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Healthcare Practice Management

How we increased patient visit volume by recalling patients not seen in 6 months

Many practices we talk to, say that they are OK with the patient volume they get. We tend to work with practices that are looking to grow aggressively. One of our clients wanted to grow their business, expand to a few more locations and also to hire more providers.

Of course, there are many ways to skin the cat. And of course, you do need to improve your inbound appointment requests (cannot depend solely on referrals, can you?). However, we wanted to get started on the low hanging fruit first and bring in revenues right off the bat.

Here’s how we added about 5,000 new appointments in 2 months – you can do so as well and it is very easy. In fact we had to slow down this campaign because we didn’t have enough providers to serve the patients that we were bringing in.

We started on June 3 and below are the appointment counts YTD. We ran that campaign heavily in the first 2 months, then pulled back a lot because we ran out of office space and providers.

Summary

As we have said before – Make sure that you know how many patients need to show up from this campaign per month before you break even. Do not start without defining this.

You are simply going through your EMR to identify patients that have fallen out of care, calling them back to your practice and re-establishing a relationship with them.

Just be diligent about this and do not give up on patients that do not pick up the call. You will notice that the more time that a patient has been out of care (i.e. your practice), the harder it is to reach them and to recall/reactivate them.

As we have mentioned before – If you want to take this initiative seriously, consider using a healthcare focused CRM that helps you with outbound dialing and is always in sync with your EMR. If you do not have a dedicated team to make these calls, hire a BPO team that does the calling and reporting for you.

Steps to take

  1. Identify the people, processes and technologies for your campaign
  2. Define your campaign
  3. Prepare your campaign’s data
  4. Execute your campaign
  5. Monitor your campaign and improve

Identify the people, processes and technologies for your campaign

You are going to need the right people / staff with the right skill set for this. We run various campaigns and the folks that perform best in this campaign are the ones that have decent sales skills. Most patients do not quite understand that “prevention is better than cure” (at least the patient population that we work with). Your team’s job is going to be to make them understand and appreciate that fact – and have them agree to coming back in to you see your provider(s).

What we discovered is that most patients ended up thanking us for recalling them while they came in for a check up.

You are going to need to have a team that knows excel spreadsheets well enough – even then, managing the volume of data is on the hard side.. If you use a healthcare focused CRM, it does get easier (my experience).

You will need to decide on the process your staff will follow, the scripts they are going to use and how they will churn the patient data.

We found that the older this data gets (i.e. the longer it has been since your patient had an encounter with you/your providers), the harder it is to get these patients back to your door. So, make plans accordingly and staff your team accordingly.

We also found that the older the data, the more chances of the phone numbers being incorrect (at least in our patient population – hello Obamaphones?)

Do the return on investment math like this (or something similar):

  1. In our experience, we noticed that every day, an agent is going to be able to call about 200 patients once.
  2. Out of these 200 patients called, they are able to connect with about 20% (i.e. 40) patients.
  3. Out of the patients they talk to, about 50-70% agree to be re-appointed (about 25)
  4. So, effectively, out of 200 patients, you win 25 back, lose 15. This means that you are left with 160 patients to add to the next day’s workload.
  5. Do the math accordingly and size your team correctly. The benefits are tremendous if you multiply each patient visit with your revenue per visit.

Define your campaign

When we first started this campaign, we decided that we are going to recall all patients that have fallen out of care for more than 6 months (do keep in mind that every day, more patients keep being added to the list).

Define how many attempts you are going to make. we don’t recommend calling the same patient more than twice a month.. That means, every month, a patient will get exactly two calls from my staff. Keeping in mind that the older the data, the harder it is to reach the patients, you’d arguably want to try the older patients first – BUT a very important point to keep in mind is that your team will not be as motivated when their conversion rates are on the low side (bound to happen with older data).

Play with a mix of such patient data – mix older data with newer ones so that it keeps everyone happy.

Before you start, you are also going to need to define the various legends that you are going to use in your campaign.

As an example, what are the various outcomes / dispositions that you are going to accept from your calling team? We use the following (you can have your own):

  1. DONE – this means that the patient was re-appointed
  2. NOANS – this means that the patient did not answer the phone. We recommend that your team calls them back in 2 weeks
  3. WNUM – this means wrong number. Yes, it happens ALL the time.
  4. CBACK – this means that the patient has asked for a call back at a certain date/time or both. The agent needs to be able to set a reminder for themselves to call the patient back.
  5. LOST – this means that the patient has either found another doctor or has decided that they do not want to come in for an appointment (i.e their need has been met). Usually, we put these patients in another campaign to try and win them back.
  6. DCONN – this means that the patient’s phone number is disconnected. The patient population that our clients work with tends to have this happen to them (obama phones).
  7. UNAVLBL – this means that for whatever reason the patient is not available, but the phone number is correct (e.g. someone from their family picked up the phone but your agents are not allowed to book appointments unless they speak to the patient directly)
  8. HUNG UP – this also happens wherein a patient simply hangs up. Don’t call them back immediately but try reaching out to them 2 weeks after.
  9. DNC – this happens (for whatever reason) when the patient does not want to be called any longer. They tell your agent to not call back again – these are a separate category of patients that are lost. DNC is something that we consider as non-recoverable, where as LOST patients is something that we consider as LOST for now, but will try to win back later.
  10. RECONFIRMED – sometimes due to data errors, the agent runs into situations where the patient has already called in and made an appointment to come back, but the agent’s spreadsheet does not reflect this new appointment. In that case, the agent simply confirms the new appointment date/time.
  11. DUPLICATE – happens all the time where the patient record is a duplicate in the spreadsheet they are working off of.

Define how you are going to monitor the efforts and try to understand what the calls amount to. E.g. here’s a sample

Prepare your campaign’s data

We are going to give you an example with Carecloud – just because our latest client uses Carecloud as their EPM (their EMR is on EMA).

Preparing the baseline data is going to require some work. Export the patients from your CareCloud analytics tab (in your case it could be some other tab of your EMR). Make sure that this spreadsheet gives you the following info:

  1. Last Encounter Date
  2. Last Appointment Date
  3. Next Appointment Date

Move patients to a new spreadsheet where the following conditions are met:

  1. Last encounter date is > 6 months before today
  2. Last appointment date is either the same as last encounter date or is, still, > 6 months before today (e.g last encounter was 7 months ago and last appt date where this patient was a no-show was 6 months ago). You do not want to take the patients whose last appointment date is within the last 6 months because they might be part of your no-shows campaign (if you are running one). If you are not running a no-shows campaign, then you can include those patients.
  3. Now, filter out patients that have a next appointment date in the future (as we are sure you will catch those in an appointment reminder campaign)

Keep in mind that you will have to run this kind of an export / report every week (or every day) and add more patients that have fallen out of care. You can very easily schedule a report every day to get fresh data (in carecloud, you simply schedule a report from the analytics tab).

Save this somewhere that you have designated as HIPAA compliant.

Enhance your combined spreadsheet with some columns to “sort of” make it like a CRM (this allows your staff to be laser focused on working the list). We tend to include columns like these (yours can be different to suit your needs).

  1. Disposition – ie. the outcomes we discussed above
  2. Appointment Date – if and when an appointment is booked, that appointment date.
  3. Remarks – usually we use this for what the patient said, the insurance details (if updated)
  4. LAST CALL DATE – so that each agent knows when the patient was called last (this is super important as you don’t want multiple agents calling the patient and ticking them off).

The following, you will get from carecloud exported CSVs anyway.. Some (not all) of these are needed for your agent to be able to effectively talk to your patient when they do answer the phone…

Patient, Appointment Date, Appointment Time, Provider, Location,Nature of Visit, Phone, Referring Physician, Chart, DOB, Policy Type, Member ID, Co-pay, Balance, Status, Comments, Cancellation Reason, Cancellation Comments, Payer, Referral Source, Eligibility, Resource, Chief Complaint etc..

Execute your campaign

You can decide to set aside a few hours each day, start dialing, dispose the call with an outcome, notes and follow up if any required. Since my clients typically hand us more than 20K patient records, this usually requires several FTEs. You can go ahead with lower FTE count but as the data gets older, it is harder to connect with patients.. So, you are better off with a much higher FTE count initially to avoid data getting further more stale.. Once you have “caught up” with the entire backlog (maybe over a year or so), you can reduce the headcount.

Keep adding to the list, keep working the list (never ending process). Understand the basic math as mentioned above. In one week, the backlog of calls to be made does add up significantly.

How we execute these campaigns is that we allow agents to call the patient twice a month and have a target of 200 patient calls per agent per day. So, in 2 weeks, they have a target to call 2,000 patients. Let’s say they are able to re-appoint back 10% of the patients. That means they have converted 200 of those patients.. So, they are left with maybe 1800 patients from these 2 weeks. We add these 1,800 odd patients plus get 200 new / fresh new patients from the larger backlog and run the same campaign over the remaining two weeks of the month.

How long does this go on? If you decide that you will give up after 4 contacts with a patient, then this list will be refreshed once in 2 months.

Do not let patient data get stale.. If you need more agents to add to this team, do so and you will reap the rewards.

Please do read the other post “Tips on the people, processes and technologies you need to run your healthcare call center” to get a better handle on the technology and the execution part(s).

Monitor your campaign and improve

Monitor the performance of your efforts and fine tune calling times if needed. We have noticed that certain kinds of patients tend to pick up the phone early in the morning, around lunch time and then again around 4 PM onwards. Another set of patient demographics seems to pick up the calls throughout the day.

We have experienced that around 60-80% patients that we talk to, do want to be re-appointed. The % of patients that pick up the call still remains the same (maximum 20%). So, you really need to increase the number of calls you are making.

Fine tune the number of calls to be made before you give up on that patient. We have wavered between 3-5 calls, but we don’t ever truly give up on a patient. We simply move patients from campaign to campaign – if they have not rebooked within 3 calls, then we might move them to a completely different campaign altogether.

Play with power dialers (not robocalls) vs dialing manually – you can achieve a lot more calls per day but it does increase your phone bills significantly. Be careful with extremely high volume of calls (read tips). You need to plan for the total number of outbound numbers you will purchase.

Good luck with this – keep at it and you will see HUGE rewards. If you need any help, let me know.

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