Welcoming Newly Insured Patients to Your Medical Practice

At the beginning of 2014, family physician Andy Pasternak's two-physician practice braced for an influx of new patients. But while a few new patients who purchased insurance through the federal and state health insurance exchanges had trickled in by early March, new patient demand was far lower than what Pasternak expected.

"We had sort of been geared up for the large flood of people starting Jan. 1 because there was this whole, 'Everybody's going to get signed up and everybody's going to have health insurance,' and there was a lot of concern that there were people that maybe were going to have a lot of urgent needs," says Pasternak, whose practice is located in Reno, Nev. "We've had some exchange patients, but it's certainly not been the large overwhelming flood of patients that we were kind of concerned about."

Pasternak is not alone in experiencing a slower than anticipated uptick in new patient demand. While several factors may be contributing, technical glitches in both the federal health insurance marketplace and state health insurance exchanges may be a key driver.

Still, by the deadline of March 31, just over 7 million Americans had signed up for health insurance plans via the exchanges, according to the Obama Administration; thanks to a surge in enrollment days before the end of the open enrollment period.

While it's difficult to determine how this will affect your practice, it's likely that many of you will begin encountering these new patients - and it's smart to be prepared. And even if your practice does not experience a surge of new patients, brushing up on how you handle new patients is a smart move. As patient satisfaction plays a growing role in reimbursement, and as more payers ask patients to shoulder more of their healthcare costs, your new patient orientation policies and procedures should change accordingly. Here's how to ensure that you are efficiently and effectively welcoming new patients to your practice.

Assess and update

Start by assessing whether your new patient orientation documents need to be updated or expanded. These documents should outline your practice's basic policies - for example, how to schedule appointments, how to request prescription refills, and who to contact when questions arise, says Gail Levy, founder and president of The Levy Advantage consulting firm. They should also outline your practice's payment policies, letting patients know if you require them to pay copays at time of service, how you handle past due balances, and so on, she says.

If your practice is encountering patients who are newly insured, consider adding a glossary of key health insurance terms to your new patient education materials. A December 2013 study published in Health Affairs found that fewer than 1 in 4 uninsured Americans understands key terms like deductibles, out-of-pocket spending caps, or provider networks. The more informed your patients are about how their insurance works, the easier it will be for your practice to collect what it is owed for services.

Distribute copies of patient orientation materials to your new patients by mail, e-mail, or in person, preferably prior to their first appointment, says Audrey "Christie" McLaughlin, of medical practice consulting firm McLaughlin Sales Group LLC. If you significantly updated these materials, distribute them to all of your patients at their next appointments. Also, post the materials on your website and/or your patient portal so they are readily accessible to patients, she says. "Now is the time, when you have this influx of new patients, to look back and review how you have been orienting new patients to the practice from the get go, and get that information out there."

Gather and share

When new patients call to set up appointments, make sure that your staff members have plenty of time to gather information and distribute information to them. "You want them to walk in the door already oriented to what to expect," says McLaughlin. "It's much easier on the patient that way and much easier on you too, because you avoid that bottleneck at the front desk when the patient gets there."

As always during the initial phone call, staff should document the patient's name, address, date of birth, insurance information, and the reason for the visit, says medical practice management consultant Owen Dahl. If the patient purchased insurance through one of the exchanges, staff should ask him to bring proof that he has paid his premium to his appointment, says Dahl, pointing to a recent New York Times article that noted that one in five people who signed up for insurance under the exchanges failed to pay their premiums on time, and therefore did not receive coverage in January. Others, Dahl says, paid their first month premium but failed to pay the following months. "... We've said 'OK, bring proof of payment, bring a receipt, bring a canceled check, bring something that shows that you actually made that premium payment,' so we know that it's a legitimately covered patient," he says. If the patient cannot provide proof, reschedule him until he can do so, as long as it is a non-urgent situation, says Dahl.

Once staff members gather the relevant information from patients, they should instruct them to bring completed pre-visit paperwork to their appointments. Provide a few options for patients regarding how they can receive this paperwork, says Levy. For instance, offer to send it in the mail, e-mail it, or ask patients to download it from your website or fill it out on your patient portal. Keep in mind that some of these new patients may be less economically stable (for instance, if they received coverage through the Medicaid expansion), so they may not have access to a reliable Internet connection, says Levy.

While on the phone with patients, staff should also discuss payment expectations; letting them know if your practice requires copays at time of service, as well as some general education regarding how insurance works, says Dahl. If staff is unable to provide this information over the phone, an informed staff member should meet with the patient for a few minutes when she comes to the practice for her first appointment.

Welcome and build

The more informed your patients are prior to visits; the smoother new patient intake will go. That, of course, will enable your front-desk staff to focus more on customer service. "I'm a big proponent of everybody feeling welcome and comfortable when they come into the office, and that just goes back to generally creating a hospitable environment, smiling, treating patients well," says McLaughlin. "... Medical practices really have to focus on good customer service or good patient service in order to make sure that they put the best foot forward for their patients."

To go above and beyond, when welcoming new patients, consider assigning a front-desk staff member to each new patient, says Dahl. After the patient calls to set up an appointment, this staff member can call the patient back, welcome him, ask if he has questions, and provide insurance education, if necessary. Then, if the schedule allows, that same staff member can welcome the patient to his first appointment.

But the burden of welcoming new patients should not lie squarely on staff members' shoulders. "I think that the impressions that the patients get about your practice are heavily weighted to the interaction that they have with the provider," says Dahl.

For that reason, physicians should focus on "relationship building" when meeting with new patients. "You're trying to work toward a relationship of, 'You can trust me, I'm a good provider,'" says Dahl, adding that physicians should ask about patients' family, kids, and so on, rather than just focusing on the clinical aspects of the visit. "I think they need to be approached as, this is a long-term relationship that we're attempting to establish."

Review and reevaluate

Moving forward, regularly assess your new patient intake process to identify areas that need improvement, says Dahl. Also, closely monitor your new patient growth and your payer mix to determine if you need to make adjustments.

"Reviewing your processes on an annual basis, and then doing the appropriate staff selection [to assist with new patient intake], getting the right people with the right personality, and then getting them trained is important," Dahl says. "How do you answer the phone correctly? Do you smile? Do you look up at every patient that walks in, or are you so busy that you don't acknowledge them? Those are little things, but those are the little things that can make a big difference as to whether or not the patient stays with your practice or goes somewhere else."

Dealing with more complicated patients

Many patients who purchase insurance through the health insurance exchanges or who gain it through the Medicaid expansion may be newly insured. Make sure your practice is prepared, says Gail Levy, founder and president of The Levy Advantage consulting firm.

"Some of these patients may have never had insurance and who knows what kind of unmanaged, untreated, ongoing chronic conditions they may have," she says. "... You're dealing with a good number of people who socially, economically are in a situation where they have never really been able to receive good, managed care - they've done a lot of episodic ER-type care."

To prepare for these patients, your physicians should define "care policies" for their front-desk staff, says Levy. These policies should make it clear how staff should handle various new patient requests. For example, if a new patient calls with a sore throat, the policy, depending on your physicians' preferences, might be that the staff should schedule the patient for a complete physical. "They're going to say, 'When patients call with this range of symptoms, this is our response,'" says Levy. "If that's not clear at the onset, the staff is going to go crazy with strategies to how to work these people in."

Customer service tips

Starting off on the right foot with new patients does not require a lot of time and effort. Here are some small ways you can provide a great first impression, says Audrey "Christie" McLaughlin, of medical practice consulting firm McLaughlin Sales Group LLC:

• Make eye contact with patients and use formal titles, unless the patient instructs you otherwise.

• Escort patients from the exam room to the front desk.

• Never assume patients understand what you are talking about. Explain everything - from insurance to procedures to diagnoses to medications.

 • Smile when you answer the phone. "You can really hear the difference in somebody's voice when they smile," says McLaughlin.

Coverage calculator

Many of the plans offered through the health insurance exchanges include higher deductibles, meaning your practice must step up its patient collection efforts. Educating patients about their responsibility for payment and how insurance works can help ensure your practice can collect what it is owed.

To help educate your staff, and therefore help your staff educate patients, try CoverageCalculator.com. It's a free, simple way for patients and practice managers to quickly determine out-of-pocket costs. The website, developed by retired plastic surgeon James Weintrub, instantly calculates out-of-pocket cost for any combination of fees, copays, deductibles, out-of-pocket maximums, and co-insurance. The site also has a short video explaining how insurance works.

Aubrey Westgate is senior editor for Physicians Practice. She can be reached at aubrey.westgate@ubm.com.

This article originally appeared in the June 2014 issue of Physicians Practice.