Working the Phones

Lorraine Laurio and her colleagues used to spend hours calling patients to remind them of upcoming appointments. “Two of us would spend the better part of our afternoons calling people, and of course we’d never get anybody. Our two doctors see about 100 people a day - and there’s no way we can make 100 calls a day,” says Laurio, a medical assistant at Springhill Dermatology Clinic in Mobile, Ala.

Then the clinic began using telephony software to handle callbacks. Now, Laurio says, “it takes five minutes, tops, and I’m done.” The system is programmed to make calls between 5:30 and 8 p.m., when more people are at home, and the staff is freed up to handle other matters in the afternoons. “I can’t imagine why any practice wouldn’t have a system like this,” Laurio says.

Surprisingly, very few practices do. Although these phone-based software applications are hardly new, research estimates that only 2 to 5 percent of practices across the country use an automated callback system; even fewer utilize automated systems for lab results, prescription refills, or the other features collectively referred to as telephony systems.

Why? Industry experts say it’s perception, not reality, that holds back the majority of practices. Smaller practices think they can’t afford the systems. Some worry that their patients won’t like it, or their staff will find it too complicated to operate. But many practices using telephony applications report that these potential downsides don’t necessarily materialize - and that the payoffs can be greater than expected.

Wise investment

Traditional reminder cards or calls leave a lot to be desired. But without callbacks, the no-show rate climbs, disrupting the schedule, and costing the practice money. And when the cost of traditional procedures like reminder postcards is added up, telephony applications may prove to be a bargain in the long run.

“Financially, it pays for itself,” says Suzanne Fink, systems manager at Bassett Healthcare in Cooperstown, N.Y. “Our no-show rate went down about 30 percent [after adopting a telephone recall system].” Laurio agrees. “Our no-show rate nose dived. Now if we have a cancellation, we have time to fill it.” Most new adopters of telephone technologies experience similar improvements - as well as the cost savings and efficiencies that result.

For example, telephony applications can also save labor costs. Vivek Oberoi, systems administrator for Middletown Medical Clinic in Middletown, N.Y., says their automated phone system eliminated one full-time administrative position. “In our market, that’s at least $10 an hour, giving us a savings of over $20,000 a year.”

Some systems can save money on phone bills as well as personnel budgets. “Many of our calls from a centralized location are actually long distance,” says Sharon Pitzer, project manager for WellSpan Medical Group in York, Pa. “There are no long distance charges” using the telephony service.

So, telephony systems can save you money - but just how much do they cost? As with most things, the answer is ... it all depends. Today there are more choices than ever before, both in available services and prices.

Premise-based or ASP?

Until very recently, all telephony systems were “premise-based,” meaning the software was purchased outright and installed on a PC or network. Depending on the size of the database and the complexity of the system, premise-based systems start at $3,000 to $5,000 and can run into the tens of thousands. Service agreements and upgrades are usually paid for separately on a contract basis.

Now another option is available, offering dial-up access to the telephony system through the Internet. Known as a “hosted application” or an Application Service Provider (ASP), this option offers several benefits. First, there is little or no upfront investment - just a monthly or per-call charge. With an ASP, practices can try a system without making a large financial commitment. And with charges as low as 15 cents per completed call, even small practices can utilize the technology without taking a big bite out of the budget. Of course, depending on the number of daily calls, the per-call fees can add up, making the one-time fee for a premise-based system more economical for some.

ASPs don’t require high-tech hardware, either. “All you need is a modem - you don’t even need an Internet service provider,” says Neil Armentrout, president and CEO of TeleVox, whose telephony systems are used in over 3,500 sites worldwide. “We can bring over 10,000 patient appointment records from a practice management system on a 56k modem in just a few minutes.”

New technology can be easier to access through an ASP, as well. For example, TeleVox recently upgraded its ASP product to include automatic speech recognition technology. “This technology is very expensive to adopt,” says Armentrout. “It would add about $3,000 to the cost of a $5,000 premise-based system.” But through an ASP, there is no additional charge.

Patient perceptions

“Expense is one thing, but patients’ happiness is most important,” says Oberoi. That sums it up for a lot of physicians, who worry that their patients will react negatively to a pre-recorded phone call.

But that concern isn’t borne out in research or in real life. According to a study conducted by the Centers for Disease Control and Prevention (CDC), 99.5 percent of patients expressed a positive opinion about automated phone calls they received. Many practices say automated services are so common now, patients don’t even notice. “We’ve had no response from patients one way or the other,” says Kenneth Hertz, administrator at MacArthur Surgical Practice in Alexandria, La.

“The majority of patients appreciate the reminder,” adds Fink. “But we do have people who hate being called by a computer - maybe 3 percent of our patients.” Fortunately, most systems provide options to accommodate those people. For example, elderly patients who may be confused by a push-button response system can receive customized messages without those options. And patients can ask to be placed on a “never-call list” - a request than can be fulfilled with a few keystrokes.

While all this technology may seem intimidating to some, automated phone systems are generally easy to use. “I’m not a totally computer-literate person,” admits Laurio, “but I can press a few buttons and record a few names.” A good vendor will handle set-up, installation, and training, and usually staff can take it from there; additional support is usually readily available. Vendors offer technical support call lines, annual service contracts, and are available for on-going training as necessary.

Not just for recalls

While recall is the most common telephony application, the systems can manage many other aspects of a practice as well. Lab results can be retrieved confidentially using a personal identification number (PIN). Prescriptions can be refilled without staff intervention. An inbound calling system can enable patients to leave messages for specific staff members, page on-call staff in emergency situations, receive answers to common questions, and check appointment and account information.

The future is bringing even more capabilities. Automatic speech recognition is one, allowing patients to navigate a telephony menu by speaking instead of pressing buttons. Experts say this technology will speed call times and greatly increase the capabilities of the systems. The telephone isn’t the only communication resource - many systems can now send messages via e-mail, fax, and wireless devices. While few patients may use these methods now, telecommunications experts expect they are the wave of the future.

One thing is certain - automation is not going away. And while many practices may have reservations about using it, those who take the leap rarely look back. “I’m so glad I bought the telephony system,” says Oberoi. That enthusiasm is typical - and quite a contrast to the staff’s mood after hours spent making phone calls or licking stamps.

Jennifer Arnold can be reached at editor@physicianspractice.com.

This article originally appeared in the July/August 2001 issue of Physicians Practice.