Medical call center guide

Summary

Leveraging a medical callcenter rather than using only a medical answering service helped me grow my group practice tremendously. We followed the following strategy.

1. 80% of daily patient appointment volume should be from existing patients.
2. Taking a preventive care approach with existing patients provides undeniable health benefits to patients in addition to keeping your office busy.
3. Being proactive about appointing patients is key to this strategy.
4. 20% of new patient volume comes from inbound patient appointment requests and your own business development activities. 
5. Inbound patient appointment requests volume is directly related to patient reviews on Google.
6. Your business development activities should include physician referral outreach and community outreach.

Medical call centers are an essential component of healthcare delivery, providing patients with timely and efficient contact with healthcare providers.

By serving as a centralized point of contact for patients, medical call centers can streamline the patient journey and improve the quality of care and attention patients receive.

One of the key benefits of medical call centers is their ability to reduce wait times and minimize the need for in-person visits.

This is especially beneficial for patients with mobility or transportation issues who may find it challenging to attend appointments in person.

With a medical call center, patients can access healthcare services from the comfort of their own homes, reducing stress and inconvenience.

Medical call centers also play a critical role in enhancing the patient experience by providing personalized support and guidance throughout the patient journey.

With trained professionals available to handle a wide range of inquiries and concerns, medical call centers provide patients with peace of mind knowing that they have access to expert advice when they need it most.

In addition to improving patient experience, medical call centers can also help healthcare providers optimize their operations by reducing administrative burdens associated with appointment scheduling and follow-up care.

This allows healthcare providers to focus on delivering high-quality care to their patients without being bogged down by administrative tasks.

How a medical call center gets more patients

A dedicated medical call center (whether you have it in-house or you outsource it) should do the following:

1. Run + manage various campaigns on existing patients (example list)
   1. Reactivation campaign
   2. No shows campaign 
   3. Cancelled patients campaign
   4. No encounters campaign
   5. Patient reviews campaign
2. Run + manage various campaigns for new patients from
   1. Existing referring partners
   2. New referring partners
   3. Community outreach
   4. Existing patient referrals

How does remote referral marketing outreach work?

Make sure to assign several medical call center agents as referring physician liaisons to make calls throughout the week.

These referring physician liaisons work to establish rapport & educate via the phone. They also determine who the key decision makers at the referring partners are.

The physician referral marketing team can also set up appointments for meetings between staff from your office with decision makers at the potential referring office.

How long does it take to generate new physician referrals?

It takes at least 3 months to start seeing results. Over these 3 months, the potential referring physician should be contacted at least 6 times. As you are well aware of, it takes time to build rapport and credibility with referral sources. In some highly competitive towns/cities in California, Florida, New York this might take longer.

Callcenter return on investment

Here’s a simple way to calculate your expected return on investment on the medical call center (in-house or outsourced).

1. Let’s say that each day, a single agent can dial about 200 patient phone numbers. They could dial a lot more if they are using the right call center software.
2. Out of all patients called per day per agent, I found that about 20% (i.e. 40) patients pick up the call. So, each agent is going to talk to 40 patients a day.
3. In my experience, out of the patients that agents talk to, about 50-70% agree to be re-appointed. So, each agent can re-appoint about 25 patients a day.
4. Net-net, out of 200 patient calls per day per agent, you win 25 patients back, lose 15. This means that your agent is left with 160 patients per day to add to the next day’s calling workload / queue.
5. So, conversion is 25 / 200 = 12.5%. In other words, you can add 40 more contacts to your agent’s list.
6. If each patient gets exactly 1 call per week, this means that your agent would need 200 * 5  = 1,000 numbers to contact.
7. Each day, 40 numbers are removed from their calling list. In 5 days, you can add 40*5 = 200 more numbers. So, you might want to start with approximately 2000 numbers per agent, per month (there will be many wrong numbers as well).
8. Using this math, you can decide how many agents you need to hire. e.g. if you have 4,000 patients, you would need a minimum of 2 callcenter representatives handling ONLY outbound calls.

Revenues per patient

You should know the average collections per patient being re-appointed. Assume this to be $100/- per follow up appointment per patient.

If you are adding 5*25 = 125 patient appointments from a campaign and only 70% of them show up, you have 88 * $100 = $ 8,800/- in additional revenues per week.

If you hire our team (minimum 10 for inbound + outbound) your cost will be $1,760/- per agent per month. You will profit about $33K per month per agent.

Based on this calculation, How many return patients do you need from this campaign to break even?

Do not start without defining this. 

That’s how much one agent is contributing to your top line per week. In a month, you are looking at approximately $35K new revenues per agent you have.

Medical call center people / staffing

Hiring the right call center supervisor and call center agents is crucial. Make sure you hire someone with medical call center experience.

Call center agents

You can get away with having remote agents working from home (know how to handle HIPAA and SOC2 compliance).

Hire call center representatives with empathy. Do not hire staff that prefer volume work over work with empathy.’

Hire career call center representatives – i.e. people that have been agents for a majority of their careers. The remaining talent is typically using your call center job as a “stop-gap” in their careers.

The industry burnout + attrition is very high. You need to constantly be hiring and maintaining a bench of call center customer service representatives to be good at this game. 

Medical call center supervisor

Hiring a call center supervisor is crucial and depending on the size of your call center team, you might have to hire more than 1 team leads as well.

My general recommendation is that one manager should have no more than 10 direct reports. So, if you have 30 call center agents, you are going to need 3 managers (at a minimum). 

Do not skimp on hiring a call center supervisor.

In addition, do not underestimate the importance of a training program for your call center. I cannot state this strongly enough. Your supervisor will be responsible in defining the training as well.

Director of patient access

Initially, this might not seem as very important, but having a single medical call center coordinator / director of all patient access challenges is crucial.

This person is directly responsible for patient access, satisfaction, maintaining KPIs related to patient AND provider satisfaction.

Steering committee

This is a disruptive and transformative change in your small business or your medical practice.

Make sure you identify a steering committee that will take on this initiative and will guide/coach the team.

This could include your office manager, site supervisors, patient access director (if you have one), front desk/receptionists and a lead from your medical billing department.

Try to include the receptionists from each office location and the office manager.

Include someone from the medical billing department. They have a LOT of inputs into what the receptionist must do / the information that the front desk must gather from patients. This helps them avoid downstream issues in the medical billing process.

Call dispositions

We use the following (you can have your own). To avoid handling these headaches, use a medical CRM.

• DONE – this means that the patient was re-appointed
• NOANS – this means that the patient did not answer the phone. I recommend that your team calls them back next week (i.e. it goes into next week’s backlog)
• LVM – this means that the agent left your patient a voicemail. This is a bit tricky because if the patient calls back and books an appointment, usually another agent answers the call. You need to ensure that this agent also updates the spreadsheet with the fact that the patient now has an appointment hence should be removed from your no-shows campaign.
• WNUM – this means wrong number. Yes, it happens ALL the time.
• 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.
• 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, I put these patients in another campaign to try and win them back.
• DCONN – this means that the patient’s phone number is disconnected. The patient population that my clients work with tends to have this happen to them (obamaphones).
• 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)
• HUNG UP – this also happens wherein a patient simply hangs up. Don’t call them back immediately but try reaching out to them the week after.
• 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 I consider as non-recoverable, where as LOST patients is something that I consider as LOST for now, but will try to win back later.
• 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.
• DUPLICATE – happens all the time where the patient record is a duplicate in the spreadsheet they are working off of.

Max attempts per patient

I have typically defined this as five(5) – ie our BPO team should call the patient at least five times before they give up on that patient.

Prepare your campaign’s data

1. Export data as spreadsheets or CSV file – keep in mind that as soon as you download the data, it is obsolete because within 5 mins, your staff could update the EMR and one or more of the records you downloaded, would be stale. This is usually free.
2. Connect via APIs – as per CMS mandata, each EMR is expected to have API connectivity into their data for ONC certification (typically this is free as well). Keep in mind that when you connect via APIs, you pull data as and when needed. As soon as you pull data, that data might be obsolete as well, since 5 mins after pulling the data from your EMR via APIs, someone from your staff might have updated the EMR with changes.
3. HL7 integration – this is true, real time integration. As soon as a change happens in your EMR, the data is pushed via secure FTP as a new record so your application can act on it. This means that you always get the latest and greatest changes pushed to you. 

Almost every EMR allows you to get data from it. Here are a few ways:

Monitor your campaign

Monitor the performance of your efforts and fine tune calling times if needed.

Calling times

I have noticed that certain cohorts 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. 

Number of calls

I have also experienced that the conversion rate seems to decrease as the total number of calls to the same patient increases. This means that if the patient picks up the phone in the first try, the chances of reappointing them are close to 100%, if they pick up at the second try, the chances go down a bit to around 70% or so, if they pick up on the 3rd try, it reduces further etc. 

Fine tune the number of calls to be made before you give up on that patient.

Total costs of ownership of a medical contact center

Operating costs of a contact center would generally break down into a few well known categories. You’re going to have the following (for each location of your business):

1. Real estate costs
2. Infrastructure costs
3. Utilities costs
4. Hiring costs
5. Training costs
6. Payroll expenses 
7. Technology expenses

Technology related items

At a minimum, you are going to need to plan for:

• Inbound phone numbers that you provision via your carrier or a VOIP provider.
• Extension set ups or direct inward dial (DID) numbers for each team member.
• Computers.
• Headsets.
• Physical phones if that’s how your call center will operate.
• Voicemail set up if you need it
• Web based chat software if you support that channel at your call center
• Software to enable customers to text your call center
• Soft phones (not all soft phones are alike)
• A reliable, reputable call center software
• Automated call distribution capabilities
• Skill based routing capabilities
• Call queues and routing profiles capabilities
• Medical CRM
• Call recordings – Audio file storage facility
• IVR set up
• Reporting and analytics software
• WhatsApp support software
• Facebook chat if you support that channel
• iMessage software if your call center supports it as a channel
• HIPAA controls and audit software
• SOC2 compliance controls and audit software

When centralized medical contact center makes sense

A centralized contact center brings in economies of scale and all the benefits from achieving economies of scale.

If your contact center is going to be staffed with only a handful of staff, there would be no economies of scale to achieve. You don’t need scale as much and won’t need to centralize your contact center.

However, a decentralized contact enter model allows you to leverage several benefits as well.

• Labor arbitrage across locations wherein certain locations might be significantly cheaper than other locations. 
• Real estate costs across locations might also vary significantly.
• Having multiple locations allows you to have a backup site in case of natural disasters in one of your other call center sites.
• In certain businesses, customers might simply prefer being served in their local languages.

Medical call center scripts

If your staff is experienced in recalling and reappointing patients – you might not need scripts. However, if you are hiring brand new staff to run medical campaigns, you should prepare calling scripts.

At a minimum, you need to have scripts for the following workflows:

• Inbound calls related
• Outbound calls related
• Appointments scheduling, rescheduling, cancellations
• Surgical coordination
• Pharmacy / medication related issues
• Customer balances collections
• Insurance / eligibility related issues
• Billing related issues
• Customer appointment reminders
• Reactivating no-show customers
• Reactivating customers that have fallen out of care
• Appointing no-encounter customers
• Community outreach
• Customer balance reminders and collections
• Getting new customer referrals from existing customers
• Past due collections. Here, do keep in mind that if you are calling on behalf of your own practice, you are a first party collector and do not have to handle Miranda rights to the extent that a third party collector has to handle.

The following scripts are recommended to be used after introducing yourself and the usual niceties. 

Script to reappoint cancelled patients

“Well, I’m calling because we had to cancel your appt recently and upon reviewing your chart, our doctor recommended that we set up a video call with you and our doctor. This will help our doctor determine your care plan.”

OR, if the patient had cancelled the appointment themselves.

“Our clinical team looked at why you had needed the appointment in the first place. They feel that you should definitely have our doctor look at it further. This will help us possibly figure out the underlying cause. We don’t want to let that recur later on. Have you seen a doctor for this yet?”

Script to reappoint no-show patients

“Our clinical team noticed that you had missed your appointment on <date/time>. Are you OK? What happened?”

Many patients are no-shows or cancel due to work reasons. Being able to do a televisit allows them to not have to travel and not have to take time off of work.

This way, you at least retain the patient.

Of course, if the patient wants to come in to the office, you don’t decline the appointment. The most important thing to keep in mind is that the next appointment should be ASAP – not 2 weeks away. If that requires a televisit appointment, so be it.

“Our clinical team looked at why you had needed the appointment in the first place. They feel that you should definitely have us look at it further. This will help us possibly figure out the underlying cause. We don’t want to let that recur later on. Is a video call easier for you?”

Script to convert follow up appointments to tele visit

“Well, I’m calling because you have an upcoming appt on < date time > and upon reviewing your chart, our doctor recommended that we set up a video call with you and our doctor. This will help us determine your care plan and next steps..”

Script to request referrals from patients

1. When the agent speaks with a patient to confirm their appointment, the agent asks the patient something as simple as “As you know, we are a young practice. Can you think of anyone that you would recommend our doctors to?”.
2. If the patient mentions names/numbers – the agent takes that information down, calls the referred patient and introduces themselves as “Hi, I am calling from <your practice name>. I was talking to <the actual patient name> about their upcoming appointment. They wanted to recommend doctor <provider name> to you. Hence, I am calling”.. 

Script for community outreach

I am calling people in our neighborhood to let them know how we can be of service. 

Remember, you are just introducing yourself and don’t expect an appointment.

“Just wanted to let you know that help people that are facing issues with their <add some chief complaints here>. Our doctors are available to see patients via video calls as well. If you know of someone that needs help related to <your specialty>, could you please let me know?”

… answer questions etc.. 

The goal here is NOT to have the patient make an appointment with your provider, but rather, to be aware of your service offering.

So, while the patient is on the call with your agent, use this script to get the cell phone number of the patient.

Why don’t I send you an SMS with our locations and phone numbers so you can forward it to friends and family?”

OR

Sure, I can set you up with a video call appt with one of our doctors”

Call recordings for supervision and training

Call recordings are a must have – you are going to need them for quality audit purposes and you are also going to need it for training purposes.

Most medical call center software have the ability to record all calls. Keep in mind that medical call recordings have to be stored in a HIPAA compliant manner. 

Auditing call recordings for supervisory purposes is mandatory. While it is never going to be possible for your supervisor to audit all call recordings, a random sampling of 10% of call recordings every day is more than enough.

There are several factors to audit recordings on – here are suggestions.

• Call opening
• Call probing
• Empathy displayed during the call
• Call resolution
• Script adherence
• Call closing
• Call compliance