on the phone and always introduce yourself. “Good morning, Dr. Smith’s Practice, this is Jane. How may I help you?”
5. Providers should always shake hands with patients and others in the exam room.  That first touch is so important!
6. New patients should receive a special welcome and should receive special attention, remembering that the patient doesn’t know how the practice works.
7. Have a patient information brochure that describes your practice’s services, providers, and policies on medication refills, after-hours services, filing insurance, filling out forms, and making payments.
8. Have multiple ways for patients to complete their registration information – forms mailed to them, online completion, completion in the practice at a computer kiosk, completion at the practice with personal help, or pre-registration by phone.
9. Ask patients how they would like you to communicate with them about lab/test results – telephone (home, work or cell), email, mail, phone retrieval and let them know (in writing if possible) when they should call if they haven’t heard from you.
10. Place tablets and pens in the waiting area so patients can write down questions for their provider while they are waiting.
11. Have computers in the waiting area for patients to use. Have Wifi for patients to use their own computers while waiting.  Have instructions available for using the Internet to look up medical information and provide a written list of medical websites that your providers recommend.  Place this information on your website.
12. Prior to touching a patient in the exam room, assistants and providers should wash or sanitize their hands and be sure the patient can see them doing it.  Additionally, it’s good to say to the patient “Let me wash/sanitize my hands before I examine you.” so the patient knows you are practicing good infection control.
13. Provide staff with patient questions and preferred answers so everyone can answer most questions and no one tells patients “That’s our policy.”
14. Have a water fountain with cups in the reception area.
15. If you have a television in the reception area, make sure patients can change the channel or the volume.
16. Invite patients to become a friend of the practice on Facebook and communicate regularly with your patients keeping them up-to-date on practice news, health news and local events.
17. Pretend that every patient is a mystery shopper (and they are!) and treat them like a VIP.
18. Give patients a way to reach a real person on the phone, and a way to go through the automated attendant.  Remember that not every patient wants or needs the same thing.
19. Have an annual open house or patient appreciation day and do blood pressure checks or home safety checklists.  Serve healthy snacks and visit with your patients.
20. Call 2 days before the patient’s appointment and remind them of the date and time of the appointment.  Ask them to press “1″ if they plan to keep the appointment and “2″ if they would like to cancel the appointment.
21. When the patient is checking out, ask “Were all your questions answered today?”
22. If you give out wrapped candies, make sure to supply sugar-free candies as well as regular.

EASY

1. Have multiple ways for patients to complete their registration information – forms mailed to them, online completion, completion in the practice at a computer kiosk, completion at the practice with personal help, or pre-registration by phone.
2. If your parking lot is shared with other businesses, make sure there are parking spaces marked specifically for your patients.
3. Use wayfinding systems to help patients navigate around your practice.  Many patients will not read signs, but will identify symbols or pictures if you explain the system. Use themes for providers or services to help patients find their way when coming out of the bathroom or lab.  Carpet or tile designs and art pieces can also be used creatively to direct patients in and out.
4. If you have a choice, front-load your practice space with patient rooms and leave the furthest rooms for non-patient activities such as offices and staff rooms.
5. Give patients their medication list and problem list on a wallet-sized card.
6. Bring services to the patient exam room instead of having your patients move around the practice.
7. Offer numerous payment options including financial assistance, Medicaid enrollment, medical loans, checking account drafts through debit cards and credit card drafts.
8. Offer a “chat with the insurance lady” feature on your secure portal.
9. Have new patient pre-appointments for patients to meet with staff to take baseline vitals, log medications and prep chart prior to their first visit.
10. Have maps available for patients for any place you might be referring them to, whether in town or out of town.
11. Give patients a sheet to take with them that lists medication changes, future appointments, referrals and has a place for them to write down questions between appointments.
12. Give patients a customized sheet that shows the name of their medication, what the medication looks like and how to take the medication.
13. Send patients emails or letters and post on your website any information relating to hot topics in the news – vaccines, radiation exposure, etc.
14. Make your website a one-stop destination for practice information, health information, practice forms and secure messaging with the practice.

UNEXPECTED

1. If a patient has a particularly unhappy experience in your practice: a long wait, a mixed-up appointment, give them a gift card with a sincere apology.
2. Hand-write an apology to a patient who has had an bad experience with a staff member.
3. Validate parking for patients if they have to pay to park to come to your practice.
4. Ask patients to rate your service – have forms in the exam rooms and in the waiting room and in new patient packets and on your website.
5. If your practice is near a shopping or eating area, give patients a pager to buzz or ring when it is time to see the provider.
6. Use your EMR or voice recognition to complete the patient’s medical record and print them a copy of it to take with them when they leave the exam room.
7. Have a blanket warmer to give patients who are sick, or have come in on a gurney a warm blanket.
8. Go through the daily obituaries to know when patients have passed and send condolences to the family.
9. Have an option on your phone system to speak to the manager and take complaints personally.  Answer all complaints and call any patients back who leave messages, and any patients that employees tell you had a problem at the practice.
10. Call new patients the day after their appointment to see if they had any questions after their first visit.
11. Call particularly sick patients the day after an appointment to see if they are improving. (Thanks to Kristen Baird.)
12. Give patients who call a benchmark for when they will hear back from you (2 hours for same-day visits, 6 hours for questions, etc.) and exceed your own benchmarks.
13. Have a mystery shopper come to your practice and tell you what you don’t know about your practice.
14. Send your patients a birthday card.

What do you do in your practice that is Friendly, Easy for patients or Unexpected?

Welcome Denise Price Thomas, practice administrator (32 years) and consultant. Throughout her career, Denise has been passionate about creating positive experiences for patients and customers. She enjoys teaching customer service and effective communication.  She strives to inspire others by using heart-warming stories and humor gleaned from her management experience in her informational, inspirational and motivational presentations.  In addition, “Gladys Friday”, (aka Denise), completes the package of “Health, Hope & Humor” by telling entertaining stories about funny moments in health care settings.

I received a call from a practice administrator who said, “When I am observing the front desk staff, I find them to be helpful and attentive to our patients, however when the patients are visiting with the physician, he receives multiple complaints per day.  I cannot be with them at all times.” This is so true as is in many practices.  The staff is on their best behavior when the administrator, manager or physician is around.

After meeting with the administrator and physicians, it was decided that they were in need of a practice evaluation, to see how things look “from the other side of the desk.”

I was to be there at 10:00 am.  The administrator and physicians were aware but they had elected to keep the surprise to themselves.

I arrived to find the sliding window CLOSED.  Although it was a clear glass (thinking the person on the other side could actually SEE through it) I just knew it would open…..it didn’t.  In fact, nothing happened.  The receptionist was “busy” writing and her head was down.  As I stood there waiting “patiently” (as she thought I WAS a patient), I looked around at all of the real patients, looking through magazines – angrily flipping pages.  I could tell immediately that they had been greeted in the same manner.  There were loud sighs, eyes rolling as they looked at their watch; people were not happy.

After giving it a few minutes, I decided to tap on the CLOSED window.  Still without looking up, she said, “I’ll be with you in a moment!”   After waiting another minute or so…..I decided to put on my brave suit and go for it.  I slid the CLOSED window open and said, “May I see your administrator please?” (still trying not to give it away).  She said, (again without looking up – I still have NOT seen her eyes – nor has she seen mine) “M’AM, I SAID I would be with you in a minute!”  I politely said, “thank you.”

BINGO!  I had located the trouble, when suddenly there appeared before me….the administrator.  I was so happy to see her.  She said, “Denise, come on back.”  She introduced me to the clinical staff and we made our way to the front desk.  She said to the “greeter” at the front desk, “this is Denise, she will be performing a practice evaluation to see how we may improve our services.”  The “greeter” said, “It is SO NICE to meet you.”  No, it really wasn’t.  She decided at that point that she needed to be nice to me when she should have been NICER to her PATIENTS, the reason she was there.

Realizing that she wasn’t really a “people person” to say the least, it was decided that she work in another area in the practice, where she was happier and the person from medical records was much happier working with the patients.

End result, happier patients, happier physicians, happier staff.

Moral of this story:  You can have the most wonderful physicians but if you have a sub-standard staff, patients will not be happy.

Things to look for in a front desk applicant:
Fortune teller – able to know when someone has changed insurance companies, divorced, remarried, deleted insurance, moved, etc.

Air traffic controller – able to smoothly divert patient traffic in an attempt to keep them from running into others and finding out their “time of arrival” is the same as others.  Able to handle maximum doses of STRESS!

Medi-copter pilot – able to hover over an emergency, assess and remove the patient in distress and deliver them to the safest place  AWAY from the lobby – seeking clinical assistance – while remaining calm

Multi-lingual – able to understand multiple languages and be able to effectively communicate

Coach – able to motivate the team, support the team, protect the team while being part of the team’s proactive plan, not the team’s problem

“One Ringy Dingy” – Switchboard Operator– able to pleasantly answer each phone call addressing each one as it is the only call

Multi-tasker – able to effectively & efficiently perform multiple tasks while wearing a smile and a positive attitude – with each patient

Juggler – able to maintain balance while keeping eyes on the patient

Circus trainer – able to be the master of MANY ceremonies

Reservation Concierge – scheduling and rescheduling while exhibiting exceptional customer service skills, GLAD that the person has contacted their practice for “reservations” (an appointment)

Infection Control Officer – ensures cleanliness and minimizes germs

Minimalist – able to work without the clutter igloo around them

Walmart Greeter – happy to see everyone that walks through the door

Helpful characteristics to look for when interviewing a medical front desk applicant:
Unflappable
Patient
Exhibits kindness
Compassionate
Positive attitude
Exhibit good eye contact
Nice soothing voice
Multi-tasker
Non-complainer
Willingness to help others before themselves
Desire to be cross-trained
Does not have the words, “It’s not my job” in their vocabulary

Most healthcare workers that have BEEN a patient or have been with their family member through sickness…..make great healthcare employees.  They KNOW how it feels to be on “The Other Side Of The Desk”

Denise Price Thomas

Note: Denise’s partner in DPT Consulting &Training is Gladys Friday, pictured here.  If you are interested in contacting Denise or Gladys about their services, they can be contacted through their website here or by phone at 704-747-8699 or via email to denisepricethomas@gmail.com.

I invited readers of MMP, colleagues on LinkedIn, and Tweeps (friends on Twitter) to comment on my post “101 ideas for Increasing Revenue and Decreasing Expenses.” I’ve listed their ideas below and hope you’ll chime in on the comments with even more ideas!  Thanks to everyone for contributing.

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David Kirkup

Partner at B2B CFO® – Experienced CFO for Rent. Fast, Effective, Affordable.

Consider adding a part-time CFO to the mix. Many medical offices have very weak financial capability or understanding. Assistance can range from better financial reports, capital expenditure analysis, budgeting and exit plans.

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Bobby Jones

Eastern Region Sales Manager – Billing Tree

1) Build a relationship with the patient before he/she leaves the practice.
2) Make sure they know you are expecting payment on the portion they owe, and when you are expecting that payment.
3) Let them know what your process is for collecting, and when they will go to an outside agency.
4) Enable a web site to take payments 24 hours a day.
5) Set up an IVR system to take phone payments after hours.
6) Communicate your available payment acceptance methods in writing, on the phone and every time you speak with your patients.
7) Send the invoice or statement when you intend to send it.
Re-inforce the payment acceptance methods on the first and any subsequent invoices.
9) Adopt a plan for following up with any patients that don’t pay after 10 days.
10) Get email addresses from all of your patients and their permission to contact them in that manner.

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Sukrit Tripathy

Sr. Product/Process Trainer and EDI Implementation Consultant

One suggestion would be to integrate the revenue cycle mangement function with your clearinghouse {for electronic billing} with integrated solutions like Coding database and Updates, Industry Broadcast, Performance and Audit reports for Claim Edits, Transmission and Rejects. Also, better training resources for billing staff actively into the practice management system.

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Barbara Rotter

Consultant at Pacific Women’s Medical Group

I would add effective cash management (even if interest rates are so low).

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Michael Glass

Medical and Business Consultant at Transworld Systems

Utilize a Flat Fee Collections Agency for Non-responsive Patient Pay concerns.

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Randall Shulkin

Principal Consultant – Culbert Healthcare Solutions

- Do you collect co-payments on the way in rather than on the way out?
- Does your PM/Scheduling system show the patient co-payment and outstanding patient balance in the appointment screen? If not, then can you download a listing for your front desk staff?

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Denise Price Thomas

DPT Healthcare Consulting & Training

I’d like to add “acknowledge the patient with eye contact” and offer “polished customer service” and they will WANT to return = return on your $ $

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Stacy Mays

Managing Partner, Dynamic Grape Companies

One other thought… don’t be afraid to try new technology. For example, one of my clients has developed a kiosk that allows patients to take their own weight and bp and electronically feeds the data into their EMR. The whole set up costs about $3500 and can save a ton of staff time. Tele-health in general should also be considered.

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Angela Short

VP at Operations

If you select a reasonably priced EMR and you implement enhancements then you more than save on staff cost. Keep in mind that my practice rolled out the EMR five years ago, so we have had time to get it right. Here are some of the savings/revenue opportunities:1. We utilize our electronic technology to send text messages and emails to our patients to remind them of their appointments. This function alone saves my practice one FTE. Not only do we save with staff time we improve patient satisfaction, as our Blackberry users loves the email or text that they can directly add to their calendars. The revenue enhancement to this function, we decrease no shows and lag time in our physician’s schedules.

2. The robust reporting within the EMR allows the organization to assemble important quality measures that we use in contract negotiations. Without the EMR this would be a labor intensive task.

3. We are able to push a secure message to our patients regarding their pathology results saving staff time on the telephone and increasing patient satisfaction by eliminating a visit just to obtain a normal result.

4. No more chasing charts for a phone message. My call center takes ALL clinical messages. This is attached to the patient’s electronic chart and routed to either a nurse to respond or a physician. This process greatly reduces staff time, decreases the time it takes to respond to the patient’s issue and provides a legal record of the telephone call which is often missed in a paper environment.

5. We receive a discount on our mal-practice insurance because in an electronic environment it is guarantee that your notes are legible.

6. The formulary function built into most EMR’s provides the physician will a real time snapshot if a prescription that he/she is about to write is covered by the patient’s health plan and provides alternatives if available.

I have just highlighted only a couple examples of the administrative benefits. There are many more. It is tough to imagine going back to a paper chart.

I have done the math and we could cover our current EMR with the incentives offered through the government initiative.

I will comment that physicians need to be trained on how to use the EMR. You can lose site of the patient and focus the entire visit on the computer versus the patient, however, we teach our physicians that the patient first and then chart completion. We conduct patient satisfaction surveys and I rarely receive a complaint regarding the physician’s time at the computer. I do however, receive praises from patients regarding the ePrescribe as it decreases their wait times when the arrive at the pharmacy, the prescription is ready.

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Okay Readers, it’s your turn – what’s your secret weapon for increasing revenue or decreasing expenses?

Mary Pat

My personal list of new employee orientation best practices has been shaped by my experiences in private practices as well as hospitals. Every organization has different resources to draw upon, but each group has core goals that must be fulfilled by a good orientation:

• completion of paperwork including federal and state W-4s, I-9, direct deposit and benefit elections
• emergency contact information (included in hospital employee health intake)
• orientation to the organization, including designations, specialties, departments, sites, affiliates and an organizational chart
• completion of mandatory annual training such as safety, standard precautions, and HIPAA
• mechanics of name tags, parking tags, lockers, keys and codes
• signing off on understanding and agreement to confidentiality, compliance and personnel policies

In addition to these core goals, critical information to be shared during this time should minimally include:

• personnel policy review with emphasis on important (typically abused?) policies
• code of conduct/ shared basic competencies (mission and values, professionalism, communication, chain of command)
• computer security (passwords, internet policy, protection of PHI)
• workstation ergonomics and patient lifting policy (sadly lacking in many medical practices)

Important training that is rarely covered:

• Customer service (what is it and how do we measure our success or lack thereof?)
• Cultural sensitivity and diversity training
• Non-clinical employees’ role in medical emergencies
• Personal safety (coming in early or leaving late, patients threatening staff by phone or in person)
• Expectations for the first 90 days (training, communication, questions, problems)

Making Orientation Memorable

(more…)

The older I get, the more I dislike going to the dentist.  I don’t know if it has to do with the increasing number of root canals and crowns I’ve needed, or if it has to do with becoming more controlling as I age and feeling totally out of control in the dentist’s chair.

Regardless of my feelings about going to the dentist, I had a surprising customer service experience at my new dentist’s office recently.  I had been putting off finding a new dentist since we moved to the big city over a year ago.  It became urgent to find one when I started having a sensitive tooth that made me shriek (inwardly) every time I drank or ate something cold.

I did my research: asked people, went online to Yelp and tried to discover what I could about the local dentists.  I also needed to find a dentist in my insurance network.  I found the one that seemed to fit, called, made the appointment, and showed up at the appointed time after receiving a nice email reminder.

The receptionist greeted me, introduced herself and SHOOK MY HAND.  I had barely sat down with my clipboard of forms to complete before the clinic door flew open and the dental assistant called me.  She introduced herself and SHOOK MY HAND. She said we would deal with the paperwork as time allowed.  She talked to me about x-rays, and asked if she could take new films and a dental impression.  She asked about my former dentist in another state, and when I couldn’t remember his name, the receptionist returned with a page of names from the Internet and asked me if anything looked familiar.

The dentist came right in after the x-rays, surprisingly did not shake my hand, but proceeded to look in my mouth carefully, gently, and asked lots of questions.  Then he discussed a tentative care plan with me, and when we agreed, he turned me back over to the assistant for some remedial gum care training.  Magically, I completed my paperwork by the time I was done in the chair.

I stepped to the check-out desk feeling confident that my dental health was in very good hands.  Then the receptionist (whom I found out later was the dentist’s wife) had some information for me about what the care plan would cost.  She had called my insurance company and found out what my plan would cover and what I would be paying out of pocket.  She explained it beautifully and I was so impressed I asked her for some advice about the financial counseling program I am starting in my practice.  She had some interesting insights to share.

To Recap:

1. Got positive feedback on dentist online.
2. Was able to get an appointment within a week.
3. Got an email reminder.
4. Receptionist and dental assistant shook my hand.
5. Dentist was gentle and talked things over with me.
6. Receptionist explained my insurance plan clearly and what I would owe, and gave me choices for scheduling services.
7. I felt cared for, respected, and that they were happy to have my business.

I stepped inside an Apple Store last weekend for the very first time, and had an amazing customer service experience.  For one thing, the doors were wide open.  There may have been detectors at the front door to make sure I didn’t try to steal anything, but I didn’t see them if they were there.

Walking inside I was immediately greeted by an Apple employee.  Not an employee standing at a podium or sitting at a desk, but one wearing an orange shirt and a headset who greeted me and asked how she could help me.  I explained that I was thinking about a new laptop but didn’t know a lot about Macs.  She told me she was the concierge and her job is to match customer needs with Apple store staffers and service.  On the very busy saturday that I was there I saw three concierges (conciergi?)  Our concierge told us that she would send the next available specialist to us and she asked for our first names.  She invited us (Doubting Thomas husband accompanied me) to look at the computers while we were waiting.

At other stores I’ve visited for the purpose of buying electronics, there is one, or sometimes two of each model.  You may have to wait a bit to see the model you are interested in if the store is busy and it is not unusual to go through an extensive decision making process only to find the model you want is not in stock.  At the Apple store I rounded a large rectangular table twice before it dawned on me that I was looking at six of the same model of computer, and that the next large table had six of another model.

One thing that struck me quite forcefully about the Apple store was that it was so different from I had EXPECTED and had formerly ACCEPTED.  We expect and accept wasted time, poor service, poor attitude (the last time I was at a big store I asked the salesperson if he was having a tough day he looked so miserable) and out-of-stock items.

After about 15 minutes, David (in a light blue shirt) found us.  The things he discussed with us were:

• moving from PC to Mac
• the basics of moving around the desktop and what each of the icons were
• getting the remains of my PC (which passed away after 5 days in the computer hospital) installed onto a Mac
• discussion of what came with the Mac and what would be optional (Office for Mac, Service Plan, Training Package)
• financing options for the purchase
• a question Doubting Thomas had about iTunes

Recap of exceptional customer experience:

1. Doors of store were wide open (which I took to mean “welcome.”)
2. Greeted immediately by the concierge who was friendly and helpful.  She took our names, told us what would happen next, and gave us a great sense of being properly in line for service.
3. There were lots of the same computer model to try out and play with – no waiting for a turn to touch the product.  All the computers were plugged in and worked.
4. A salesperson who seemed to know all the answers waited on us, and brought things to me without me having to make my way to the back of the store to check-out.

Today I had to run to the drugstore to get a bunch of cough drops and cold medicine and some microwave chicken noodle soup for my husband, who has a nasty cold.  I ran in, grabbed a bunch of stuff and juggled it in my arms (not taking the basket as always because I’m only getting a few things) and unloaded at the cash register.  Not only did the cashier search through the Walgreen’s circular because she was sure there was a coupon for something I was buying, but another Walgreen’s employee came up to me, took a handful of coupons from her smock, and found two more for items I had on the counter.  Between them, the two clerks saved me almost $3.00!

Neither one of the clerks had to help me in the way they did.  I had no expectation that I would get to use coupons because I was in a hurry to get in, get out, get back home to ditch the stuff for my husband, and head back out to work.  These Walgreen’s ladies thrilled and delighted me by offering me more than 10% off my bill, and I felt they wanted me to get the discount.  If Walgreen’s instructs employees to help customers this way, they are brilliant.  If the Walgreen’s in my neighborhood has a manager that promotes customer service, I commend him or her.  If these ladies are the creators of this customer service ethic, I bow to their excellence.

What could be better than a customer service surprise?  Something you didn’t require, or expect, but certainly appreciate.  What could you do to create this in your practice?

• Validate parking on a special day (election day, the practice’s anniversary, veterans day, etc.) for a location where patients usually have to pay to park.
• Provide information on local pharmacies so patients can easily find the closest pharmacy to your office, or find a pharmacy that delivers.  This could go hand-in-hand with helping patients to find the pharmacy with the lowest price for their prescription (see my post on getting started.)
• Send new patients an email thanking them for coming to your practice and making sure they know how to get back in touch with the practice if they have any questions or concerns.  Most practices may not be ready to open this door, but I suggest you be one of the first and set the pace for your competitors.
• I suggest you take down the signs saying “no cellphones”, and recognize that patients are trying to multitask and get things done in exactly the same way that we are.  Invite loud cell phone talkers to step outside and give them a pager to call them when you’re ready for them.  Meet patients on their terms.
• What are your ideas?