How to create or expand a call center: Experts share their tips

It’s important to have a vision, UPMC director says

With reports touting the financial and customer service benefits of call centers, it’s no wonder that more hospitals — often under the aegis of their access departments — are looking either to establish a call center or to expand the capabilities of an existing one.

According to research by Solucient (www.solucient.com), the average caller to a hospital call center generates 150% more revenue for the facility per year than the average hospital patient — $13,848 in hospital charges vs. $5,524. The average retention rate of call center customers for hospitals in the Solucient study — which looked at 11 call centers serving 25 hospitals — was 70%, compared to 46% for other patients.

With results like that, it makes sense for access directors to consider whether a call center is right for their organization and, if so, what form it will take. Gillian Cappiello, CHAM, senior director of access services and chief privacy officer for Swedish Covenant Hospital in Chicago, agreed to share with Hospital Access Management some of the questions she is asking as her hospital explores the possibility of expanding its call center. HAM, in turn, asked a patient access director who oversees a successful call center as well as two consultants who have helped create them for the benefit of their experiences. Other aspects of call center development will be discussed in future issues of HAM.

Q. The first thing we want to figure out is what we want the call center to look like. We have appointment scheduling, community event scheduling, and physician referral included, but what are the other opportunities?

A. It is important to have a vision when designing a call center, says Georgina Trunzo, director of patient access services for the University of Pittsburgh Medical Center (UPMC), but it may be necessary to scale back from one’s original vision in order to get something up and running.

"I wanted to keep the scope reasonable so we could achieve success, and I didn’t want to get in over my head," she explains. "We focused on six of our health system’s 18 hospitals, and do reservations, pre-registration, insurance verification, pre-certification, and authorization of referral management for inpatients, same-day services, and high-dollar outpatients."

"At the same time," Trunzo adds, "we work collaboratively with the physician services division, which is on the same floor, on every project we touch to make sure we are not being redundant."

Rather than focusing on how many of the 18 hospitals joined the call center, she notes, it was more important that patient access policies and procedures — including such things as job descriptions and methods of cash collection — were standardized across the system.

Trunzo oversees a financial call center, and she notes that programs such as Ask-A-Nurse are part of a completely separate consumer call center, and transfers from other hospitals are handled in a medical staff call center. Hospital operators are part of the medical call center, she adds, while calls from people wanting to make physician appointments are handled by the consumer call center.

At one point, Trunzo says, UPMC looked at centralizing bed management in the financial call center, and she contends that "it would be great to include everybody in one place, as much as you can get together."

"Our original vision was to include all in one," she adds, "but it got so large we would have still been talking about it two years later. We didn’t want to just be talking about it, we wanted to be showing results."

John Woerly, RHIA, MSA, CHAM, a senior manager with the Indianapolis-based consulting firm Capgemini, who worked closely with Trunzo in developing UPMC’s call center, says he has developed technology and process methodology for the following call center — or to use the more sophisticated term, customer relationship management (CRM) — applications:

  • Physician referral
  • Consumer referral
  • Community education (class registration)
  • Marketing fulfillment (smoking cessation class, pediatrics campaign, etc.)
  • Demand management/disease management ("Ask-a-Nurse")
  • Clinical and financial clearance (pre-registration, insurance eligibility/benefit verification, pre-certification/authorization, PCP referral, medical necessity review, and financial counseling)
  • Patient support center for case management/ utilization review activities
  • Bed management (including medical necessity and appropriateness of care review)
  • Enterprise scheduling (outpatient, preadmission testing and surgery scheduling)
  • Customer service (billing/collection response and problem resolution)
  • Switchboard
  • Physicians’ answering service

"These services can easily serve multiple hospitals at an enterprise level," Woerly notes. "It is important to know your market and the desired service outcomes."

Trunzo agrees, noting that those looking to develop call centers should "outline very carefully the scope and the results you want to achieve."

Q. What’s working for the organizations that have call centers? Is there a service they’ve tried and now advise against, for example?

A. The ease of communication with the customers is working well for the call center, says Trunzo. "Physician offices — a large customer for us — know that they can call one area and that everything comes to one location. When they submit a reservation, they can communicate electronically, they can pick up the phone, or they can fax it over."

"It’s so much easier to manage the financial piece when it’s centralized and off-site," she notes. "All the employees are right here on half a floor." When employees performing these functions were in individual hospitals, Trunzo adds, they were the first to be called on to fill in for other employee vacancies."

One of the challenges, she says, is making sure that everything is done in a timely manner for those who are on-site at the hospitals and dependent on call center staff for the pre-arrival functions.

"There are still consents [for example] that need to be signed, or patients we have financially counseled who will bring money [to the point of service] instead of paying by credit card, so the sites rely on us to make sure all of the information is in the system," Trunzo says. "We can never take [those communications] for granted. Sometimes there are printing glitches."

Woerly adds that while there are many services that can be offered through call centers, they should be looked at through the lens of these questions:

  • What is the desired outcome?
  • What is the return on investment (ROI)?
  • What is the budget, and how do we prioritize program offerings?
  • What is the level of administrative and clinical support?

Q. We have a physician answering service [that is] run through the hospital switchboard operators. Should we consider moving that to the call center?

A. "There is no right or wrong answer to this question," Woerly says. "It is highly dependent upon the level of service that you desire to handle. I have had [physician answering services] in a call center environment."

Although it is desirable to have all services offered 24/7, it is not cost-efficient in most cases, he notes. "However, by combining like functions in a consolidated call center, you can blend various job offerings and staff skill sets."

It may not be possible to effectively train a switchboard operator to effectively perform scheduling and financial clearance functions, in addition to his or her own duties, Woerly adds, but there may be other combinations of work in which staff can be cross-trained. "This is important for after-hours and weekend coverage," he says. "Economy of scale and full deployment of resources (people, processes, and technology) is the key."

Q. Because our physician referral telephone number is widely advertised in the community — it might be given out on a radio station, for example — that number gets a lot of calls that don’t have anything to do with physician referral. How do you handle that issue?

A. Different services require different phone numbers to best serve each independent population, Woerly points out. "You don’t want to mix switchboard calls [transactions usually conducted in fewer than 30-40 seconds] with consumer referral calls, which may take five to 10 minutes. You need to blend various employee skill sets and call requirements. "If you are serving multiple communities, you may need different numbers for each community, [especially] if there is sensitivity within the community that business is being taken out of our community,’" he adds.

Q. What kind of technology are organizations using?

A. Capgemini customers are using "all levels of technology — from typical phones to full CRM technology," says Woerly. "Databases of information are essential."

At UPMC, the information flowing between the physician system and the hospital system has made for a lot of improvements, Trunzo says. "We also have medical necessity software up and running, and we’re going to a point-and-click front end, where the screens are more user-friendly."

In addition, she notes, there are many direct connections with payers, whereby insurance information automatically populates UPMC systems.

Also, Trunzo says, "we’re working with a company now to have a predictive dialer for pre-registration to hook us directly to patients so we can contact them and put codes in if we need to call them back. That’s in the process of being implemented."

"We’re always looking at giving staff tools to do their job," she adds, "because we’re not increasing staff and volume is not going away." 

Q. Outsourcing is huge right now, and we’re hearing more about it in regard to call centers. I definitely don’t want to outsource. I think it takes away from the personalized approach that is one of our distinguishing features as a stand-alone organization, but that might not matter so much with a large hospital system. What are your thoughts?

A. Outsourcing can be very successful if you partner with the right resource, Woerly says. "It is up to you to do due diligence to ensure that you have selected the best resource. You can also establish your own scripts, key performance indicators, etc., to ensure that personalized service is delivered."

A combination of internal and outsourced services may be beneficial, he adds, especially for after-hours and weekend coverage.

Trunzo says she is not a fan of outsourcing call center functions to an outside vendor, although she considers the hospitals served by the call center to be outsourcing to her. "If it’s internal to the organization," she adds, "I think it’s great!"

Q. There’s some pretty compelling evidence for the positive impact of call centers on hospital revenue. According to the Solucient report, each call represents a significant amount in downstream charges. How are those who have call centers tracking the financial benefits?

A. Depending upon services offered by the call center, Woerly suggests tracking various performance indicators, including one or more of the following:

  • Length of stay — Case management and capacity management strategies should drive length of stay down, he says.
  • Accounts receivable (AR) days — Good clinical and financial clearance procedures will positively affect AR days.
  • Denials — Good clinical and financial clearance procedures will reduce clinical and technical denials.
  • Increased patients — The physician and consumer referrals should be tracked against the number of new patients coming to your physician offices, clinics and/or hospitals. This can be tricky to accomplish, Woerly says, but it is important to measure increased revenues generated from these services as well as various marketing programs.

At UPMC, the financial benefits have been dramatic, Trunzo says. "Denials have been reduced tremendously in the past two years — to 1.8% of total charges — and that’s just what was denied the first time. We have an actual write-off rate of only 0.3%."

In the past year, she adds, AR days are down 14 days to 52. While the improvements are due in part to successful partnering with the business office and other factors, Trunzo says, "they wouldn’t have happened if [services] were not centralized into a call center."

Q. What kind of training programs have been developed? I’m assuming customer service and telephone skills are addressed, but what about other areas of training?

A. "Train! Train! Train!" is the operative phrase when it comes to call centers, suggests Woerly. It’s important that employees fully understand the programs that are offered, he says. "If there is a smoking cessation class that they are scheduling for, have representatives from that department talk to the staff and explain the program. The more contact the call center employees have with their internal customers the better."

Medical terminology also is very important, Woerly adds. "In some cases, registered nurses and other clinical staff should be blended into the staff model. Again, this is dependent upon what programs are added to the call center."

At UPMC, notes Trunzo, the call center has its own systems and training development division on-site, with four trainers who are responsible for training call center staff — as well as all patient access staff — in learning the admissions-discharge-transfer system, insurance and customer service skills, etc. Each employee receives 12 hours of continuing education per year, and all new employees receive two weeks of training.

Each year, she adds, call center employees receive a manual that reviews policies and procedures, customer service standards, goals and objectives, and other pertinent information. They also attend monthly meetings to keep up to speed. In addition, she says, "we review productivity weekly with everyone and also have random audits (so many per employee, per month) to look at accuracy."

Customer service and telephone skills are addressed annually, with a 2½-hour presentation that includes a test, Trunzo explains, "and there is not a month that goes by that we don’t focus on some aspect of customer service."

Because of the crucial importance of telephone skills, call center employees are observed during calls to see how the person’s voice sounds and how she identifies herself, she points out. "The focus is on treating each customer with respect."

Employees who excel receive letters from the vice president or gift cards as part of the organization’s Rising Star program, Trunzo says. "Employee recognition is key with us."

Katherine Dean, SPHR, a partner in the Toronto-based international professional services firm Banks & Dean, notes that training in such customer service skills as active listening and how to keep a timely call flow while also meeting the customer’s needs is critical. But she says her firm, which partners with Interim Leadership Solutions of Austin, TX, finds that another aspect of training is equally important.

"A key issue is helping supervisors find the time in their schedules to coach [call center] representatives," says Dean, whose firm specializes in selection and retention solutions for call centers. "Coaching of reps [provides] one of the best returns on value."

Dean suggests that call center managers make coaching a priority and then determine how best to do it.

Q. What about the use of consulting services for best practices, gap analysis, etc., in creating call centers?

A. UPMC worked extensively with Woerly and other Capgemini consultants in the development of its call center, says Trunzo. Capgemini has devised a four-step progression for a call center, with increasingly complex technology at each higher level and was helpful, she says, in "looking at what we could do [initially] and what we may look at in the future."

More recently, Trunzo notes, UPMC has worked with Chicago-based Jeselnick & Associates, which has provided assistance in productivity reporting/technology, such as the predictive dialer system for pre-registration, and with denial management initiatives. "Their major focus is on revenue cycle management," she adds, "and they have primarily been working on the patient accounting side, but have worked as a team with me on the front end as well."

Woerly notes that the use of consultants is "dependent upon internal resources, sophistication of the desired program, and time frames to implement."

[Georgina Trunzo can be reached at (412) 432-5050 or by e-mail (trunzog@msx.upmc.edu). John Woerly can be reached at (312) 395-8364 or by e-mail (john.woerly@capgemini.com). Katherine Dean can be reached at (888) 241-8198, or by e-mail (kdean@banksanddean.com).]