PHONE MANAGEMENT

How Does Your Practice Sound on the Phone?

Many patients derive their impression of your practice from telephone contacts. Here are tips for doing a better job.

Lyndia Flanagan

Covered in FPM Quiz

How do you rate with your patients on the phone? Can a caller schedule an appointment easily? Are doctors readily accessible by phone? Are emergency calls processed quickly? Are other calls returned in a timely fashion?

If you haven't evaluated your practice's phone service recently, it may be time you did. Patients tend to judge the efficiency of a practice by how well its phones are managed. Patients who have difficulty making appointments, contacting a doctor or obtaining care for an urgent problem are more likely to change practices. It may be disappointing, but "what keeps patients coming back to the same practice is the quality of service, not the quality of care," says Susan Keane Baker, a practice management consultant and author of Managing Patient Expectations: The Art of Finding and Keeping Loyal Patients.

Recently, we asked members of FPM's Board of Editors and Panel of Consultants to share tips for handling patients' calls. Here are some of their best insights.

1. Test your current system.

Good telephone management begins with a needs assessment. Before you can set performance standards and implement protocols, you must understand the demands on your system. How many calls does your office receive each day? What are the peak hours for incoming calls? How many calls are you losing because lines are tied up?

KEY POINTS: To many patients, how your practice manages its telephone calls is an indication of how well your practice manages care. A good way to assess your practice's phone skills is to put yourself in your patients' shoes and call your practice. Above all, when physicians and staff speak to patients over the phone, they must sound interested, caring and helpful.

If you have relatively sophisticated equipment, you may be able to program your telephone system to produce usage reports. If not, ask your phone company to conduct peak-load and busy-signal tests (also known as a "busy lamp" study). This information will help you determine how many published numbers and incoming and outgoing lines you need to process your practice's volume of calls.

2. Plan how to manage the flow of calls.

Once you have a sense of your call volume, investigate ways to better manage specific types of calls. One option is to maintain different telephone numbers for calls from physicians and certain services, such as billing, insurance processing and prescription refills (see "Minimizing the hassles of prescription refills"). If you do maintain separate numbers for billing and insurance, include this information on your statements and in your practice's brochure and newsletter. Another option is to direct calls from patients with nonurgent messages for doctors into voice mail.

'Accessibility is key to promoting satisfied patients.'

If your staff is overwhelmed by a flood of calls at certain times of the day, encourage patients to contact your office during nonpeak hours. Print this time frame on appointment cards and other practice materials, including patient education handouts (e.g., "For nonurgent matters, we encourage you to call between the hours of 1 and 4 p.m., when we can give you faster service"). Also, dedicate one or more lines for outgoing calls to reduce the likelihood that patients calling in will get busy signals.

Keep in mind, however, that adding lines and new phone numbers for certain services won't lead to more efficient patient communication if your switchboard hours are too limited. "Accessibility is key to promoting satisfied patients," says Maxine Pollack, MA, president of MSP Associates, a practice management consulting firm in Pepper Pike, Ohio, and author of Manage It Right. "Keep the phone lines open when patients are able to call, such as during lunch time and before and after normal work hours."

3. Put yourself in the patient's shoes.

With the help of several volunteers, check out how your patients' calls are handled. How efficient is the switchboard operator or receptionist in answering, screening and directing the calls of patients seeking appointments, requesting insurance information, needing referrals or demanding to speak to a doctor? Let staff know that you plan to test the system periodically by asking volunteers to make test calls, then meet with the staff after each test to discuss your findings.

If you have an automated attendant, try calling it yourself. Listen carefully to its instructions. Press the buttons for the various options to find out how quickly patients get the information they need. Are the options sufficient -- or overwhelming? How does the system handle emergencies? (See "Making your automated phone system user-friendly.")

Minimizing the hassles of prescription refills Many practices have dedicated phone lines for prescription refill requests; some channel these calls directly from an automated attendant into voice mail. J. Landy Damsey, MBA, MHS, president of Damsey & Associates in Norfolk, Va., offers a different approach. "Educate patients to call the pharmacy, not the physician's office, regarding prescriptions," he recommends. "Advise each pharmacy to fax all prescription requests to a special fax located at the nurses' station" (one used only for this purpose). Then, every hour or two, a nurse can talk with physicians between patient visits and obtain authorizations. According to Damsey, practices that send pharmacies a letter about their intention to handle prescriptions this way after a certain date (at least 30 days after the letter) have had an excellent response. "To further refine the process, provide the pharmacies with a turn-around form designed by the practice but initiated by the pharmacy," advises Damsey. The pharmacy faxes the form to request a refill, and the nurse returns it to the pharmacy with approval, denial or other instructions from the physician.

If voice mail is among the system's options, test it. What type of greeting does a patient hear? Does the greeting include what to do if the caller has an emergency? Does the system allow time to record a lengthy message? Is the quality of the recording high enough to ensure that the caller's message can be understood?

Finally, don't overlook your answering service. Does it handle calls professionally? Check to see how quickly and accurately the service relays information to the physician on call.

4. Set performance standards and implement protocols.

"It is extremely important for a staff member who receives a patient's call to sound like he or she is interested in the patient's concerns and to see that they are addressed," says Robert Gillette, MD, a semi-retired family physician in Poland, Ohio. "It has been my experience that most patients are reasonable if they feel that the person they are talking with is genuinely trying to be helpful."

Pollack agrees: "The first person a caller comes in contact with can immediately set the tone for the practice."

So how do you convey a warm and caring atmosphere over the phone? Here are some suggestions:

• Set ground rules for those who staff your phones: Avoid curt greetings, don't keep a caller on hold too long and minimize the number of times a caller is transferred. In other words, make sure your staff practices good phone etiquette (see "Telephone etiquette").

• Create tools to help your staff handle the full range of patients' inquiries. Hold a brainstorming session to identify the most frequently asked questions, and then develop scripts or protocols for answering them. This will help ensure consistency in the nature and quality of information patients receive.

• Develop a list of routine screening questions for certain types of callers. For example, Michael Arnow, CPA, owner of Arnow & Associates in Glendale, Wis., recommends asking the following standard questions when scheduling appointments with new patients: Do you know how to find our office? How long have you had your current problem? Who referred you? What is your insurance coverage?

  "Make sure to always ask if established patients have changed insurance since their last visit," adds Reed Tinsley, CPA, a shareholder in the Horne CPA Group in Houston. "If patients have changed plans, remind them to bring in their new insurance card, and make sure the receptionist knows to ask for it."

• Implement triage protocols for managing calls related to urgent, same-day or next-day appointments as well as providing phone advice. A number of sources offer help in this area. Methodist Hospital of Indiana, for example, has published a multi-volume set of protocols for ambulatory care to help staff determine what type of care a patient needs and who should field certain requests. This set, Telephone Triage Protocols, can be purchased from the Academy by calling 800-944-0000.

Making your automated phone system user-friendly "I couldn't figure out what to do, so I hung up." "I don't want to listen to a recording. Why can't I talk to a real person?" Do these patient observations sound familiar? To avoid these and other complaints about your automated attendant, take the following steps: Make instructions for medical emergencies the first option so callers can choose it quickly. Provide a range of options tailored to the most common needs of your patients. For example, "If you wish to schedule, reschedule or cancel an appointment, press 2 now. If you wish to request a prescription refill, press 3 now. If you wish to request a referral, press 4 now." Limit the time a caller must spend with the automated attendant to less than 60 seconds. Educate your patients about the benefits of the system and how it works by displaying this information in the reception area and including it in your newsletter, new-patient letter and other communications.

5. Fine-tune your staff's phone skills.

Having well-trained personnel is the key to an effective and efficient phone operation. "It takes a different set of skills and knowledge to respond to a patient's medical needs (appointments, prescription refills, etc.) versus a patient's billing or insurance questions," says J. Phillip Macon, president of J.P. Macon & Company in Jackson, Miss.

Training opportunities are available in a variety of formats, from workbooks to consultant-led workshops in your office to audiocassette and videotape presentations. For example, the Medical Group Management Association (MGMA) offers a videotape titled Telephone Talk (for more information, contact MGMA's book division at 303-397-7888).

Telephone etiquette Do you want to make a good impression with patients calling your office? Then work with your staff to implement these tips: Answer the telephone within three rings. Give the name of the practice and your name. Don't use shorthand (e.g., "Doctor's office."). Allow callers to speak without interrupting them or placing them on hold. Give callers your undivided attention. If you are preoccupied or distracted, they will hear it in your voice. Avoid leaving a caller on hold longer than 40 seconds. Research suggests that people are less likely to hang up if you return to them within that time. No matter how brief the exchange, make a point of using the caller's name. Monitor your tone of voice by watching your facial features in a small mirror by the phone. Callers can sense an audible difference between a smile and a frown.

6. Be a good role model.

Your attitude about patient communication sets the tone for your staff.

Evaluating your current system, implementing protocols and improving basic phone skills go a long way toward cultivating a patient-friendly phone service. But, ultimately, your attitude about patient communication sets the tone for your staff.

"I had the good fortune to grow up watching a physician father who saw most of his patients as friends, people he was happy to see and talk with," says Gillette. "It still can be like that, the government and the managed care plans notwithstanding -- and it should be."

Lyndia Flanagan is senior editor of Family Practice Management.

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