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Enhancing patient satisfaction, safety, and risk management through medical call centers

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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 …

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.


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  • 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 Center1
  • 2. The insults ―moron,‖ ―idiot,‖ ―imbecile,‖ and ―cretin‖ were all once official medical diagnoses. - Balderdash & Piffle, BBC 22
  • 3. Today, we will talk about: • Healthcare reform impact • Accountable Care Organizations • Traditional & Innovative solutions bringing it all together3
  • 4. Resources • TeamHealth – Dr. Gar LaSalle, Chief Medical Officer – TeamHealth Midsouth • HFMA • AHLA Connections • Facebook and Twitter • Studer Group4
  • 5. Resources You!5
  • 6. 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 rising6
  • 7. 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.7
  • 8. Healthcare Reform8
  • 9. Healthcare Reform Goals• Reduce costs with goal to assure affordable coverage, and: – Invest in prevention & wellness – Improve safety and patient care9
  • 10. 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?‘10
  • 11. Accountable Care Organizations11
  • 12. Accountable Care Organizations• Getting started – Target market – Local ACO? – Reimbursement structure – Identify patient-related strategies – Identify organizational strategies12
  • 13. Accountable Care Organizations• Managing risk and the market place – Timely information – Who does what? – Cost to begin an ACO/ongoing costs – Which physicians will participate?13
  • 14. TriviaWhich plant shoots from the hip?14
  • 15. 15
  • 16. Traditional Call Center Solutions • Clinical – Community lines – Physician after-hours services16
  • 17. Traditional Call Center Solutions • Non-clinical – Physician referral – Class scheduling17
  • 18. WIIFM? • Market share • Brand presence • Market growth • ROI • Community outreach, (non-profit hospitals can satisfy IRS qualifications) • Recruiting & retention opportunities • Best allocation of resources18
  • 19. Questions…Comments?19
  • 20. InnovationHow do you move forward on the monkey bars?You let go of the bar behind you.20
  • 21. 21
  • 22. Social Media22
  • 23. Innovation—Twist on Community Outreachand Class Scheduling Combined with social media, can be a new way to approach the market23
  • 24. 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 blogs24
  • 25. 25
  • 26. 26
  • 27. Facebook27
  • 28. Facebook28
  • 29. Social Media Risk • HIPAA violations • Employee policies29
  • 30. Social Media is here to stay • Not using social media could create a generational gap in communication • Educate employees on the right use30
  • 31. WIIFM? • Market share • Brand presence • Market growth • Community outreach31
  • 32. Questions…Comments?32
  • 33. 33
  • 34. ―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 TeamHealth34
  • 35. Innovation—New approach on an old routine35
  • 36. Innovation—Patient Satisfaction,Safety and Risk Management • Post Discharge Calls • Who should make these calls? – Emergency Department – Inpatient – Outpatient – Other36
  • 37. Obstacles to the patient follow-up routine37
  • 38. 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 38
  • 39. Annals of Internal Medicine, February 2003 Type of Adverse Events “Nearly 1 in 5 patients”* Other 400 patients surveyed Fall 8% 76 (19%) had adverse events after discharge Nosocomial 4% Infection 5% Adverse Procedure Drug Related 17% 66% Event * 81 events occurred in 76 patients * 81 events occurred in 76 patients “Adverse Events After Discharge from Hospital”* “Adverse Events After Discharge from Hospital”, Annals of Internal Medicine,February 2003
  • 40. State University of New York Study Mayo ClinicProceedings, August 2005 • Only 28% knew medication names • Only 37% knew purpose of medication • Only 14% knew side effectsState University of New York Study Mayo ClinicProceedings, August 2005
  • 41. What else should Post Discharge Calls include? • Concern • Compassion • Care • Help the patient move forward with next steps in care process 41
  • 42. 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 42
  • 43. Specific ED risk management discharge calls • TIA‘s – Some will have an adverse event within 2 – 5 days43
  • 44. Specific ED risk management discharge calls• Abdominal pain – when the cause hasn‘t declared itself at time of discharge44
  • 45. Post Discharge Call benefits: • Reduce non-reimbursable readmissions • Patient safety • Patient satisfaction • Reduce risk • Brand presence • Best allocation of resources45
  • 46. 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
  • 47. Post Discharge Calls and HCAHPSSeven 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)
  • 48. Post Discharge Calls Likelihood of Recommending – Inpatient “Likelihood of Recommending” 100 98 98 99 98 98 98 99 90 80 75 76 70 64 60 62 Percentile Rank 60 56 59 50 40 30 20 10 No No No No No No No Call Call Call Call Call Call Call Call Call Call Call Call Call Call 0 3Q06 4Q06 1Q07 2Q07 3Q07 4Q07 1Q08Source: New Jersey Hospital, Total beds = 775 Studer Group No Call Call Source: New Jersey Hospital, Total beds = 775
  • 49. Post Discharge Calls Likelihood of Recommending - ED “Likelihood of Recommending” 100 95 93 93 88 87 90 80 76 77 76 70 70 62 63 Percentile Rank 60 47 47 50 38 40 32 27 29 30 25 20 10 No No No No No No No No No Call Call Call Call Call Call Call Call Call Call Call Call Call Call Call Call Call Call 0 1Q 06 2Q06 3Q06 4Q06 1Q07 2Q07 3Q07 4Q07 1Q08Source: New Jersey Hospital, ED Visits: 85,034, Total beds = 775 Studer Group No Call Call Source: New Jersey Hospital, ED Visits: 85,034, Total beds = 775
  • 50. 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
  • 51. Questions…Comments?51
  • 52. Innovation—Patient Experience:Our observations Common practices needed to become more physician-specific52
  • 53. Our solution Dedicated outbound patient satisfaction calls53
  • 54. What did we do with the information? Brag Board54
  • 55. Other Results55
  • 56. Challenges and Learning Experiences • Highly organized program • Managing data and delivery – Frequency – Benchmarking • Reminder: – Coaching and motivational tool – Not a replacement tool for formal surveys56
  • 57. 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 – Accountability57
  • 58. Overall, why is it important? • Leadership • Brand Marketing • Service Recovery • Tool for your clinicians – Recognition – Customer happiness – Loyal customers58
  • 59. Questions…Comments?59
  • 60. 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 Growth60
  • 61. 61
  • 62. 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 strategy62
  • 63. Who else might you want to engage? • CMO • CNO • Others63
  • 64. What should you look for in amedical 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 competencies64
  • 65. How will you grow forward? 65
  • 66. Tina Minnick Director of Business Development (865) 985-7313 Tina_Minnick@TeamHealth.com www.thmedicalcallcenter.com66