Operations: Tales From the Front

An unexpected mystery shopper helped Bill Edsel gain important insights into Pinehurst Surgical, the 36-surgeon practice in Pinehurst, N.C., where he’s the CEO. Edsel’s wife had a friend whose numerous health problems caused her to visit various members of the practice.

“Every time she’d come in, [my wife’s friend] would tell [her] she had to wait, didn’t know how long it would be before the doctor saw her, and [then] my wife would tell me,” Edsel recalls. “I talked to the woman and told her to look at the environment and the efficiency of the staff and to report to me. She provided feedback on the doctors and the employees.”

Edsel came to realize that his patients would be less troubled by waiting if they had more information. With input from staff and physicians, he developed a waiting-room sign that read: “We appreciate your visit with us. If you have waited 20 minutes past your scheduled appointment time, please ask the receptionist to check on your appointment. It’s all about your health, and we want you well.”

Now Edsel’s already excellent front-desk staff has another tool on hand for smoothing their interactions with patients.

Any physician who has stopped to think about it recognizes the undeniable importance of a top-flight front-desk staff. Known not so long ago as “the girls,” today these groups of women and men serve as physicians’ primary link to their patients. If they are well-trained and highly professional, they work hard to keep both patients and doctors happy and satisfied.

Starting out right

The first front-desk staffer who greets a new patient can have a real influence on how that patient views the entire office visit.

“Front-desk people are the first and last voices patients encounter. They are critical to the practice,” says Ken Hertz, a senior consultant with the Medical Group Management Association (MGMA). “Physicians should call their own main number once in a while to see what their practices sound like.”

At Northern Rockies Orthopaedics, a five-physician practice in Missoula, Mont., excellent service begins with a patient’s first phone call. When making an appointment, front-desk staff members obtain as much information as possible, including patient demographics and insurance details. Staff members work hard to best ensure a patient is prepared for the visit. They check whether a physician referral is necessary for the appointment, find out whether the patient has had an X-ray or MRI when applicable, and determine how to gain access to pertinent patient records.

“It makes a huge difference, and it’s worth the time it takes to do it,” says Shawna Brownlee, a checkout clerk with Northern Rockies. “We fill out a form with the billing information and send that to a person in the office who does a benefits check ahead of time. It’s all entered into the [EMR] system. So as a checkout person, I can see if the patient has a deductible or copay and ask for it.”

Service at Town and Country Pediatrics, a 16-physician practice with three offices in Chicago, also begins before patients show up. Receptionists make an effort to arrive at the office early to prepare the day’s charts and print out the “superbills” the group uses for that morning’s appointments.

A designated “greeter” meets patients as they come through the front door. She verifies the patient’s appointment, makes sure the patient’s information on file is
correct, and collects any copays.

“We ask people to come in 10 minutes ahead of their appointments to help keep the doctors running on time,” says Cecilia Navarro, Town and Country front-desk supervisor. “When they ask why, we tell them it’s to go over the information on their charts, but it’s also to allow extra time in case they get caught in traffic or have difficulty parking.”

Staying on schedule

Staying on schedule can be difficult for physicians in busy practices. Addressing long waits is another of the front-desk staff’s many duties. At Pinehurst Surgical, patients who have waited 20 minutes beyond their scheduled appointment time are instructed to step up to the front desk.

“The instructions for our check-in staff are to call the nurses station at the different specialties and ask how much longer it will be so that they can tell the patient,” says Pinehurst’s second-floor supervisor, Terry Smith. “If a doctor is behind, I just apologize profusely. Some patients you can’t please, but we bend over backward to do it.”

The front-desk staff at Town and Country Pediatrics works hard to keep physicians on schedule. If a doctor knows she’ll need more than the usual 15 minutes for an appointment, extra time can be scheduled in advance. Patients typically wait no longer than 15 minutes. If they have been waiting longer, they are given the option
of rescheduling.

At Northern Rockies Orthopaedics, some physicians run very close to schedule while others tend to lag behind, says Brownlee. She suggests that patients call ahead to determine what their wait time may be. If they have been waiting in the office for a while, she takes their cell phone numbers and suggests they go out and run some errands.

“We try to explain to the patients that part of the reason the doctors may be behind is that they spend a lot of time with patients, giving them the attention they need,” Brownlee says. “And once a patient has been back for a second visit, he remembers that.”

Of course, doctors aren’t the only ones who can hold up a day’s schedule. If a patient fails to show up for an appointment at Pinehurst, the staff sends an e-mail to the doctor, who must decide what to do. Staff may be instructed to call the patient or send a letter to offer an opportunity to reschedule.

Town and Country front-desk workers place reminder calls to patients the day before their appointments and save date-stamped call sheets for six weeks as proof the calls have been made. No-shows are charged $50. This policy has cut down on last-minute cancellations.

Checking out with a smile

Patients also require thoughtful handling at checkout. At Pinehurst, signs posted in the office explain that patients need to submit copays at the time of service. Nevertheless, patients often complain about being asked for money.

“When patients check out, they’ve just seen the doctor and may have received bad news,” says Angela Armstrong, a checkout clerk at Pinehurst. “You need to take a little more time and show compassion. Or if a patient is very disgruntled about the care he’s received, you offer a chance to talk to the manager or the doctor. You don’t want people to walk away unhappy.”

It’s not enough just to hand a patient a checkout sheet and say, “You owe me $50,” agrees Tammy Clark, another Pinehurst checkout clerk who keeps a constant smile on her face while explaining insurance copays to patients.

Choosing appropriate employees to ask patients for money and training them to do it properly makes a difference, says Jefferson Kilpatrick, a facial plastic surgeon at Pinehurst. He says the person who collects copays at his practice does “a phenomenal job.”

“Part of it is she’s not afraid to ask for the money,” Kilpatrick explains. “Another person may not feel as comfortable … Maybe a person who doesn’t feel like asking for money is better as a greeter.”

In general, the best front-desk workers possess excellent communications skills. Listening attentively can make all the difference in how patients feel when they leave the office, says Nil Tunca, Town and Country’s practice administrator.

“When they want to talk, most patients want me to listen without interrupting and let them vent,” Tunca says. “At the end, they feel better for getting it out, and they usually apologize for taking my time. I take notes on dates and issues and ask them how I can resolve the problem. I always tell them I will get back to them, and I do. That’s usually very satisfactory.”

Maintaining high morale

Not that long, ago physicians managed their own front-desk staff. But today with practice managers and administrators more frequently taking on that responsibility, doctors can focus on what they do best - treating patients.

“A great front-desk staff communicates with our patients to satisfy their needs and solve their problems on a day-to-day basis,” says Howard Rice, a pediatrician and the president of Town and Country Pediatrics. “They sometimes are shock absorbers or play the role of an educator, translator, and psychologist to the needs of patients.”

But where do those great people come from? When hiring people, Robin Monogue, Northern Rockies Orthopaedics’ office administrator, wants to be sure they will fit in with the established front-desk staff team. People who come for second interviews spend a minimum of two hours test-driving the positions they’re applying for. This helps them understand exactly what the jobs entail and gives staff members a chance to look them over.

“Then I poll the staff, and we as a group decide on who will work best in our office,” Monogue says. “That shows the staff that I don’t just hire someone and put her in place. I want their input, I want them to be happy, and I want a personality that works with all of them. They have a part in the hiring and don’t feel that I’ve forced someone down
their throats.”

Continual training can keep front-desk workers at the top of their game. As a result of cross-training at Northern Rockies Orthopaedics, if one staff member is away, there is always another who knows her job and can step into her place. This leads to a strong sense of teamwork.

Monthly staff meetings strengthen that sense of togetherness. At Northern Rockies, these meetings may involve training in new procedures or offering individuals a chance to communicate about current and ongoing problems. Monogue runs two seminars for improving office morale with the humorous titles, “Give Them the Pickle” and “Fish.” Both focus on customer service and how to get along with other staff members who may have difficult personalities.

Monogue, who says the doctors in the practice bring a sense of fun to the workplace, affirms that physicians also can help contribute to staff morale. When a new deli opened in town, one physician suggested ordering lunch for the staff so everyone could try it out.

“The staff has learned not to be afraid to approach a doctor when a problem comes up in their clinic, and the doctors are very helpful in return,” Monogue says. “They’re approachable, and, because of that, problems get solved rapidly.”

Terry Smith says ongoing training at Pinehurst Surgical helps the daily schedule run smoothly and gives staff members the self-confidence of knowing they are good at what they do. Smith and Pinehurst’s other floor supervisor, Carolyn Ussery, meet weekly with their management team to listen to concerns, talk about what’s coming up, and ask how they can better help the staff.

“It’s a communication tool; it may take just five minutes to learn what we can do to help each other,” says Ussery, referring to her relationship with Smith. “We also talk daily by phone, e-mail, or face-to-face. We have two floors at our office, and this keeps them in touch.”

Pinehurst’s 18 check-in clerks work well together as a unit. Smith and Ussery agree that having tough skin, speaking one’s mind, and remembering to let go of small
hurts makes that possible.

“When you spend eight hours a day together, you’re like a family, and you know how families are,” says Armstrong, jokingly. “Sometimes they don’t get along. But we work it out, talk it out, and get back to business because that’s what it’s about: keeping the business going.”

Janice Rosenberg has been a Chicago-based health care and business writer for more than 15 years. Her work has appeared in local and national publications, including Physician’s Financial News and the Chicago Tribune. She holds a master’s degree in library science.

This article originally appeared in the March 2007 issue of Physicians Practice.