Performance monitoring a necessity
(The discussion of call centers that began in the October Hospital Access Management continues this month with some follow-up questions — posed by Gillian Cappiello, CHAM, senior director of access services and chief privacy officer for Swedish Covenant Hospital in Chicago — on staff training, balancing call workload, and other issues.)
Question: In regard to staff training, could you address the issue of cross-training or staff blending? Is it better to have all call center representatives trained in all functions, or can you successfully have "pods" of representatives with more specialized or focused areas of expertise within a call center?
Answer: "We have done both here during the past few years," says Georgina Trunzo, director of patient access services for the University of Pittsburgh Medical Center (UPMC). "We have pods, but everyone has a backup specialty as well. It has helped us to have specialists in certain areas, such as self-pay/commercial, but cross-training is critical, as vacancies, illness, and increased volumes occur."
The more full service the call center, the more diverse staff and organization of staff are required, notes Mary Lou Anderson, director, physician and guest relations, for University Hospitals of Cleveland (UHC). "Considering a full-service call center that includes physician-directed referral, consumer referral, and hospital operator and physician answering service, there are two distinct staffing levels — clinical and nonclinical," she adds. "In this model, there are four workgroups with the potential of additional pods supporting referral services — scheduling pods for specific clinical areas based on volume."
There is sufficient diversity within this model that allows staff to be deployed at high peak times so they can assist with services when one area is short-staffed, Anderson says. "For instance, the answering service staff has high volume during lunch hours and evenings, while hospital operators are at high volumes mornings through late afternoons. Both are 24-hour services and have staff within the same skill-based level. There is dedicated staff for each service and a cross-service group that can work in either area, depending on high and low peak times," she explains.
At orientation, UHC call center employees receive information about the overall goals and objectives of the organization and the call center, she explains, and are given clear definition of behaviors and standards that drive pay for performance. "Training continues within each work group so that information is drilled down to the specific requirements, standards, and behavioral expectations," Anderson says. Training then moves to the front line, she adds, where mentors are assigned to new staff for on-the-job training and are available as a primary go-to person for a defined period of time.
John Woerly, RHIA, MSA, CHAM, senior manager with the consulting firm Capgemini, says he prefers a skills-based blending of the work, dependent upon the individual staff member’s experience and learning abilities, and the complexity of the job function itself. "There really is no right or wrong answer as to which job functions can and should be blended," he adds. "Many issues need to be considered, including the depth of the job function, volume of customer contacts, etc. Some job functions can be easily blended, while others may have such a level of sophistication and knowledge transfer that if they were blended, high performance would be difficult."
Certain jobs lend themselves to the pod concept, Woerly notes. "Financial clearance activities are a prime example. The functions pre- registration, insurance eligibility/benefit verification, precertification/authorization, primary care provider referral, and financial education/ counseling can be successfully combined, providing patients with a consistent financial intake contact."
Question: How have hospitals with call centers successfully incorporated inbound and outbound calls vs. inbound only? Our call center is predominantly inbound, with some outbound calls for follow-up (i.e., to preregister patients if we couldn’t do it at the time of scheduling, to get a diagnosis, clarify a test, or get a referral).
Answer: Call metrics should be used to properly balance workloads of inbound and outbound calling, says Woerly. "The worst possible service would be to advertise an incoming number and have no one to answer it, or to answer only after multiple ringing."
"Dependent upon call volume," he adds, "coverage may need to be assigned [to] either incoming or outgoing call management. With the proper call distribution systems, calls can be automatically routed based upon skill sets and call volume."
Advanced call center
An advanced call center allows patients to contact the center any time and any way that best meets their needs, Woerly points out, noting that web contact, e-mailing, and other modes of communication must be considered to meet customer requirements.
The UPMC call center handles both inbound and outbound calls, Trunzo says. "We have inbound calls from physician offices placing a reservation, for urgent precertification, from a patient returning our call, or from an insurance company returning our call." Outbound calls, she adds, are to insurance companies regarding commercial insurance and worker’s compensation issues, or to patients for clarification. "For inbound calls," Trunzo says, "we have set up queues so that physician offices do not wait, but rather the call bounces to a reservationist. In addition, all verifiers have multiple lines before the call goes to [a recorded] message."
At UHC, according to Anderson, staff are expected to follow up with outbound calls to meet insurance/scheduling requirements for preregistration. Another opportunity for outbound calls occurs when physicians or their office staff call or fax the physician-directed referral staff with clinical information to have a patient scheduled (to a specialist or for a diagnostic test), she adds. "The clinical staff responding to these situations do the following: call the patient to obtain correct demographic and insurance information, obtain any and all required test results or physician notes, determine a preference for time or location, and schedule with the appropriate physician or diagnostic service," Anderson notes.
"A call or fax [is] also sent to the referring physician providing the patient appointment information," she explains. "This is a big win’ on the part of the referring physician, especially by providing easy access for patient appointments."
An Internet site is another area where outbound contact is required, she notes. If requests for referral or information are directed to the call center, Anderson adds, staff can respond by e-mail or telephone.
Question: From your experience, which services are people calling for most often?
Answer: "Our service is a predominantly physician-directed referral, and our primary contacts are the referring physicians, their office staff or their patients," says Anderson. "As a result, our calls are requesting full-service patient appointment scheduling to any physician specialty and hospital-based diagnostic/clinical service, based on the needs of their patients," she adds. "We respond to marketing initiatives based on the priorities of the organization," Anderson says. "Because our call center staff is knowledgeable about the organization, [they] can quickly respond to new initiatives, assist with multi-scheduling situations, and provide personalized services as needed. Our staff is involved with ongoing marketing programs in addition to one-time marketing initiatives."
No contact center is exactly like any other, Woerly emphasizes, with the type of calls coming in dependent on what the call center offers. That said, he suggests that many calls will center around:
- New patients finding a physician (physician referral)
- Care issues (disease management)
- Questions regarding appointments (scheduling)
- General information (hours of operation, location of facilities, visiting hours, call transfer to an inpatient, etc.)
- Questions around financial/insurance issues (financial clearance, financial counseling and/or customer service)
Question: What is the value of a new person calling for physician referral or to sign up for a community event? How are organizations faring as far as downstream revenue is concerned? What about other measures of financial impact?
Answer: The goal of any call center is to bring in new business by fulfilling the requests of a caller, notes Anderson. "If the caller is satisfied, there is the option for that relationship to grow." The first contact is the most critical and must be handled by knowledgeable staff with a high level of customer service, she continues. "Once a relationship is established, there is the potential for continued interaction and referral to other services. The caller may also share his positive experience with others, resulting in new business for the organization."
Activity must be analyzed against the financials of the organization, which must define its rules, including definitions of new business contacts, Anderson says. "There needs to be a time period established prior to the encounter that determines no activity since . . . ,’" she suggests. "For the population that meets your requirement, the next step would be to look forward from the date of service one year out and document all activity."
Financial analysis should be done annually and for each marketing initiative or source of referral, Anderson says. "Determine which programs meet your objectives: Are you creating image and/or driving business? Conduct quarterly reviews of initiatives to determine call volume and appointments scheduled."
"Don’t be afraid to stop a program or change along the way if the results are not what you expected," she adds. "Always return to your objectives."
Anderson describes these specific financial benefits derived from the UHC call center:
- Contained referral to University Hospital and within the health system
- Increased patient appointments scheduled annually since 2000
- Increased referral to diagnostic areas
- 93% of UHC business physician-directed
At UPMC, the financial benefits also have been dramatic, says Trunzo. In the past two years, denials have been reduced to 1.8% of total charges — "and that’s just what was denied the first time," she continues. "We have an actual write-off rate of only 0.3%."
In the past year, Trunzo notes, AR days have decreased by 14, from 56 days to 42 days. (Editor’s note: This figure was incorrectly stated in the October issue of Hospital Access Management.)
Question: If the call center is to be the one resource for everything, how do you manage that database of resource information? If the caller asks, "Do you have a program that deals with weight management?" What resources does the call center representative have to know how to direct the call?
Answer: A relational database and management of that database are critical for success, Anderson advises. "It is important for staff to be able to respond quickly and with knowledge." Information about marketing initiatives should be shared with the call center, she says, and the call center should also be involved in the planning of the marketing initiative. Once information has been identified, add it to the database.
At the University Hospitals’ call center, Anderson explains, every contact is associated with a source that allows the organization to link calls and actions taken to sources of referral. "Our database includes physicians and their associated organizations," she says. "This is absolutely necessary for physician referral — the ability to identify where business is coming from and why."
UHC has unique telephone numbers for physician referral and others for consumer referral, Anderson notes. "Our consumer referral has general consumer lines [local and toll-free], as well as those specific to an ongoing marketing program. Successful identification for the source of a call is important whether it is identified from a defined phone line or from information obtained at the time of the call," she says.
Availability to access other applications depends on the needs of the staff to respond or the function of the call center, Anderson adds. "If scheduling patient appointments is important, then access to a scheduling application is important."
Anderson emphasizes that, if call center employees do not know the answer to a question or are not sure of the answer, it is OK for them to say that they do not know. "It is better to say this than to give out wrong information," she adds. "Our staff will take the time to find the answer and return the call."
Most advanced call centers have sophisticated customer relations management support, Woerly notes. "Keeping data and staff current on new programs, changing conditions and operational issues is essential." Although it may be possible to run a successful call center manually, he adds, as functional layers are built and operations increase, it will become increasingly difficult to maintain quality performance without investing in technology. "Knowing what technology is required is the fine science," Woerly points out. "Additionally, having strong management in place with strong telephone knowledge is essential. Performance monitoring is a must."
[Editor’s note: Georgina Trunzo can be reached at (412) 432-5050 or by e-mail (firstname.lastname@example.org). Mary Lou Anderson can be reached at (216) 844-7557 or by e-mail (MaryLou.Anderson@uhhs.com). John Woerly can be reached at (312) 395-8364 or by e-mail (email@example.com).]