How to Improve Your Front Desk Performance
George Conomikes is head of the practice consulting firm. He has been editor and publisher of Conomikes Reports on Medical Practice Management for 20 years and has written two books – Successful Practice Management Techniques (1988) and The Answer Book on Maximizing Practice Profits (1997). The Conomikes organization has also presented over 350 workshops, sponsored by over 35 specialty, state and medical associations. George was also featured on Medical News Network with a special series on practice management. He is an economist who formerly taught at the University of Chicago, where he was also head of the Commerce Department. In addition he has been a guest lecturer at over 15 universities and colleges. He is listed in Who’s Who in America, Who’s Who in the World and other Who’s Who directories.
Sponsored by Quill.com
Co-hosted by HealthCents, Inc.
Video Transcription of How to Improve Your Front Desk Performance
Steve: We are ready to begin. First, I would like to welcome you to Quill Healthcare's second monthly value-added webinar. Quill Healthcare is the leading seller of medical and office supply products and is dedicated to providing you with useful content in these webinars purely as a value-add to your practice.
I am absolutely certain that today's session, "How to Improve Your Front Desk Performance," will send each of you away with many tips that will help you improve the efficiency and the effectiveness of your practice's operations.
Today's topic will be presented by Mr. George Conomikes, who is the head of the practice consulting firm Conomikes Associates. George's firm has undertaken over a thousand onsite consulting assignments throughout the U.S., and George has been the editor and publisher of Conomikes Reports about medical practice management for over 20 years.
The Conomikes Organization has also presented practice management workshops sponsored by over 35 specialty, state and medical associations.
George is a prominent speaker. In fact, he is an economist who formerly taught at the University of Chicago, where he was also the head of the Commerce Department. In addition, he has been a guest lecturer at over 15 universities and colleges.
He is listed in several Who's Who in America, Who's Who in the World and other Who's Who. We are really pleased to have George with us today.
Briefly, I would like to introduce myself and my partner, Susan Charkin. We are consultants with Quill Healthcare, and combined we have over 35 years of experience in the healthcare and computing industries. So we bring a collection of skills here to assist as well, including other topics related to practice management, healthcare consultancy, and healthcare payer contracting.
So we're very pleased to emcee this session on behalf of Quill Healthcare, and we will commence the session.
Before we get started with the main event and before I turn the floor over to Mr. Conomikes, I do have a few administrative matters.
One of the things that we would welcome here is your participation. These sessions tend to be much more valuable if we end up with an interactive dialog with thoughtful questions coming from you, the audience. We welcome this being a team sport, so to speak, and we would really like you to ask questions in whatever form you're most comfortable asking those questions.
One way you can do so is by simply sending an email to info@healthcents.com at any time during the session. In doing so, we will gather the questions and during break points in this discussion we will pause, we will ask your questions for you and answer them.
Additionally, when we get to break points during this session, I will pause and allow you to go ahead and ask your questions live.
At any time beginning now you may send your questions to info@healthcents.com. They will be retrieved by my partner, Ms. Susan Charkin, and she will ask your questions for you.
If for some reason you lose connection to this web session, you can of course dial back in on the telephone side to the phone number information and conference IDs that you have, but you can also go to //Join.Me/healthcents in any browser and you will be instantly restored to this webinar session.
Additionally, as I mentioned, we are recording the session and the recording will be made available to all webinar participants as well.
Just to test the mechanism before I turn the floor over to Mr. Conomikes, what I'm going to do for the moment is I'm going to go ahead and unmute the line so that people can ask questions. If you have any questions at this time before we start about the administration of this session, then go ahead and ask your question.
I will pause for just a moment before I turn the floor over to George. Silence is usually the sign of no additional questions.
Donna: Hello?
Steve: Did you have a question?
Donna: I do. My name is Donna. I'm calling from Gary from Community Healthnet. I'm the clinical nurse manager here. I was wondering if you're able to copy the presentation slides afterwards.
Steve: Thank you for asking that question, Donna. At the end of the session, I will provide everybody who is here instructions about how to obtain a PDF copy instantly at any time of this entire slide deck. That will be made available.
Donna: Thank you.
Steve: Thank you.
Without further ado, I'm going to turn the floor over to Mr. George Conomikes. George, take it away.
About Conomikes Associates Consulting Services
George: Thanks a lot, Steve, for that nice introduction and thanks to Quill Healthcare for sponsoring this important workshop.
Our company is Conomikes Associates and I happen to be the head of it. As Steve mentioned, we've done over 1,000 onsite assignments with all specialties and all sizes of practices from solo to large groups.
Our major type of activity is called Improving Practice Performance and Profitability. Most of these consults we have found need a redesign of front-desk activities, which is why we chose this topic for today.
Here are some recent examples of practices I've been to. I was at a two-doctor rheumatology practice in Los Angeles about three weeks ago. Their front desk was a major problem, and we told them how to reorganize it.
Two weeks earlier, I was in Texas with an eight-doctor gastroenterology practice, and again this practice had problems at the front desk. We'll be referring to both of these practices and others as we go through.
The other assignment that we seem to do a lot of right now is practice valuations for a practice sale or purchase. As a lot of you know, a lot of hospitals are seeking practices and a lot of large groups are seeking smaller practices. What we do is help the doctors know what the value of the practice is.
These are our two major activities as a background.
Front Desk Activities Vary
The next slide is Front Desk Activities Vary. As we know, the more doctors, the more front desk activity. Also, as a rule of thumb we find that primary care practices have more traffic at the front desk per physician than the other specialties, on top of which primary care physicians see a few more patients per day and per week than the other specialties do.
Now we would like to find out more about you. I'm going to turn this over to Steve who will do the polling with you.
Steve: Thank you very much, George. I mentioned that this is going to be a team event. Besides asking your questions, we're going to be asking you throughout this session about four questions to learn a little bit more about your practices.
The first thing I want to mention is that your answers are obtained instantly and anonymously, so we don't know who is answering, but it is most helpful if you would participate in answering these short questions. I will show you how to do that.
Question 1: How many physicians are in your practice?
First of all, the question here is how many physicians are in your practice? Are you a solo practice? Answer A. Are you a practice of two to five physicians? Answer B. Are you a practice of six to 10 physicians? Answer C. Are they 11 or more? Answer D.
The way that you go about answering these questions is to go to www.Healthcents.com/q1. I will give everybody a moment.
I will show you as if I were answering the questions as you are how to go about doing that. You simply go to www.Healthcents.com/q1, and when you get to that question it will be the same question, How many physicians are in your practice? You pick your answer and click "Done." It's as simple as that.
I will wait about 60 seconds for that to occur and then we will take a look at the results. Again, go to www.Healthcents.com/q1 to do your polling on this question. How many physicians are in your practice? I'll wait just a little bit longer to give everybody an opportunity and then pick it up.
Let's take a look at what the answers might look like. Here is what we have. We have 51 responses, so the first thing is I would like to thank those of you that participated and encourage you to continue to do so during this session.
George, here is what we have. Solo, we get about 27% of the audience with 14 as the count. Two to five is about 50%. Six to 10 is about 10%. Eleven or more is about 11%.
I find this interesting because, on the broader set of data that I've seen from sources such as InfoGroup, while about 50% of the physicians currently in the U.S. are part of largely merged practices of 10 or greater in size, still the vast number of practices tend to be solo to 5-physician practices.
Sure enough, we can see about 77% that have taken the survey are in that situation. So we have again about 77% that are solo to five.
George, did you have any other comments about this?
George: That fits in roughly with the data that's available from the American Medical Association and also from list companies that keep track of physicians.
You'd think with all the hospitals buying practices, which they've been doing in great numbers the past three to five years, you'd have less solo and less two-to-five, but that seems to have held, and a number of hospitals have actually brought in these small groups and just stopped at that point.
Seventy five percent between one and five doctors is not out of the question. That's a pretty healthy range.
Steve: What I found revealing as well is the InfoGroup list service, which when asked the question about number of practices, again it's in about this range of 75% one- to five-physician practices. Yet when asked the question about how many physicians belong to practices that are greater than 10 in size, there are at least half of the physicians today that are in these larger practices.
Again, this illustrates the importance of the small practice. While there are a lot of mergers, hospital-based groups and ACOs forming, these small practices still comprise the lion's share of practices in the United States.
Thank you for participating and answering that question.
Question 2: Type of practice
Now we're going to go to our second of four questions, which is we'd like to know a little bit about the type of practice that you are. Is your practice a primary care specialty only, Answer A, a specialty practice, Answer B, or Answer C, a multi-specialty practice? Please go to www.Healthcents.com/q2.
As before, you will simply go to your browser, go to www.Healthcents.com/q2 and up comes the question. Is your practice a primary care, specialty or multi-specialty? Again, let me give you a moment to do this.
Again, these are anonymous answers. We do not catalog who answers the questions. We simply catalog the totals.
Let's take a look at the results and see what we have. Again, we have a similar number response, 49, but 31% of you are primary care, 55% are specialists and 14% are multi-specialty practices.
George, do you have any comments about this distribution that we see among our audience?
George: That's, oddly enough, about the distribution we see. Roughly one-third of practices in the United States are primary care, which is family practice, internal medicine and pediatrics, and 50% to 60% are non-multi-specialty. Multi-specialty practices used to be only 5% to 10%, but now we can see they're approaching 15%, and probably within the next year or two will be closer to 20%. That distribution fits in with the national data.
Steve: Thank you, George.
Also, I see a couple of comments flashing by and I just want to comment. One is to make sure we're speaking loudly enough, so let's make sure both of us keep our voices as close to our mics as possible.
The other question I saw flash by was from a dental practice. Out of deference to the audience, we do have various types of medical providers on the line. While the charts and the questions are somewhat geared toward a physician practice, what I'd like to point out is that many of the techniques and challenges that Mr. Conomikes will be explaining are definitely pervasive and inclusive to dental practices, chiropractors, even veterinary practices, you name it.
Definitely bear with us there while the presentation is geared at the physician practice. I think you'll find that, regardless of the type of office you're running, 95% or more of the material is applicable.
We'll continue on from here. Thank you for participating in those two questions. We'll have two more for you in a short time, and we will be also pausing for questions and answers. Please continue, George.
Front Desk – Years Past
George: Let's talk about what the front desk was like in past years. First off, there was less volume per doctor. What we've seen in the past 15 or 20 years is that doctors, in order to make the living that they made before, if they used to see 12 to 15 patients a day, now are seeing 15 to 18 patients.
This is where we've seen the increased use of physician's assistants taking place. That boom has been started by the fact that physicians want to see more patients. One way to do this is to bring in PAs and nurse practitioners.
In the past, the front desk, although it was busy greeting patients, answering the phone, scheduling appointments and collecting from patients as they were exiting, we go to the next slide and we look at the front desk today.
Front Desk – Today
As I mentioned before, doctors are seeing more patients per week and in many cases more patients per day. What we found is that the use of physician's assistants, for example, allows a doctor that normally saw 15 to 20 patients, now sees with a PA about 30 to 35 patients. Therefore, we have a lot more activity because of this taking place at the front desk.
Though there have been a lot of changes, today the front desk still greets patients, but now they do a lot of work getting demographic data from the patients, especially starting with a new patient to get all the data they need.
For established patients, a simple idea is to give them a copy of their past data, because for patients that haven't been in, in 120 days or more, there's a good chance their insurance might have changed, they might have moved, they might have changed phone numbers, or they might have changed employers.
The next dot is collecting deductibles, co-pays, and past-due balances. Deductibles and co-pays have skyrocketed in the past few years, but right now with Obamacare deductibles are in the thousands of dollars.
Worse than the higher deductibles is the fact that many new enrollees, because of Obamacare, are more naïve about deductibles, co-pays and the rest, and they require a lot more handholding at the front desk.
The front desk still answers and directs phone calls. The front desk still schedules appointments, but they do much, much more than they did in the past. So that leads to problems at the front desk, which is in our next slide.
Steve: I would ask anyone who does not have their phone on mute to please mute it out of deference to everyone else on the line. I'm also going to put all of the lines on mute, but there will be a couple of Quill lines open. I would ask those at Quill Healthcare to please make sure that your lines especially are on mute because even when I perform this function your lines will still come through if they're not on mute. Thank you very much.
George: Thank you, Steve, for clearing that up.
Today's Front Desk Problems
Here is today's front desk. Patients are confused and too many staff. Patients sometimes don't even know who to check in with at some practices.
Front desk, if they do not collect what they should be collecting, whether that's co-pays, deductibles, or normal charges, that means that the billing staff has to do it. If we don't collect and we don't update our patient demographic data at the same time, it puts more onus on the billing staff.
We have a lot of phone traffic. At most front desks today the phones are ringing. We've been to some practices that don't answer the phone until 10 or 12 rings, which is really bad service. Patients sometimes are put on hold for long periods of time. That's not good service.
There is sometimes a lot of noise at the front desk because of ringing of the phones, patients being talked to on their way in and patients being talked to on their way out.
Believe it or not, there are also a lot of staff conflicts that are caused by this. We recently were at a practice of six doctors, and there were three people at the front desk and they all were doing the same tasks. What we found out during the interview process is they seem to get in each other's way because they really said openly that they didn't care that much about each other, which really is not a good way to run a medical practice.
Then the question, given these problems, is: What are some of the solutions?
Suggested Solutions
These three suggested solutions will be covered in depth during the next few minutes.
The first solution is what we can do to reduce or eliminate phone traffic to the front desk? Secondly, what can we do with the patient check-in and collections activity at the front desk?
Now let's stop on that one. We could have two or more staff. We could have one person perhaps at the hello window and another person checking out at the goodbye window, which we like to call it.
Next is telephone and appointment staff. Telephone and appointment staff focus mainly on making appointments for the patients.
I need to remind you that I'm going to be presenting you with options on these solutions that have worked at many practices. These are not originals with us, but we've had practices that have addressed these problems and solved them. What we're going to do is share this with you.
I want to caution you that these options do not mean that all of them will work with you, but if you get one or even a few good ideas with this webinar, it will be worth your valuable time.
Eliminate/Reduce Phone Traffic to Front Desk
Let's shift over now to how we can eliminate and reduce phone traffic to your front desk. What we've seen work at a number of practices is to have dedicated lines. One type of specialized line would be the appointments own line.
First of all, let me talk about the reason we suggest this. If you do a survey of incoming calls, and we've done a number of these, we always find that a plus or minus 50% of callers are calling for an appointment. We really believe that there should be an appointments line that is staffed by an appointments person who also could be the backup for other phone traffic.
Your billing staff, whether it's one person, two or more, should have their own line. When a person gets a bill and they have questions about it, they don't call the practice's main line. They call the line that's on the bill, which goes directly to your billing staff whether your billing staff is one, two or more people.
The other line that we've seen working at practices is what we call the nurse line. This is the line where referring physician practices call. There are calls for physicians or nurses and that line would be used. People that are calling for medical advice would be calling on that line.
Let me stop and indicate that all these lines would be clearly communicated to your patients when they first become your patients.
Last, but not least, is a manager line because the manager is there to get calls from physicians, suppliers and the rest.
These four lines with separate numbers should be on business cards that are given to all patients when they become patients.
The result of having these separate lines is you'll have less phone traffic going directly to one or two people at the front desk, and these direct lines also help the patients not be on hold and getting directly to the person they want to talk to, whether that's the appointments person, the nurse, or somebody else.
Patient Check-In/Collections Staff
What else could we do? Well, what we might consider is a patient check-in and collections staff. This usually means two or more staff, but in a smaller practice or a one-doctor practice, this may be done by one person depending upon your traffic.
If we have one doctor seeing 15 to 25 patients, the doctor is probably seeing 3.5 patients per hour, and therefore we don't have logjams at the front desk or people coming in and calling in.
The prime task of the patient check-in and collections staff people is to greet and collect. Today, we have co-pays, deductibles and other charges and we do everything possible to collect those at the front end.
The other task of the patient check-in and collections person is to collect demographic data, first with new patients. When they check in, we want to be sure that they fill out name, address, phone numbers, insurance and insurance numbers. It's important that the front desk check this data to be sure that all the data the practice needs has been filled out. We do that when the patient hands it in to us.
For established patients who haven't been in, in 90 days or more, here is the problem. They could have moved, changed phone numbers, changed employers or changed insurance.
What we want to do when the established patient comes in that hasn't been in for three or four months is print out the demographic data that we have on them, hand it to them with a red pen and say to them, "Will you please check this data and be sure that it's accurate and make any changes you want?" You provide them with a red pen so that they can make those changes.
On top of what we have here, another thing that will help patient check-in and collections staff is the preparation for today. What we recommend is that, one to two days in advance of the appointment day, people get reminder calls and emails.
Let me stop on this one. We think it is very important that all practices get email information from patients. A lot of practices have told us that emails are more effective for reminder contact than making phone calls. By the way, it also involves less time.
We could use the emails for appointment reminders. We could use emails to remind people at the same time about co-pays and deductibles.
For those of you that are interested in knowing how this information could be gathered, your computer system or your clearing house can provide you help with determining how you can prep a patient by email better than by telephone.
The whole idea here is to improve your front desk collections, and this is a good start.
The next point is having telephone and appointment staff. What do we recommend here? One or more staff should be the prime phone receptionist who answers incoming calls.
Let's stop for a minute. We just talked about dissipating the amount of phone calls. If your practice has one number for incoming calls and receives 150 or 200 calls a day, by simply doing what we talked about a few minutes ago, which is separate phone lines for appointment scheduling, nurse appointments and going directly to the billing and collections staff, then our phone traffic will be reduced significantly. Therefore, the prime phone receptionist will not be answering as many calls as he or she did in the past.
That is backed up by our prime appointment scheduler, who answers the appointment line. Remember again that appointments represent about 50% of your incoming phone traffic.
Telephone/Appointments Staff
Next, in some practices we've been to, when patients who are told by the physicians to come back in one month, three months or six months, the back office staff, whether that's a medical assistant, an RN or a PA, will schedule that in the back office area rather than the patient having it done up front.
This is another option for you to consider if it's possible for your back office staff to set up future appointments with patients that are there today.
The last thing we'll talk about on this slide is considering hands-free phone headsets. The practices we've been to that are using these phone headsets tell us two things. First, it reduces the noise level. Second, it reduces the stress. It allows people to be able to use both hands to be able to make notes.
What we want to do now is address the question of peak hours and peak days. Again, what I'll do is turn this over to Steve.
Steve: Thanks, George. I did see a couple of comments again. People say that the voice intermittently is cutting in and out, so I just want to remind you to speak loudly and close to the mic and that will help a little bit.
George: Thank you very much. I appreciate it.
Steve: As far as the participants go, this is a great time for us to actually take some live questions and move into question and answer mode.
At this time if you would like to ask a question, you can ask your question and dialog with George. For anyone that would like to ask a question, now is a great time, so please jump in.
While the audience is gathering up their questions, I understand we have received a few at info@healthcents.com, so I'll turn the floor over to my colleague Ms. Susan Charkin. She has a few questions that she will be asking George on your behalf.
Susan: Thank you very much, everyone. I appreciate your time this afternoon. I have a couple of questions that came in at info@healthcents.com.
Email Reminders Question
The first one is regarding emailing for appointment reminders, George. Do those emails have to be HIPAA compliant and if so, how? If you can answer that one, we might have another one as well.
George: Do you mean do they have to comply with HIPAA?
Susan: That's correct. Because they're email reminders, do those email reminders have to comply with HIPAA?
George: No, they don't have to comply with HIPAA because it's a one-way communication, and we're not indicating the name of the patient. All we're saying to the patient is, "Your appointment with Dr. Jones is scheduled for 1:30 p.m. on Tuesday, December 7."
That's a good question because most people's emails are private emails dedicated mainly to one person.
Staff Challenges Dealing with Front Desk Problems Question
Susan: The other question I had that came in says, "What is the biggest challenge that you've seen with staff in terms of dealing with front office staff? What would you recommend overall?"
This might be redundant from some of the information that you've given, but what is the biggest challenge that you've seen in your years of doing this and how has it been solved?
George: I think the number one way to do this, and a lot of practice managers have told us this, is to really involve the staff in trying to solve their front desk problems and make it a total staff effort.
Sometimes your nursing staff and your billing staff that are not at the front desk have some very good ideas, and it's critical to involve everybody because there may be a redelegation of work.
For example, I've already suggested that we might consider having a back office staff back up when the phone lines are terribly busy. That's a possibility.
I think a manager's job is to try to bring the front desk as a problem area to the attention of every non-clinical staff member at the practice. You might even include non-physician staff as well in this process.
Most people have told us they got their best ideas from their own staff and not from attending a workshop or any other means.
Steve: I have just a quick interruption during this Q&A. I have seen a couple of instant messages flash by.
For those that joined the session a little bit later, I just want to mention that we will be providing complete copies of the slides. At the end of the session, we'll be explaining exactly how you go about requesting and immediately obtaining those copies.
They will be made available following this session, so I just want everybody to be aware of it and we'll explain that at the end.
Continue on, please.
Dental Office Front Desk Question
Susan: We have one more question for George and this is from a dental office. Are there any particular items that would be different for how a dental office is run as far as their front office staff versus a physician office?
George: The question is what percentage of your patients has dental insurance? It is the dental insurance patients that need to be given a different type of message regarding their co-payments, if any are required for the visit or the service to be rendered.
Aside from that, I think again they could employ email, and I think they could do the same types of reminders that other practices do.
A key issue on this is that some practices have found that reminder calls, no matter what the specialty, whether it's dental or medical, done two days in advance are sometimes better than one day in advance.
If we do it a day in advance and a person is at work and they come home at night to a reminder call and realize that they have something on their agenda that will preclude their coming the next day, it might be better to do the reminder calling two days in advance so people, if they cannot make the appointment, could call and allow you to work somebody else in.
That's a very good question, Susan. Thanks.
Steve: I might add as well, George and Susan, that for medical practices particularly that have patients who may be in the health insurance exchanges, one of the trends that we're seeing is much higher deductibles and much higher coinsurance and co-payments potentially for those types of patients.
It's very important to do the patient verification following some of the processes that George has indicated up front in terms of benefit verification.
Certainly for dental offices it's apropos because you're likely to have a much higher portion of payment required from the patient.
Have the business processes in place to do the upfront verification with the health insurance company, not just to verify that the patient has a benefit, but nowadays to make sure that you know what the patient obligation is, and then for office visits being able to collect for that up front becomes very key.
George: That's a good point, Steve, because one of the key questions that should be addressed with patients is to verify what plan they belong with, because people nowadays are changing plans more frequently than ever before.
Some employers are changing plans more frequently. Some are dropping coverage and people have to pick up their own coverage, so the first question is eligibility.
When we get the information in advance, we want to check that person's statement on insurance because they might have had certain insurance 90 or 120 days ago. What we may want to do is verify their insurance in the reminder call two days in advance and then call the plan to find out if they still are enrolled.
That's the new trick nowadays. A number of people are not aware that the insurance plan has changed. It might be within the same Blue Shield plan, but it may be Plan A versus Plan B.
Thanks for bringing that up, Steve.
Steve: Thank you. I saw that a viewer had a question about a smaller office. Unfortunately, the entire question didn't fly by on chat. If you'd like to ask your question, please come on in and join the question and answer session. We'd be glad to answer it.
Susan, are there any other questions for us here?
Susan: No. I think we are ready to move on.
Email Reminders Question
Sharon: I have a question that was actually asked, but I somehow missed the answer. I heard the question regarding the email reminders, which I think is a great idea. What was the answer to that about those having to be HIPAA compliant or not?
George: There's no problem in email communication and HIPAA because you don't have to identify the name of the patient when you're calling. You just say first names, like, "George, this is your appointment reminder for Wednesday at 1:30 p.m. with Dr. Jones." That's all you need to say.
You could say, "P.S., if there are any problems with this appointment. please call the following person," with a direct line to that person.
Sharon: Thank you so much.
George: That's a very good question. Thank you.
Steve: I think with that, George, we're ready to continue on.
Question 3: What are your peak hours of operation?
George: I think we want to now do a survey of peak hours and peak days of operation. Are we ready to do that, Steve?
Steve: Sure. In fact, we're going to ask the final two questions back to back. For those that have been on the line, I'll remind you how we do that, and for those that may have joined in flight here I'll also explain the short process.
First of all, the question is "What are your peak hours of operation?" We're going to be asking you first about peak hours of operation and then we're going to be asking you about peak days. Here we have three choices. Answer A is between 8:00 and 10:00 a.m. Around 1:00 to 3:00 is Answer B. Other is Answer C.
To actually answer the questions, go in a browser session to www.Healthcents.com/q3. These answers that you give are all anonymous, so we don't know who is answering the questions. We're simply tabulating numbers to make it interesting for all of you to see what the patterns are relative to peak hours and days of operation.
Let me illustrate once more how you go about answering the question anonymously. You go to www.Healthcents.com/q3, just like you see in my browser, and there is the question. You simply choose the circle that represents your answer and click "Done" and you're done.
I'll wait a few more seconds, and then we'll go take a peek at what the tabulation of answers look like from the group. For those of you who have ever been in a ballroom, this is kind of like where they give you those little hand-held devices and you press a red, green or yellow button. This is our virtual voting.
Let's take a look and see what we have here. First of all, thank you again. We have 53 responses. It looks like the winner is around 8:00 to 10:00 a.m. That seems to be the busiest times for most of the practices on the phone. We had about 47%. About 19% were from 1:00 to 3:00 p.m. and then Other was 34%.
George, do you have any further insights on that one?
George: The first hour of the day every day is usually the busiest. We'll address how to decrease that traffic later on, but that's true to form. Forty to sixty percent of the calls come in within the first hour or hour and a half of the day.
Question 4: What are your peak days of operation?
Steve: Toward that end, we have one final question for everybody and we'd appreciate once more if you would participate at www.Healthcents.com/q4.
This one is about your peak days of operation. Is it Mondays and/or Fridays, other days of the week, none of the above or all of the above? Let' see how the group answers that.
Once again, you go to www.Healthcents.com/q4 and you'll be presented with your choices. Simply select your choice and we'll tabulate the results. This is about peak days of operation. Pick your choice, click "Done" and you're done.
Let's go back and see how everybody voted. It looks like we have a clear winner here. Mondays and/or Fridays was almost 64%. Other days of the week was at about 19%. None of the above was less than 2% and about 15% said all of the above.
George, what do we learn from this kind of a distribution?
George: I've been to practices and my colleagues have been where Mondays are called disaster days at the practice because we just have this high volume. Basically, we've been closed Saturday and Sunday, and people have been saving their questions and their desire for appointments, so especially Monday morning is just a peak time.
Fridays are also a peak at many practices because people want to get into the practice, especially people with problems, before the weekend starts.
I would say that probably two-thirds of those 64% that said Mondays and Fridays, roughly 45% or 50%, are Mondays being peak days. This fits in with the norm.
Steve: Excellent. We'll continue on here.
Consider Relocation of Some Front Desk Staff
George: Continuing on, what we've seen work at some practices is relocating some of the front desk staff. For example, I was recently at a three-employee front desk practice. There was a high degree of noise going on, and people were getting into each other's way.
Very simply, what we recommended was that two people remain at the front desk and one person be relocated away from the front desk and be moved into an area where they're the primary receivers of incoming phone traffic and allow the front desk people to serve the patients that are checking in and also serve as a backup to that third person. That's very often the suggestion.
We've been to one practice relocating staff away from the front desk where there were four people at the front desk. What we did was we moved two of them literally just six feet back of the front desk area, where they had their own desks, but six feet removed from where their two colleagues at the front desk were. These people were the prime phone answerers, and they used those headsets that also reduce the noise level.
At another practice that we worked in quite recently, we recommended that a key person at the front desk be relocated, and there was no room to put them anywhere near the front desk. They literally were put into another office, and they were the primary phone answerers, which reduced the pressure on the two other people at the front desk.
Again, headsets should be considered for everyone, even including front desk staff. One thing I've seen people do with their headsets is if they're at the front desk and they're helping check people in, they will actually move the mouthpiece away from their mouth so people will know that they're not on the phone.
In some cases, they simply take the phone off and assume that the other colleagues will be answering the phone on their behalf.
These are some ways of redesigning the way people work by just changing where they're located.
Consider Part-time Staff for Backup of Telephone/Appointment Staff
That brings us to the question of telephone activity and how we can address the problem. Our survey that we just did showed that Mondays and Fridays are the peak days and the first couple of hours of the day are the peak hours.
What some practices have done is they've brought in part-time staff for backup and they actually will have this person or persons work peak hours, usually the first hour and a half or two hours of every day, and in some cases peak days.
Maybe they'll back up the staff all day Monday, especially Monday morning. In some cases, where we have peak days on Mondays and Fridays, have this person involved not only in the first hours of every day but consider having that person spend more time at the practice on the peak days such as Monday and Friday if those are your peak days.
The other thing we need those people for is if staff is taking time off for dealing with personal matters and vacation days. It's very tough for those people to come back to work with a big backlog of work to catch up. We think that the part-time staff is a good way to go.
In addition to the idea of part-time staff, we've been to some practices where, when all is said and done, there are some times where there are super-busy times, even with this part-timer working as backup.
What some practices have done is to have their billing staff, whether it's one person or more people, as backup at the super-busy times, which again could be your Monday mornings, all day Monday, Friday mornings or all day Friday.
This is the use of part-timers as well as considering the use of employees already there, such as your billing and collections staff.
Increase Phone Availability for Patient Convenience
Next we want to talk about increasing phone availability. I'd like to stop at this point and remind everybody that what we really should do with our telephones is put a dollar sign on the telephone.
It needs to be recognized that the way a practice makes money is to answer the phone. If you answer the phone, you serve patients. If you answer the phone, you make appointments. If people come in for their appointments, they provide money to the practice. That money in the practice pays your salaries.
Phones should not be looked upon as the enemy. They should be looked upon as the single tool that brings revenues to the practice and helps pay everybody's salary.
Another problem is that people have to recognize that, for a new patient caller, their first impression of the practice is how the phone is answered.
A major goal that we've been covering is to make sure that phones are answered and secondly that patients are not put on hold for a long time. There's a big irritant if you're put on hold and you're not dealt with within the next 30 seconds.
Here's another negative. The first dot there says, "Eliminate phone prompts." I was at a practice in Texas six weeks ago where there were seven phone prompts. If you want to talk to the billing staff, press 1. If you want to make an appointment, press 2. If you want to talk with a manager, press 3. If you want to talk with a nurse, press 4. I'm saying, "My God."
The reason I'm calling and 50% of all callers roughly are calling to make an appointment, and they don't want to be hit with those phone prompts.
Phone prompts are a way of trying to avoid talking with a patient, and really we've recommended eliminating them at practices because most practices that have them have four to seven phone prompts. What we have just talked about so far are ways to be sure that the phones are answered. That's your front line of patient service.
What else will help you? One practice I was at three months ago was closed all day Friday afternoon from 12:00 on. If you called after 12:00 p.m. on Friday, you were given a phone prompt that said the office is closed.
Now this practice happened to have eight physicians, so the question I raised was, "Why are we closed on Fridays?" The answer was, "We've always done it that way." "Well, that means that roughly 10% of your patients are not being served." They said, "What do you mean?" I said, "Friday afternoon is a half day. There are 10 half days a week, therefore 10% of your patients are not being served on Friday afternoons."
We strongly recommended that they stagger their hours of their employees even if the doctor for whatever reason didn't want to work Friday afternoons.
What also will help is let's start answering the phone earlier in the morning to avoid the logjam that we have at 9:00 a.m. One way to do this is to start answering the phone at 8:30 a.m. If we still have a logjam, start answering the phone at 8:00 a.m.
If we're answering the phone now at 8:00 a.m. and we have a logjam from 8:00 a.m. to 8:30 a.m., consider starting your morning telephone hours at 7:30 a.m.
Another thing I'd consider is closing phones later in the afternoon. At a lot of practices we go to, the employees are still there, but they turn the phones off promptly at 5:00 p.m.
I think we have to remember that there are a number of people that are working people that don't want to make phone calls to their doctor's office while other people are around, and they're more likely to be calling you in the early morning hours or after 5:00 p.m. for purposes of privacy when they're at work.
That brings us to the next item, not being closed for lunch. Many practices are closed for lunch. We were at a two-doctor practice not so long ago where they were closed for lunch between 12:00 and 2:00 p.m. every day.
The question is: What do you expect patients to do if they're calling during their lunchtime at work and don't want to share that information with their colleagues?
We reorganized answering of the phone calls, and the practice now answers the phone from 8:00 a.m. to 5:30 p.m. We did that simply by recommending that they stagger their working hours and the lunch schedules of the employees so that they would have better phone coverage.
Let's do that again. Eliminate phone prompts. Start earlier in the morning. Answer the phone later in the afternoon. Don't be closed for lunch.
That means we're going to have to redesign our work hours, and we might consider one group of employees coming in at 7:30 a.m. or 7:45 a.m. to start answering the phone at 8:00 a.m. and they leave the practice early, and other employees come in a little bit later than 8:30 a.m. or 9:00 a.m. and they stay on until 6:00 p.m.
Then they stagger the lunch hours so that we have staff available to answer the phones. The people that answer the phones during lunch hours don't have to be the same people that answer it at other times.
To us, the ideal phone availability for patient convenience is having 8:00 a.m. to 6:00 p.m. coverage. It's convenient for your patients, it's convenient for your referring offices, and there will be no extra cost for your patients. This is a very important consideration.
Patient Involvement Reduces Phone Traffic
Last but not least is patient involvement to reduce your phone traffic. One way to reduce phone traffic is to email your appointment reminders with the date and time of the appointment. With the email reminder, you could also talk about any co-pays or deductibles that are due from the patient at the time of the visit.
Doing both of those things, date and time of appointment and co-pays and deductibles, if we made that phone call as we traditionally have done, that phone call will take approximately 90 seconds if we find the patient. If we don't find the patient, we would leave that message.
The problem with leaving the message is the home phone line that we're calling may be shared by spouses and their adult children, and it may be that you don't want them to have that information recorded on their answering machine.
Again, this gets us back to the use of emails. We can use the emails for appointment reminders in which we talk about the date and time of the appointment. We also talk about any co-pays and/or deductibles that are due.
Let's take it one step further. Aside from emailing appointment reminders, we could also email normal lab results. We would have obviously called people with any abnormal lab results.
Email practices are fine. If emails are dealt with more efficiently at the practice, we can get may more emails for less time involvement than we used to when we made appointment reminders by phone.
It also allows patients to respond to an email to either confirm or change an appointment and make a new one. That's the advantage of email. Everybody nowadays is used to receiving emails and responding to them.
Allow the patients to fill out forms online or faxing them forms to complete rather than having people come to the practice and have to fill out two forms. One is patient demographic data such as name, address, employer, insurance information, etc. and the second would be a patient history form.
Wouldn't it be nice if patients were able to receive that by email or by fax? That would allow them to take the time off premises at their home to do this and not do it while sitting in your reception area?
I was at a cardiology practice a year and a half ago where the patient history form ran four pages with 115 items on it. People that were filling that form out in the reception area were taking 5 to 15 minutes to fill it out.
The other thing that we have found and that practices have told us is if patients receive those forms at home, then they have more time to fill them out. Sometimes they don't have the specific information at their fingertips, so they may ask a spouse or adult child or they may call their pharmacist to find out more about the prescriptions that they are using.
This takes us to the patient involvement area. I think now, Steve, is a good time to allow the attendees to ask any more questions that would be of help to them or to their practices.
I will turn it over to Steve who will explain again how you can ask questions for me to answer. Thanks a lot, Steve.
Steve: Thank you very much, George. At this time, we are moving to our second to last opportunity for questions and answers, so if you would like to ask a question, please jump right in and ask your question.
I understand we have several questions that came into info@healthcents.com, so I will turn the floor over to my colleague, Ms. Susan Charkin, to ask those questions.
Handling Irate Patients Question
Susan: Thank you, Steve. Yes, I have a couple of questions here. The first one says, "How do I handle irate patients when I can't get them an appointment that same day or when they come into the office and we have to collect co-payments up front and they don't want to pay?"
George: I think that a patient that tries to indicate that they're not prepared to pay, or if they've been prepared to pay and come in and say they're not prepared to pay, I see no reason why the practice should see them.
Secondly, let's deal with this irate patient. I always recommend that any patient that is out in the front and is making any noise, questions or challenging, that person be immediately escorted to the back and turned over to the practice manager.
A manager's job is to deal with that person away from the front desk. If the manager is not there, then a key billing staff would be the person.
When you change the venue of a complaining person, first you might change their attitude and secondly you get them away from other patients that are waiting in the reception area that shouldn't be bothered by this noise. That's the answer to the irate person at the front desk.
The irate person that's on the phone that's irate about co-payments should be reminded that if they have a problem with this they should talk with whoever is providing them with the insurance. They should be asked, "Who pays for this insurance? Do you or your employer?" Allow that person to answer questions to reduce their anger factor. That's about the best we can do.
There are simply some people we cannot satisfy, but we don't hang up on them. We just ask questions until we calm them down.
Do you want to repeat that question, Susan, so I can be sure that I've answered all parts of it?
Susan: Sure. How do I handle irate patients when I can't get them an appointment the same day or when they come into the office and we have to collect the co-payments up front and they don't want to pay?
Work-In Patients
George: I didn't address the first part, patients that are irate that they can't be worked in that same day.
Every practice should take the time to do what we call a work-in study. The work-in study is as follows. If you've got an appointment scheduled for Dr. A on Monday and Dr. A is scheduled to see 20 patients, at the end of the day Dr. A had 20 patients scheduled, but on top of that we had three work-ins and we had no no-shows, that tells us that we should, every Monday, have appointment slots for three work-ins.
In other words, these slots should be empty. The doctor should never at any day of the week have a schedule that's completely filled.
Going back to what we talked about earlier and what was surveyed, if peak days are Mondays and Fridays, if we study our peak days consistently, we'll find out that Mondays and Fridays have higher work-in rates and therefore we should save more appointment slots on Mondays and Fridays than we do other days.
The other thing to watch out for, especially in primary medicine, is your work-in rates skyrocket during a flu epidemic. What some practices have done in primary medicine is they do not schedule any patients during the days during a flu epidemic and they simply deal with work-ins of that day. Otherwise, the practice becomes a disaster area.
Thanks for repeating that question, Susan.
Dental Office Staff Ratio Question
Susan: No problem. I have a couple of other questions, one of which is from dentist. A dentist has four full-time dentists, a part-time dentist, and four full-time hygienists. Is there a ratio of support staff to doctor or doctor to hygienist that one would expect to see?
George: Not that I know of. It depends on the doctor's specialty. We find that periodontists, for example, use more hygienists than non-perio dentists.
I would say that the way to test this is by starting out with part-timers per doctor. If they could see more patients, then we would move them to a fuller-time basis. It's the test of the individual practice. Some practices make high use of hygienists while others make very little use of them.
Ratio of Front Office Staff to Physician and Patients Question
Susan: This leads me to another question we had from a physician office. In general, what's the average number of front office staff members to physicians and number of patients scheduled? Basically the general question is, is there a ratio that for every physician there should be X number of front office people?
George: Anybody that tries to answer that question is naïve. There is no number.
I was with an allergist practice in central California that had 14 employees and he was a solo allergist. What he did was he used a lot of nursing personnel to do his maintenance work with patients.
This doctor obviously was super busy. He was highly regarded in the community, and he simply kept adding nursing staff to be able to deal with allergy patients that were chronically ill.
In that part of California, there were two major allergy seasons. In some cases, he used part-timers during those peak seasons on top of what he did before.
Anybody that says there is an answer to this is naïve. I think what it is, is that some practices based upon certain areas, for example, affluent suburban communities where people have very good insurance and a lot of coverage, we tend to find a lot of unnecessary office visits because the people even with the slightest medical problem will immediately call a physician and want to see a physician because they have good insurance coverage and it doesn't cost them anything to see the doctor.
Conversely, people that are paying more out of pocket today, for example, under Obamacare, if you are in a Bronze plan and you want family insurance, your deductible is going to be somewhere close to $7,000. That type of situation means that patients are going to be more reluctant to come into your practice that don't want to pay their co-pays.
This is one reason we've seen an increase of traffic going to non-physician offices, places like CVS Pharmacy and Walgreens around the United States, where people can go in and know that they're going to have a visit that's not going to cost them over $85, whereas their co-pays may be more significant than that.
Getting back to the basic question, there is no answer to the question. You just keep adding staff when your staff is overwhelmed, but you may be able to do this by the addition of part-timers instead of just full-timers.
The other problem of course is a physical facility problem. Where do we put them? In some practices, it may mean adding space.
We went to one practice where their billing staff was not at the same location as the main office. They were one floor below in the same building, but they did all their paperwork and they didn't need to be at the office because by electronics they were able to receive stuff from their colleagues one floor below.
That's another way of not answering the question because we really don't know any number.
Steve: We're getting a little bit of fade. Again George, I just wanted to remind you as we're doing the Q&A if you could just speak up a little bit.
George: Thank you.
Steve: Let me put this back to the entire audience again. There's going to turn out to be a final opportunity here to ask questions if you would like to ask one, or you may send a quick email to info@healthcents.com and at the very end we will pick those up.
Are there any other questions at this point? I think Susan Charkin has a quick question.
Ordering Quill Office Supplies Question
Susan: This is a Quill question. It says, "I usually order my office supplies during lunch. Can you remind me what the phone number is and are there any discounts when I order my office supplies?"
George: The answer is that I understand Quill is giving a discount to those people that are attending this workshop. I think that will be explained a little bit later on.
There is one question that I will raise and answer.
Steve: I just wanted to address that. First of all, as far as ordering Quill supplies, the best place to go is www.Quill.com/healthcare.
In fact, this month, Quill Healthcare had a huge announcement and rollout where it has astronomically increased its assortment of products in the medical supply area.
I would encourage everyone on the line to take a look at that because you may in fact find that there's a great opportunity now to buy all of your office products as well as medical supply products from a single-source supplier, that being www.Quill.com, which also has an excellent customer-service team to back you up. www.Quill.com/healthcare is a great place to go.
In fact, for all of you participants that have taken time out of your valuable day to hear this valuable webinar, we're also offering a discount. The information is on this chart and in just a moment I'll be explaining how you get a complete copy of the chart so that you'll have these offer codes.
Basically, if you spend up to $50 or more on medical supplies, you'll get a $15 off coupon, and if you go over $100 you'll get a $30 off coupon. You can speak to your representative about www.Quill.com's volume discounts if you plan to do very large orders as well.
I'll go back to George. It sounded like you had a couple of comments as well.
George: Steve, here's a quick question. It says, "If you spend $50 on medical supplies." Would that include office supplies?
Steve: This particular discount I believe is applicable to medical supplies only, but I will clarify that with the Quill team. I don't know if Lena is on the line. If you are, maybe you can further clarify that.
George: Do you want me to make the comment that I was going to make, Steve?
Steve: We will double check that and include a reply following the session. Go ahead.
Hiring Front Desk Staff
George: Basically, what I think I wanted to wrap up my comments with is that I've been to two practices in the past six months where the problem with employees is that they were hiring people in small office settings that had no prior experience and they did that to save money on salaries.
Frankly, these practices were suffering because a few number of staff were devoted to trying to train somebody from scratch to learn everything that they knew.
The difference between a non-experienced person and an experienced person is probably somewhere in the range of about $3,000 a year difference. It really comes out to be $2 per working hour. The difference between hiring somebody for $13 or $15 is a great difference.
I would say to resist any pressure by the owner/physician or physicians to say, "Let's hire cheap." Hiring cheap comes back to bite you.
Thanks, Steve.
Wrap-Up
Steve: Thank you, George. We're pretty much getting close to the wrap-up. I do have some information here about obtaining information about this presentation and, for that matter, further information.
First of all, for information about Quill Healthcare, as I mentioned, you can go to www.Quill.com/healthcare or you can call the Healthcare direct line at 1-800-789-1186 for product ordering or other questions.
To contact any of the presenters or emcees today, including George, Susan and me, you can simply call 1-800-497-4970 or at any time send an email, as some of you have been during this session, to info@healthcents.com.
Additionally, if you would like a complete copy of this presentation, you can at any time starting now send a quick email to charts@healthcents.com. It doesn't matter what the subject is. As soon as that email is received, an automatic email will be sent right back to you to tell you how to get to the PDF version of the charts.
Additionally, we will be posting the information from this webinar. The actual live recording will be posted at an unlisted YouTube URL, meaning only those who have a copy of the URL will be able to find it. You wouldn't just be able to do a general YouTube search at this point. We will also be including that link at charts@healthcents.com within the next 48 hours.
In the meantime, if you would like a copy of these charts, including the promotional discount that I went through before, simply send charts@healthcents.com an email and the PDF file information will be returned to you as soon as you do that.
At this time, on behalf of Quill Healthcare and your emcees and presenters, I want to thank you all for having taken time out of your day to hear this very compelling presentation from Mr. George Conomikes about improving front desk performance.
We will be inviting you to future webinars. The next topic is going to be all about HIPAA compliance. I know that's a topic near and dear to our hearts and questions came up here. We'll let you know about that one. It will be in a little less than a month.
We appreciate your participation today. That concludes our session. Thank you all for your participation. Have a good day.
