Executive Summary

By recording phone calls with patients and providers, patient access managers can determine whether complaints about rudeness or incorrect information are valid. Here are changes made at Mission Hospital:

• Scripting was changed for greeting of callers.

• Employees were educated to avoid scheduling CT scans with contrast for allergic patients.

• Guidelines were made clearer about each specific location and appointment type.

 

Members of the patient access staff at Mission Hospital in Asheville, NC, weren’t too happy to learn that every incoming and outgoing phone call would be automatically recorded. However, their opinion changed dramatically after a few months.

“It has saved them, quite a few times,” says Lee Anna Mull, manager of patient access. Calls are retrieved and listened to if a complaint is made.

At times, irate patients complain to Mull about rude treatment. When she listens to the call, it turns out the patient was the one who spoke disrespectfully. “Typically, once you tell them that all calls are recorded and that you listened to the call, they tend to chill out,” says Mull.

The same is sometimes true of providers. In one case, a physician complained that patient access was rude. “When I told her we listened to the phone call, she told me that the financial counselor was not rude to her at all, and that she was the one who was rude,” say Mull.

Patient access learned these things from the recorded calls:

• Some employee began without a greeting, saying simply, “Scheduling, this is [name].”

Scripting was changed. Employees are now expected to say, “Good morning, this is scheduling, this is [name] speaking.”

• Some employees were scheduling services at the wrong location.

“Certain types of appointments and therapists are only available at one location,” says Mull. Guidelines were updated to reflect this. For example, some therapists can see patients only at a certain location for physical therapy.

• Some employees were picking the wrong type of appointment repeatedly.

For example, many routinely scheduled CT scans with contrast for patients who were allergic to contrast. This scheduling sometimes caused delays when the patient arrived for the test.

“That sent up flags that education was needed, not just for that employee, but for the entire staff,” says Mull. Managers provided one-on-one training or group refresher courses. “We also updated guidelines to help instruct the schedulers to make sure the correct appointment was chosen,” says Mull.

Some recorded calls revealed that the incorrect information on the test had been given to patient access by the provider’s office. “That gave me the opportunity to reach out to the office, to improve on future processes,” says Mull.

Estimates are just that

The most common patient complaint is that they were given incorrect estimates by financial counselors. One patient complained, “They told me I had to pay upfront or they’d cancel my surgery.”

Mull listened to the call and learned that the employee said nothing of the kind. However, she encouraged financial counselors to emphasize to future callers that non-payment would not cause surgery to be cancelled.

In responding to patients who complained about an incorrect estimate, Mull takes a businesslike approach, to explain why the estimate and the patient’s out-of-pocket costs differed. Sometimes, this difference is because when the patients originally called for the estimate, they told the employees they were having a certain procedure, but additional procedures ended up being done. Staffers always explain that taking care of the account before the date of service will speed the check-in process.

“A lot of people don’t know their insurance and think the hospital is just out for money,” says Mull. “We’ve had to educate the community.”

Calls protect access

At times, recorded calls reveal opportunities for patient access staff to improve, says Alexander Wemyss, MBA, CHAA, supervisor of customer service at Sarasota Memorial Hospital. However, staff members take comfort in being recorded.

“In most cases, the calls end up protecting patient access employees,” he says.

Here are some ways the calls are helpful:

• At times, the payer’s member services department tells the patient one thing, and the provider services department tells the hospital something different.

“This conflict can skillfully be unraveled by listening to past recordings with the insurance company and conveying the missing information to the patient,” says Wemyss. (For more information about how patient access can use recorded calls to prevent claims denials, see “Payer might claim ‘You never sent it!’ but patient access can prove otherwise,” Hospital Access Management, February 2015, p. 17.)

• Occasionally, a patient or family member complains about the lack of professionalism of a patient access employee.

“In this instance, recordings can paint a very different picture,” says Wemyss. “Anytime we receive a complaint of this nature, we immediately research the account notes and listen to the recording.”

Even if the audit findings reveal a contrary opinion to that of the complainant, patient access managers thank the patient for the opportunity to review the concern.

“Our scripting outlines how to escalate a call if the patient’s frustration level increases,” says Wemyss. He always reminds employees that they never truly know what someone is going through on the other end of the phone, because many communication cues are delivered visually.

“We may not pick up on all of the subtleties of the situation,” he says. “This is why it is paramount to treat every individual with respect, even when we are not receiving it in return.”

 

SOURCES

Lee Anna Mull, Patient Access, Mission Hospital, Asheville, NC. Email: Lee.Mull@msj.org.

Alexander Wemyss, MBA, CHAA, Customer Service, Sarasota (FL) Memorial Hospital. Phone: (941) 917-3355. Email: Alexander-Wemyss@smh.com.