Automating portions of the patient encounter--such as the initial call or patient check-in--can provide cost savings and help with the number of staff members required, but patients aren't always receptive to these technologies. The office staff members need to decide whether this is the program that will best suit their patients.
"There are going to be some people who just want to talk to a real person, and we should be giving them that option," says Charlene Burgett, administrator at North Scottsdale (AZ) Family Medicine. "There are also many people who would rather go through the automated system than to wait their turn in the calling line."
Bohler says the automated system has been a huge help for the patients at her practice. "I believe this has enhanced the communication abilities of this practice, and with each new change, the patient still has the freedom of choice," she says.
Following is a list of devices to consider in making the flow of appointment scheduling, patient telephone calls, reminders, and confirmations easier in your busy practice.
Interactive voice response (IVR): This is a telephone technology that allows patients to interact with a database to acquire information or enter data. Your practice can set up the IVR system to offer any automated features needed, including office announcements about when nurses and physicians will be available, office hours, emergency calls, prescriptions, after hours, and holiday and weekend calls. Practices can purchase and install basic, self-service, or full configuration models. This system generally fares well in handling large call volumes, particularly in busy physician practices.
Kiosk: This is an interactive display or terminal stationed inside the office and used as a patient check-in method, similar to what a person would do at an airport. The patient would punch in his or her name, and the device updates the demographics and insurance card information before the patient even speaks with a receptionist or sees the doctor. Kiosks save patients from filling out forms and allow receptionists to avoid entering the data into computers and placing daily calls to insurance companies.
Portable buzzer: The buzzer is used for the patient. This allows him or her to tend to other priorities instead of being in the waiting room for a long period of time. If the patient decides to leave the building but stays within range, the buzzer will sound and the patient can then return.
Shannon Sousa is the editor of The Doctor's Office. She may be reached at ssousa@hcpro.com. This story was adapted from one that first appeared in the January edition of The Doctor's Office, a monthly newsletter by HCPro Inc. For information on all of HCPro's products, visit www.hcmarketplace.com.
The Department of Health and Human Services is seeking cuts to the Medicaid rate paid to doctors in hospital-based practices, and the rate reduction appears to affect about 43 percent of all physicians in Maine. Members of the Maine Hospital Association say that the irony is any doctors in private practice won't take new Medicaid patients because their reimbursement is so low, and now the state is about to penalize the hospital-based physicians practices that do see them.
Under what circumstances can a patient in an emergency room be forced to submit to a procedure that doctors deem to be medically necessary? That question--and the notion of informed consent--is at the heart of a civil case Brian Persaud, a 38-year-old construction worker who lives in Brooklyn. Persaud asserts that he was forced to undergo a rectal examination after sustaining a head injury in an on-the-job accident.
A cursory scan of news reports about the healthcare industry could make one wonder why hospitals and physicians today seem fiercely at odds with each other.
Docs are not only entering business ventures to open up new revenue streams, they're also competing in many cases directly against hospitals in profitable service lines.
Hospital administrators are complaining more and more that there are fewer physicians to maintain key services, and many of the physicians they have now refuse to take ED call or expect to get reimbursed for it.
Don't get me wrong, hospitals and physicians need each other now more than ever. Reimbursements remain tight and the cost of running a medical group has never been higher. Many physicians are looking to their hospital partners for relief in the form of administrative and technical support.
But true hospital-physician alignment is a tough task in no small part because hospitals and medical groups operate in such fundamentally different ways.
Hospital-physician alignment strategies was the topic of conversation at a recent HealthLeaders Media Roundtable that I hosted in downtown Nashville. As a reporter, I follow these issues closely, but there is no substitute for getting out of my cluttered office and having direct, in-person conversations with physicians and administrators.
Our panel of experts pointed out that medical groups and hospitals still struggle to speak the same language and understand each other's distinct business needs. This inability to communicate effectively can be a major barrier for dissimilar organizations that are trying to align objectives.
Jeffry James, CFO and COO for Christie Clinic, an 85-physician multispecialty medical group based in Champaign, IL, said that reimbursements, regulations, and expectations for medical groups and hospitals are so different that it's hard for a clinic to grasp all the things that hospitals need, and the lack of understanding can breed distrust.
"Take data transparency, for example," James said. "It's very difficult for us on the physician side to really understand how the numbers at the hospital work because they don't relate directly to what we do. When a hospital talks about losses per physician that they employ, we don't know whether that includes credit that the hospital may be receiving or not receiving for ancillary services. When a hospital talks about finances, it's hard for us to put it in terms that we can understand, because the way we account is different than the ways hospitals account."
So a hospital might share data with its volunteer medical staff in an effort to be transparent with its business partners, but if the physicians and medical group administrators don't fully understand the data, what good is it? Certainly, the data won't factor into the physicians' negotiation strategy to increase pay for call coverage.
The incentives today for hospital-physician alignment are great, said John Phillips, president of PivotHealth, a practice management firm based in Brentwood, TN. But the organizations need to begin a difficult dialog about how to align incentives.
And James said that in many cases it comes down to whether a hospital is proactive or reactive in reaching out to its medical staff. "The reactive hospital can do more harm than just encouraging a physician down the path of adding services for themselves; that stance actually pushes physicians away," he said. "In our market right now, we have one hospital that is very proactive, and one hospital that is being very reactive. This is pushing our physicians toward a hospital that they typically did not practice at. By proactive, I mean that the administration is talking to us about marketing strategies, EMR, and generally about how we get on the same page. At the same time, the reactive hospital's administration is talking about curtailing our privileges, recruiting against us, and changing the way unassigned call is provided. I think the way these two hospitals are interacting with volunteer medical staff is going to change the landscape in our market."
The Joint Commission has announced proposed 2009 National Patient Safety Goals (NPSG) requirements and implementation expectations (IE) for field review. These proposed NPSGs affect hospitals and critical access hospitals, ambulatory care and office-based surgery, behavioral healthcare, disease-specific care, home care, laboratories, and long term care.
The Joint Commission seeks comments on these potential new NPSGs and will be accepting feedback via an online survey through February 27, 2008.
The field review focuses on the following areas:
Goal 1, patient identification
Goal 3, safe use of medications
Goal 7, hospital acquired infections focusing on methicillin-resistant staphylococcus aureus (MRSA) and clostridium difficile-associated disease (CDAD); catheter-associated bloodstream infections (CABSI); and surgical site infections (SSI) in acute care hospitals
Goal 8, medication reconciliation
Goal 13, patient involvement in their care
Universal Protocol
Last year, after the NPSGs were finalized, healthcare organizations faced one new National NPSG in preparation for 2008 requiring clinicians to respond rapidly to changes in a patient's condition, and another new requirement about anticoagulant therapy, and was intended to be a light year for NPSG changes. Unlike in previous years, the 2008 goals will be phased in throughout the year, with full implementation required by January 2009.
Goal 1 Under the proposed revisions, Requirement 1A would be expanded to include an IE requiring that the patient is actively involved in the identification process, when possible, before any venipuncture, arterial puncture, or capillary blood collection procedure. Proposed Requirement 1C aims to eliminate transfusion errors related to patient misidentification.
Goal 7 Perhaps most newsworthy is the inclusion of a new proposed requirement aimed to stop drug resistant organism infections in hospitals. Specifically, proposed Requirement 7C targets MRSA and CDAD. Among its 16 IEs, 7C requires education for healthcare workers, patients, and their families, as well as the measurement and monitoring of infection rates. It also requires lab-based alert systems when MRSA patients are detected, and a surveillance system for CDAD.
Requirement 7D proposes 13 IEs, including IEs for before and after insertion of the catheter. Requirement 7E has both general and specific IEs, seven in total, for the prevention of SSIs.
Goal 8 Proposed revisions to Goal 8 are composed of new and revised requirements and IEs intended for clarification, not alteration, of previous requirements. Revisions have been made to Requirements 8A, 8B, and 8C, for the reconciliation of patient medication across the continuum of care. A Requirement 8D has been added requiring modified medication reconciliation processes in settings where medications are not used, used minimally, or prescribed for short durations, such as outpatient radiology, ambulatory care, and behavioral healthcare.
Goal 13 Two IEs have been proposed to Goal 13, which targets increasing patient involvement in their own care. The first new IE would require facilities to provide patients with information regarding infection control (for example, hand hygiene or respiratory hygiene practices), while the latter requires facilities to provide surgical patients with information on preventing adverse events during surgery (such as patient identification or surgical site-marking processes).
Universal Protocol Proposed changes to the Universal Protocol, like those made to Goal 8, are not meant to change the overall concept of the Goal, but rather to clarify existing requirements. According to the draft 2009 NPSGs, the Universal Protocol contains the same concepts as it has in previous iterations.
Extensive clarifications have been proposed for Requirements 1A, 1B, and 1C, including four rewritten IEs under 1B (surgical site marking), and six rewritten IEs under 1C ("time out" verifications).
At press time, The Joint Commission did not respond to a request for comment.
According to a survey, two out of three Georgians say they would pay $25 or more a year to support a statewide system of trauma care. That positive response has impressed several state officials, who are considering allocating millions of dollars for trauma care. Advocates of the system say it would increase funding for hospitals with trauma units and improve communications among these centers.