Strategies for Reducing After Hour Phone Calls

00:00:00 Hi, it's Dr. Weitz. Thanks so much for joining me for this episode of the private medical practice academy. Recently, one of the members of the private medical practice academy told me that one of their biggest concerns about private practice is the numbers of after hour patient phone calls they get after our patient phone calls can be an issue for every practice, regardless of whether it's a solo practice,

00:00:24 a single specialty, multi physician practice, whether it's a multi-specialty group, whether it's your practice or even if you're an employed physician, basically your practice setting doesn't matter. What's important is that you need to have a policy for handling after hours phone calls. Today, I'm going to give you a number of strategies that can help you to reduce the number of these phone calls that you get.

00:00:51 Let's start by talking about patient portals. When patient portals became mandatory, there were a lot of people who expected that there would be a decrease in the number of patient phone calls. This however has not actually come to fruition. Patient portal simply add a way for patients to engage with us. I also want to address whether or not you can get paid for phone calls.

00:01:14 I'm sure you've heard that you can now bill and get paid for patient phone calls, but before you get excited that this is a way to make some extra money, let me burst your bubble and tell you you're better off trying to minimize your after-hours calls CMS is paying $14 for a call or a whopping $27. If you spend 11 to 20 minutes,

00:01:40 depending on your contracts, you may get paid more by some of the commercial insurers, but let's be real. You're not getting 14 or $27 from Medicare. You're going to get that less. The 20% co-insurance from the commercial insurers that patient may have a copay or worse yet a deductible that they have met. Think about how much effort it's going to take you to collect that money.

00:02:06 Is it really worth a couple of dollars? Would you rather have dinner with your family or sleep soundly in the middle of the night? Now that I have your attention, let's talk about ways that you can actually minimize the number of unnecessary after-hours costs. First, there will always be after-hours calls. There is no way that you're going to eliminate these completely,

00:02:29 but you need to recognize that many of these are non-urgent calls related to issues that can be easily addressed during regular office hours. You can also use one of the many answering service solutions to help you triage calls, but that alone is not going to solve the problem. I can tell you from firsthand experience that an answering service is only as good as the process you set up,

00:02:53 including the instructions that you give to the answering service. The key is to implement strategies that help to reduce after-hour call volume, without sacrificing patient care. The first thing you're going to want to do is set up a phone system. When a patient calls after hours, your phone system should have a tree. The system should answer and give the patient a set of instructions.

00:03:18 The message should start with, if this is a medical emergency, please hang up and dial 9 1 1, or go to the nearest emergency room. After that, you're going to want to have a series of prompts that help direct calls. One of the prompts that you're going to want to have is to be able to automate commonly requested information. You're going to want to include information that patients routinely are looking for,

00:03:44 like your address, your office hours, directions to the office, your fax number and your website URL. To that point. If all of this information is on your website, as it should be, make sure to mention your website multiple times during this message. Another key is that you want to have someone who can articulate clearly and speak slowly, record this message so that this automated message can be easily understood.

00:04:14 In addition, in the event that your practice is located in a place where you may need to close, you can use this strategy to convey whether the office is going to be open or you're closing for inclement weather. So for example, in case you haven't heard, there are hurricanes in Louisiana, every hurricane season without fail. My office would get a barrage of phone calls.

00:04:38 If there was even a threat of a storm in the Gulf of Mexico, patients would call and say, can I reschedule my appointment? Are you going to be open? When do you think you're going to close? When are you going to make a decision? It didn't take me long to add this information to our outgoing message. And many, if not,

00:04:56 most systems will allow you to actually record multiple messages and store them so that you can just switch them out as needed and not have to do it just at the time that the storm is coming on the same theme, nonclinical calls, including a request to change, cancel and schedule appointments, request for medical records and billing questions can account for a significant number of those after-hours calls,

00:05:21 you don't want to set up a system where calls go directly to your cell phone because you'll have no way of sorting out. What's a real call versus one of these nonclinical calls. You want to set up a prompt that sends people to a voicemail box or boxes so that these calls can be diverted to the appropriate staff who will then answer them during regular office hours.

00:05:43 You can divert calls to a mailbox that's specific to an employee, for example, press one, to schedule, reschedule, or cancel an appointment. And then that messages left for the scheduler. Another option would be to have prompt and a mailbox that handles all nonclinical after hours. Because regardless of which of these options, you choose, though, those mailboxes need to be monitored.

00:06:08 And the calls responded to the next business day. Otherwise, you know, what's going to happen, right? People just call back often, repeatedly, and then they come up your phones during business hours. So to the extent that we can handle this preemptively, you will actually minimize your during business hours calls as well. Now let's talk about medication, refill requests.

00:06:32 This is a huge issue. I personally think that the patient should ask their pharmacy for a refill, and then the pharmacy should contact your office. This can be done either electronically or by fax. First of all, this will eliminate patient phone calls both during and after office hours, but it's also a patient safety issue. Anyone who's ever talked to a patient or listened to a message asking for a refill,

00:07:01 it can be difficult to understand the name of the drug and how they want you to prescribe it. Having it come as a written form from the pharmacy can help you actually decrease medication errors. Second, I would strongly recommend to you that you try in time refills of medications to a patient's follow-up appointment. If you know that the patient is coming in for followup in three months,

00:07:26 don't just give them a one month prescription. Of course, they're going to be calling your office for a refill. Now you may be thinking, well, I don't want to give them multiple refills because maybe you're unsure whether the medication is going to be effective, or maybe you don't know if the patient's going to tolerate it. I can think of a variety of reasons that you wouldn't want to give a refill,

00:07:47 but every one of those reasons ties back to the best patient care is to bring that patient in for a follow-up to assess the reason that you didn't want to give them a refill. Both of these strategies will actually decrease the number of patient phone calls to your office, but they will also improve your patient care. Keeping it real. Even when you do these things,

00:08:15 there will always be patients who have the epiphany that they need a prescription refill at two in the morning, harsh, as it may sound lack of planning on their part does not constitute an emergency on yours. Have a phone tree message that states your practice does not handle non-urgent medication refills during nights or weekends. Be clear about your practice's policy for managing all non-urgent medication,

00:08:42 refill requests. For example, prescription refills will be handled the following business day. Or maybe you want to say prescription refills will be handled within 48 hours. To that end. You want to have instructions for obtaining prescription refills, including when the patient will get that refill everywhere in your office, on your website, in your new patient packet. Otherwise, the patient doesn't know they're not supposed to be calling for a refill.

00:09:12 And the reason I tell you to specify when the patient can expect that prescription refill to be processed is so that they don't call you repeatedly. I'm sure you know, like, you know, patient calls for hours, go by. No, one's called them back to tell them that their prescription is ready. Guess what happens? They call your office again.

00:09:33 If they don't get an answer, they leave another message. Then it's after hours and they still haven't heard from your office. So they call the doctor on call, manage patient expectations by telling them how long it's going to take for a prescription refill to be addressed. Tell them how to determine whether the refill has been authorized. Is your office going to call them to let them know it's been approved?

00:09:56 I hope not. That's actually going to take more time and manpower than you need to expend instruct the patient to call the pharmacy, to determine whether the prescription has been filled. Following these steps can significantly reduce the number of medication related phone calls. You get both in general and specifically after hours. In other strategy you may want to implement is to inform the caller that if they choose to contact the on-call provider,

00:10:23 there will be a charge for the service. You can decide whether you want to apply this to all calls or only to the ones that are not urgent. You can also decide whether you want to drop a charge. I would recommend telling them what amount you're going to charge them. This is more effective than simply saying, you're going to get a bill.

00:10:43 Your goal is to choose a price point that filters nuisance phone calls, theologian caller can either choose to proceed to the on-call provider or to go to the emergency room. As I said earlier, some of the insurance companies, including CMS will pay you, but you're going to need to collect the co-pay co-insurance or deductible from the patient. And as a complete aside,

00:11:09 you can't bill the insurance and not attempt to collect from the patient. The point of informing the patient in the prompt before they choose to be connected to the on-call provider is that the mere threat of a bill is often enough to turn that 2:00 AM medication, refill call or the question that could truly wait until tomorrow into the non-urgent call, that it is and that your staff can handle the next business day.

00:11:36 If you're going to use an answering service, I would suggest having a prerecorded message on your phone system that directs patients who still want to speak to the on-call provider to hang up and call the answering service directly. This added step is often enough to deter patients who have less than urgent issues from following through and calling the answering service. Not to worry though,

00:12:01 those patients with urgent medical issues will overwhelmingly, still call the answering service. You're simply trying to weed out those patients for whom a simple extra phone call is too much effort for the question that they actually want to ask. Another important strategy is to track your after hours calls so that, you know, who's actually calling you. You're likely to discover that a handful of patients are high utilizers who make up the majority of those after-hours calls in our practice,

00:12:31 a high utilizer was defined as a patient who called the practice more than six times during the year. Even if you don't want to bill everyone for after-hours, phone calls, you can send the high utilizers, a letter, informing them of a change in your office policy indicating that there will be a charge for them for after-hours services. This will help decrease a lot of those calls.

00:12:57 Now I know that some of you need to differentiate patient calls from consult calls. If your practice accepts console calls from the ER or inpatient units, you're going to want to set up your after-hours, phone tree to include a separate option for those types of calls. In my experience, patients don't typically lie and choose the provider option. Once a consult option is chosen,

00:13:23 you can then choose to have the call directly forwarded to the on-call provider. Or if you're using an answering service, the call could be transferred to the answering service. They can vet the call and then forward it to you. Aside from an after-hours phone tree, I've always used an answering service that way patient and consult calls can be screened. One more time.

00:13:47 That way the answering service handles the patient who still believes their med refill is urgent or the inpatient consult for a patient with insurance that you don't accept. The cost of the answering service is minimal and provides a level of insulation. So that calls that get sent onto you really do require your attention. Having an office policy for after hours, phone calls and implementing these strategies can make a huge difference in the number of calls that your practice receives after hours.

00:14:20 Thanks for joining me, please be sure to sign up for my newsletter below, I'll be sending you tips on how to start a practice, grow a practice, and then add multiple services so that you can maximize your revenue.