enhancing patient satisfaction, safety, and risk management through medical call centers
DESCRIPTION
With the cost of health care in excess of $2.9 trillion nationally in 2009, and an estimated $50 billion being spent each year in health care fraud, reform was not just imminent, but imperative. While many view the recent health reform legislation with skepticism, its aim of reducing costs, with the goals of ensuring affordable coverage, investing in prevention and wellness, and improving safety and patient care—is shared by virtually all health care organizations. To achieve those goals, physician practices and hospitals will need to revisit their approach to patient care to ensure patient safety and meet their business needs going forward. This will mean finding new revenue sources, focusing on services that provide value, and identifying improvements that will enhance quality while driving down cost, all while maximizing the patient experience through quality outcomes and high-touch experiences.TRANSCRIPT
1
Maryland MGMA
Enhancing patient satisfaction, safety,
and risk management through
medical call centers
September 24, 2010
presented by
Tina Minnick, Director of Business Development
TeamHealth Medical Call Center
The insults ―moron,‖ ―idiot,‖
―imbecile,‖ and ―cretin‖ were all
once official medical diagnoses.
- Balderdash & Piffle, BBC 2
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Today, we will talk about:
• Healthcare reform impact
• Accountable Care Organizations
• Traditional & Innovative solutions bringing it
all together
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Resources
• TeamHealth
– Dr. Gar LaSalle, Chief Medical Officer
– TeamHealth Midsouth
• HFMA
• AHLA Connections
• Facebook and Twitter
• Studer Group
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Resources
You!
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Healthcare Statistics
• National Health Care was in excess of $2.9 trillion
in 2009, (an average of $9,300 per person, per
year)
• Health Care spending is 4.3 times National Defense
spending
• The average cost per family for health insurance in
2006 was $11,500
• It is estimated that Health Care Fraud in the U.S. is
over $50 billion each year and rising
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Healthcare Statistics
• Medicare is among the top three
Federal programs with improper
payments, totaling an estimated
$10.4 billion/3.6% of the total
improper payments in 2008.
• Medicare pays without looking
therefore, potential for waste,
fraud and abuse are high.
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Healthcare Reform
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Healthcare Reform Goals
• Reduce costs with goal to assure
affordable coverage, and:
– Invest in prevention & wellness
– Improve safety and patient care
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What does this mean for you?
• Creating a financial sense of urgency:– Revenue growth
– Focus on value
– Identify improvements that enhance quality while they
drive down cost
• Growing the patient experience:– Quality outcome & high-touch experience
• Opportunity to ask questions:– ‗Why do we do it this way?‘
– ‗Why aren‘t we doing this?‘
Accountable Care Organizations
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Accountable Care Organizations
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• Getting started
– Target market
– Local ACO?
– Reimbursement structure
– Identify patient-related strategies
– Identify organizational strategies
Accountable Care Organizations
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• Managing risk and the market place
– Timely information
– Who does what?
– Cost to begin an ACO/ongoing costs
– Which physicians will participate?
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Trivia
Which plant shoots from the hip?
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Traditional Call Center Solutions
• Clinical
– Community lines
– Physician after-hours services
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Traditional Call Center Solutions
• Non-clinical
– Physician referral
– Class scheduling
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WIIFM?
• Market share
• Brand presence
• Market growth
• ROI
• Community outreach, (non-profit hospitals can satisfy
IRS qualifications)
• Recruiting & retention opportunities
• Best allocation of resources
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Innovation
How do you move forward on the monkey bars?
You let go of the bar behind you.
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Social Media
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Innovation—Twist on Community Outreach
and Class Scheduling
Combined with social media, can be a
new way to approach the market
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Hospitals and Social Media
• At least 540 hospitals are using social media
in the United States
• Hospitals account for:
– 247 YouTube channels
– 316 Facebook pages
– 419 Twitter accounts
– 67 blogs
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Social Media is here to stay
• Not using social media could create a
generational gap in communication
• Educate employees on the right use
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WIIFM?
• Market share
• Brand presence
• Market growth
• Community outreach
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―Patient safety is at the core of every health
care provider‘s mission. And unless there is
tort reform, you must also address patient
care from a risk management standpoint.‖
— Dr. Gar LaSalle, CMO
TeamHealth
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Innovation—New approach on an old routine
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Innovation—Patient Satisfaction,
Safety and Risk Management
• Post Discharge Calls
• Who should make these calls?
– Emergency Department
– Inpatient
– Outpatient
– Other
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Obstacles to the patient follow-up routine
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What should Post Discharge calls include?
• Follow-up PCP appointment?
• Do you understand your discharge instructions?
• Did you receive the follow up care you needed?
• Have your symptoms subsided? Any new
symptoms?
• Document, document, document
Annals of Internal Medicine,
February 2003
Type of Adverse Events
66%17%
5%
8%
4%
Adverse Drug Event
Procedure Related
Nosocomial Infection
Fall
Other
* 81 events occurred in 76 patients
“Nearly 1 in 5 patients”*
400 patients surveyed
76 (19%) had adverse events after discharge
* “Adverse Events After Discharge from Hospital”, Annals of Internal Medicine, February 2003
* 81 events occurred in 76 patients
“Adverse Events After Discharge from Hospital”
State University of New York Study Mayo Clinic Proceedings, August 2005
• Only 28% knew medication names
• Only 37% knew purpose of medication
• Only 14% knew side effects
State University of New York Study Mayo Clinic Proceedings, August 2005
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What else should Post Discharge Calls include?
• Concern
• Compassion
• Care
• Help the patient move forward with next steps
in care process
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Examples of outbound Post Discharge ED Calls
• AMA‘s
• Falls by the elderly and the young
• Patients who may be a concern because of confusion or dementia
• Patients who are not appropriate for admission
• Pediatric discharges with a high fever but no other serious symptoms
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Specific ED risk management discharge calls
• TIA‘s
– Some will have an adverse
event within 2 – 5 days
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Specific ED risk management discharge calls
• Abdominal pain – when the
cause hasn‘t declared itself at
time of discharge
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Post Discharge Call benefits:
• Reduce non-reimbursable readmissions
• Patient safety
• Patient satisfaction
• Reduce risk
• Brand presence
• Best allocation of resources
Additional Post Discharge Call - Benefits
• Clinical Quality
• Reward and Recognition
• Reconfirms discharge instructions
• Reduces patient anxiety
• Reduces complaints and claims
• Reinforces patient perception that excellent care has been
provided
• Process Improvement
Post Discharge Calls
and HCAHPS
Seven composites:
• Nurse communication (Q 1–3)
• Doctor communication (Q 5–7)
• Responsiveness of hospital staff (Q 4, Q 11)
• Cleanliness, quiet of hospital environment (Q 8-9)
• Pain management (Q 13-14)
• Communication about medicines (Q 16-17)
• Discharge information (Q 19-20)
Post Discharge CallsLikelihood of Recommending – Inpatient
75
98
76
98
60
99
56
98
59
98
62
98
64
99
0
10
20
30
40
50
60
70
80
90
100
3Q06 4Q06 1Q07 2Q07 3Q07 4Q07 1Q08
No Call Call
“Likelihood of Recommending”
Percen
tile
Ran
k
No
Call Call
No
Call Call
No
Call Call
No
Call Call
No
Call Call
No
Call Call
No
Call Call
Source: New Jersey Hospital, Total beds = 775
Source: New Jersey Hospital, Total beds = 775 Studer Group
Post Discharge CallsLikelihood of Recommending - ED
Source: New Jersey Hospital, ED Visits: 85,034, Total beds = 775
27
76
47
88
32
87
62
95
63
93
47
77
25
76
38
93
29
70
0
10
20
30
40
50
60
70
80
90
100
1Q 06 2Q06 3Q06 4Q06 1Q07 2Q07 3Q07 4Q07 1Q08
No Call Call
“Likelihood of
Recommending”
Percen
tile
Ran
k
No
Call Call
No
Call Call
No
Call Call
No
Call Call
No
Call Call
No
Call Call
No
Call Call
No
Call Call
No
Call Call
Source: New Jersey Hospital, ED Visits: 85,034, Total beds = 775 Studer Group
Post-Discharge Calls:
Impact on Complaints
Cleveland Clinic Foundation, Cleveland, OH
• Compliments increased from 28% to 78%
• Patient complaints decreased from 20% to 2%
Source: Cleveland Clinic, Total beds: 1,000
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Innovation—Patient Experience:
Our observations
Common practices
needed to become more
physician-specific
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Our solution
Dedicated outbound patient
satisfaction calls
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What did we do with the information?
Brag Board
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Other Results
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Challenges and Learning Experiences
• Highly organized program
• Managing data and delivery– Frequency
– Benchmarking
• Reminder:– Coaching and motivational tool
– Not a replacement tool for formal surveys
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Benefits
• Improved patient satisfaction?– Sometimes, not always
• The big picture: LEADERSHIP– ED is the front door for the hospital
– Coaching for clinicians
– Building a culture through encouragement
– Accountability
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Overall, why is it important?
• Leadership
• Brand Marketing
• Service Recovery
• Tool for your clinicians – Recognition
– Customer happiness
– Loyal customers
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Reform and Accountable Care
• Healthcare Reform and ACO‘s will cause us to be
more proactive:
– Patient care and safety
– Reimbursement strategies• Quality outcomes
• Patient satisfaction
– Revenue Growth
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What can you do?
• Traditional approaches:– Community Line
– Physician After-Hours
– Class Scheduling
– Physician Referral
• Innovative approaches:– Post Discharge Calls
– Patient satisfaction calls
– Leverage your social media strategy
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Who else might you want to engage?
• CMO
• CNO
• Others
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What should you look for in a
medical call center?
• Comprehensive programs (clinical & non-clinical)
• Partnership
• URAC accredited
• Quality program
• Physician oversight and leadership
• Employ nurses and representatives
• Respected triage guidelines, e.g. Schmitt - Thompson
• Robust training program
• Reporting
• Why? So you can focus on your core competencies
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How will you grow forward?
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Tina MinnickDirector of Business Development
(865) 985-7313
www.thmedicalcallcenter.com