Practice Tips and Efficacy
Cutting the Phone Cord in a Mohs Surgery Office
By Sherrif F. Ibrahim, MD, PhD, FACMS
Ongoing challenges with hiring in the medical office have created difficulty when it comes to communicating with patients. As call volumes increase and staff numbers do not grow accordingly, it is impossible to answer every phone call in real time. Furthermore, society is changing rapidly in how we communicate with each other and with our various service providers. While the old-fashioned land line was previously the only way to reach patients, we now have to pivot to alternative means of communication to keep current and to keep up with patient expectations. Although many general dermatology practices use one of the readily available online appointment booking services, scheduling for Mohs and other dermatologic surgery procedures poses more of a challenge. Because many Mohs surgery offices do not see patients in consultation prior to their procedures, the appointment-making process often serves as a makeshift consultation so that patients are not completely caught off guard when they learn that their procedure is “much more than the biopsy.” It is not uncommon for the schedulers in our office to spend 20 minutes or more on the phone to schedule a single Mohs patient. With multiple physicians and the added tasks of obtaining biopsy reports, outside records, demographics, and more, we encounter a serious bottleneck for patient throughput when it comes to communication. With call volumes higher than ever, we have had to become creative in our approach, as we simply cannot answer every call as it rings. We often get complaints that we “never answer the phone,” or that patients “never get a real person,” but in reality, automated phone tree “attendants” are the norm wherever you call – restaurants, hotels, and of course, physician offices. Ours is quite simple – a congenial greeting, press 1 for scheduling, 2 for nursing, 3 for billing, 4 for everything else. If the people at the respective extension are not available to answer, the caller has the opportunity to leave a message and is told they will get a call back within 24 hours. While this system works well for the majority of patients, we still have callers who feel it is a crime to not answer every call as it comes in – something that is simply not possible while getting Mohs patients prepared for their visits. Below are a few strategies we have adopted to help ease the seemingly insurmountable volume of phone calls flowing into the office each day.
Web-based calling
With voice-over-internet systems, we have done away with physical telephones in our office. This turns any tablet, computer, or traditional cell phone into an office extension that can be taken and answered anywhere there is internet service. Our nurses and schedulers use wireless headsets and can move freely about the office while speaking with patients on the phone. If someone is unable to come to work because their car is broken or nanny is sick, they can still function as if they are at the office. Web-based calling also records every call in and out, and call logs are accessible by date. This is an incredibly helpful resource for training and performance evaluation, but also provides irrefutable evidence for the inevitable patient complaint of, “You never called me back!” When you are armed with the response, “Well, actually Mrs. W, our records show we attempted to call you on 7 occasions,” the battle usually ends immediately. An additional benefit of web-based calling is the real time transcription of all voicemails left on multiple lines. Though we have separate extensions, all transcribed messages are deposited on every terminal, so office staff can tackle and triage calls in real time – even when on the phone with another patient. With this technique, more pressing post-operative concerns can be addressed immediately just by glancing at the voicemail transcriptions.
Texting services
Several text-based companies have entered the physician/patient communication space. At our office, we use a system called Klara that has decreased the number of phone calls in and out of our office by over 50%. The majority of patients now prefer this service over calls for routine tasks such as changing an appointment, sending in their insurance cards, receiving wound care instructions, notification of benign biopsy results, or asking if their post-op incision “is doing the right thing.” We have found that an increasing number of patients will not even answer a phone call! While new patients still need a live voice and an understanding of their upcoming procedure details, Klara has allowed us to offload thousands of calls. It is encrypted, HIPAA compliant, and uploads the full conversation directly into the patient’s electronic medical record file. The system can receive texted selfies for questions about wound healing, and it can send PDF files such as wound care instructions directly to the patient’s phone. Through Klara, we send new patients Google intake forms and have them text pictures of their insurance cards and medication lists so that check-in is seamless and paper free. Think of how many text messages you send in a day compared to phone calls you make, and it will become evident that this is how we can communicate with many of our patients for routine issues.
“Virtual” Assistants
Because staff hiring, training and retention has become such a challenge (our most recent new hire quit by noon on their first day!), many national and international call center services are stepping in to address this pressing need. A traditional “call center” does not work for a Mohs surgery office, however, because there is an extensive amount of training that a scheduler is required to master in order to adequately prepare patients for surgery. A different person for every call simply does not work. We have hired a company called “Hello Rache” (many others exist) that provides a pool of employees to interview no differently than if they were to apply directly to a job listing. Once you find someone that fits with your practice, they are the only person you work with – you train them as you would anyone else in the office and assign them an extension as if they are in the office. The virtual assistant has become an integral member of our scheduling team and as our needs increase, we hire additional members. Because they are not employees of the practice, their hourly pay rate is significantly reduced, and they do not require benefits.
Despite the above tools, call volume continues to be a challenge for our staff. Advances in communication technology have allowed us to offset this demand and keep up with the changing patterns in patient desires and lifestyles. The traditional phone is no longer adequate for a modern medical office, yet Mohs surgery offices cannot transition to a fully online communication system for scheduling and patient interaction. Our staff and providers are constantly developing creative solutions to ensure timely handling of all patient issues and interactions. The process is by no means simple or straightforward and it has absolutely made me more patient on the phone or when waiting for a call back from any business I am dealing with!