Are you Operating a Practice or a Business?

- Results Reporting
by Scott Forehand

The answer to the question is “Both”. If you lose sight of that reality, then your patients will be the loser in
the end. If you focus only on the business aspect (financial), then your treatment may be perceived to be
cold or sterile. If you focus only on the practice aspect (patient care), then your practice may suffer
financially, resulting in a reduction in patient care quality.

Last week I was having lunch with a colleague who operates a local medical practice. He was remarking to
me how everything seems to get more and more expensive every year, and staffing seems to be a larger and
larger problem every year. At his practice, the ancillary staff are overworked and experience high levels of
stress and work anxiety. The patients flow is good, but long patient waits are still more the norm than the
exception. He needs to hire more staff, but cannot afford it in this economic environment. He is at odds
trying to juggle financial, staffing, patient care, and customer service issues.

From my perspective, labor leveraging and outsourcing are the solutions. There are outsource applications
for just about every function in a medical office. Following is just one solution available today.

SEMI-AUTOMATED SECURE RESULT REPORTING

PROBLEM In a traditional clinic or practice setting, patients would leave the office with instructions
to call back in a few days to retrieve testing results (lab, x-ray, ECG, etc.). In many cases, an even worse
process involving the mailing of medical results to the patient’s address of record is used, without
consideration of who at that home might open the results. In the practices that I am familiar with, the office
staff normally performs the processes of result collection, compilation, interpretation, review, and
dissemination to the patients via phone or regular mail. The problems and information bottleneck occurs at
the point of dissemination to the patient. Here are some of the potential issues:

• The patient calls back and the results aren’t back yet
• The patient calls back and results aren’t interpreted yet
• The patient calls back and the chart must be found
• The patient calls back and an authorized person is not available to give the results
• The patient calls back and it isn’t during normal hours of operation
• The patient never receives the mail, as the results get lost in the mail
• The mail gets delivered to the wrong address
• The mail is delivered correctly, but someone else at the home opens the results

In all of these common scenarios, the following results occur: staff time was wasted, the phone line was
engaged unnecessarily, the patient didn’t get the result, the patient must call back again, the results never
get delivered, the results get delivered to someone other than the patient, the results are read by or made
available to someone other than the patient, and the patient gets frustrated with the practice or clinic.

Here is a common example of current telephonic practice:

SCENARIO A child is taken to the pediatrician for evaluation of a sore throat. A swab of the child’s
throat is collected and sent off for evaluation. The child’s parent is told to call back in 48 to 72 hours to get
the results. The parent calls back 2 days later in the morning, and is put on hold while someone at the front
desk tries to find the chart and retrieve the results. As it turns out, the results aren’t back yet, and the parent
is told to call back on the next day. {5 minutes staff time, 5 minutes phone time, 5 minutes patient wait
time}. The parent calls back the next day, and asks for the results. The parent is put on hold, while the file
is found. Then someone with authority to give out the results is found and they get on the phone with the
parent. The results are given as negative, but the parent is told to complete the antibiotic course anyway,
and call back in 48 hours if still symptomatic. The parent then asks why they should continue taking the
antibiotics if the result was negative, and a 5-minute discussion begins. Upon conclusion of the discussion,
the staff member should make notes about what was said during the discussion, and the results that were
given to the patient’s parent {15 minutes staff time, 10 minutes phone time, 5 minutes patient wait time}.
The preceding all-too-common scenario yielded 20 minutes of aggregate staff time use, tied up a telephone
line for 15 aggregate minutes, and made the patient’s concerned parent wait 10 total minutes for a negative
result.

THE MATH
The scenario above is more often the norm than the exception. If you extrapolate the numbers to that of a
busy clinic or large practice (assume 7 full time providers seeing 25 patients per day with 30% of the
patients calling back for some kind of result), this process will yield around 17.5 hours of staff time and 13
hours of telephone time used to deliver one days results via one-on-one telephone conversation. The
patient will certainly appreciate the one-on-one interaction with a familiar voice, but the clinic or practice
bottom line most certainly will not. To put things in perspective, let’s say the normal process can be
completed in one half of the time (because the person doing the process is so efficient.) Let’s say that
person is willing to work for $12.00 an hour (good luck finding an efficient $12.00 per hour staff member).
The result will still yield a daily labor cost of $105.00. That’s the cost for the labor before employee
benefits, taxes, phone line use, etc. The actual costs should come in at seventeen to twenty-seven percent
higher yielding an actual daily cost between $122.85 and $133.35.

SOLUTION What happens if we automate what we can? Patients are instructed to call back at a
certain time, and to call a toll-free number. After the results are reported to the practice or clinic, they are
reviewed, interpreted, and given to whichever ancillary staff member is responsible to give the patients
their results. Here is where the timesavings and labor savings happen. The staff member responsible for
giving results will call the secure voice system and leave the results and instructions for the patient under
that patients unique ID. There is no possibility of getting a wrong number, no possibility of needing to
leave a message for the patient to call back and get the results, and no possibility that the staff member will
get involved in a protracted conversion about “the negative lab result and what else could be causing the
problem.”

RESULT The entire process is now streamlined to just under 3 minutes. The results have been
disseminated efficiently. The patient can call anytime, day or night, to retrieve the results. The patient
hears a familiar voice (as opposed to a completely automated system’s computer generated voice). Only
one practice phone line is in use, and it is calling a toll-free number to leave messages for the patients. The
patient perceives a higher level of customer service (as noted in a Press-Gainey® study). The staff takes
almost 85% less time to complete this task. Lastly, a HIPAA compliant medical-legal record is made by a
third party verifying when the patient retrieved the results, thereby mitigating some practice risk. Go ask
your mal-practice insurer if this will reduce your premium!

PRICES There are several companies that offer this service. Pricing typically comes in the form
of per call, or per provider. Per call pricing can range between $.29 and $.79 per call. Per provider pricing
can range from $79 per month to $245 per month (for unlimited use).

CONCLUSION Leveraging your labor, through use of technology or outsourcing, is an efficient

and cost effective way to help out your bottom line. The benefits go beyond that of just financial. Add a
dash of increased employee morale (due to lower stress levels), add a pinch of increased patient perceived
customer service, and add an additional layer of legal protection through mitigation of risk, and you have
the perfect recipe for a more profitable practice offering higher quality of care.