Posts Tagged medical office

Medical Customer Service — getting worse

phonemonkeyCustomer service for most large businesses has gotten worse over the past few years according to American Service Index .  Of course, cable companies and cell phone companies are the worst but medical related customer service is also at an all time low.  This blog is not about phone calls to doctors and nurses but to insurance companies, retirement plans, ambulance companies, pharmacies etc.

You probably have your own horror stories (please add them in the comments).  Here are a few from friends and family:

  • The long term care insurance plan that repeatedly credited an account then send out a bill for the same amount.
  • The ambulance company customer service that changed billing codes to anything they thought would get a claim paid but could not send any documentation for a Medicare appeal.
  • The insurance company customer service that could not stop double billing for insurance coverage — “that’s a computer problem”.
  • The laboratory customer service representatives that only know the amount of a bill but not the service that was performed — “we only do what is ordered” —  they billed a urine culture but no urine sample was obtained.

One person had to call customer service over 20 times to get a medical billing problem resolved.

There are 2 major problems:

  1. customer service is outsourced — if the answers are not in the “computer” then you will get no help
  2. there is no follow-through.  Meaning, customer service says they will send a message to some department that will respond in “7-10 days”.  But, they never do and you have to call again.

So here are some suggestions for dealing with medical related customer service:

  1. Be prepared — have your customer number, billing number, a bill itself and other things you may need.  Many medical bills will have billing codes (CPT codes and ICD10 codes — look them up online if you can).  If your are calling for someone else (like a spouse or parent) — make sure that person can come to the phone.  A cool way to make this easier is to use Skype to include multiple people in a call if they live elsewhere.
  2. Be friendly, not overly stern.  Remember:  you are dealing with a person, possibly one that has little control over the company, don’t make their day worse.  You will get better results with honey than vinegar.
  3. Take notes as you talk.  Absolutely record the name of the representative, the date and what they tell you to do.  If possible get a phone number, fax number, email address and post office address if you need to communicate further.
    Depending on the urgency or the dollar amount in question (like over $20) then send a letter to customer service  summarizing your discussion and what still needs to be done.
  4. Is it worth your time:  If the problem in question is minor consider dropping the issue — your time is worth something. If you have to call back because you did not get a call or letter that was promised or the instructions you followed were wrong then demand to talk to a supervisor from square one — not another front line customer service rep.
  5. Go to the next level:  if the supervisor can not solve the problem or wants you to wait for a call-back or something to come in the mail tell them you need the phone number of the executive office or CEO in case the issue is not resolved since that is where you will call next.  Again send a summary of your discussion to the supervisor.
  6. The executive team:  If the problem is not resolved by the supervisor then call the executive office or CEO — you can almost always find the executive office phone number with a Google search for the business if needed.  Again, send a summary letter of the conversation.  Or if you can not get through send a certified letter with your concerns.

Pay the amount that is billed — but mark your checks “under dispute” if indeed there is a financial issue.  In general, resorting to legal action is a waste of time and money for disputes less than about $1000 since most legal fees will exceed that amount.

Complaints to the Better Business Bureau, the State Licensing Board, the State Attorney General or the Insurance Commissioner often get their attention.

If you are going to go nuclear, first send the CEO a brief letter with your complaints, the harm that has been done and what you want them to do — say you are serious and do not plan to drop the issue (no threats!).  Wait a while then send a second letter of what actions your are taking and do them – complaints to local or state officials or start legal action.

Medicare fraud is a serious matter, it should be reported as soon as it is identified.



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Hidden Healthcare Capacity — learn from lean manufacturing

conveyorbeltHealthcare in the past has shunned “conveyor-belt” surgery, “cookie cutter” treatments and “cookbook medicine”.  But, the disdain for efficiency, as honed by manufacturing, has put the spotlight on medicine and surgery as very inefficient with a huge hidden or wasted capacity.  Patients and healthcare providers are asking for the training of more healthcare professionals — they can’t manage the wave of baby-boomers needing care or the influx of new patients using the methods of the past.   So, let’s not use the methods of the past, it’s time to learn from industry, from Toyota, from Ford.
The key principle is “lean” —  definition of Lean, as developed by the National Institute of Standards and Technology Manufacturing Extension Partnership’s Lean Network:

“A systematic approach to identifying and eliminating waste through continuous improvement, flowing the product at the pull of the customer in pursuit of perfection.” 

Here is a translation for healthcare:

“A systematic approach to identifying and eliminating waste through continuous improvement, providing health care as needed by the patient in pursuit of perfection.”

 Here are the 8 “wastes” to be eliminated, as might be applied to a medical office:

  • Overproduction — From a medical office standpoint this is excess staff at certain times — indicated by an appointment schedule that is not full.  Staffing must be adjusted to patient load.
  • Waiting — Patients waiting for appointments, providers waiting for test results.  Ideally the when patient arrives  the provider is ready to begin.  Needs to be monitored with visual controls all the time.  Solving patient problems on the phone prevents clogging the system with unnecessary visits and reduces excess inventory.
  • Transportation — equipment (like gowns and syringes) need to be at the point of use not transported around the office.
  • Non-Value-Added-Processing (reworking) — having to review patient data because the problem was not resolved initially.  Sometimes multiple workers collecting the same information (very common when patients are admitted to the hospital) And, excessive medical documentation, a common problem with speech to text systems.
  • Excess Inventory —  No room in the appointment schedule because it is all filled up, patients want to be seen but no staff are available.  Represents a failure to hire adequate providers and staff.  Larger organizations are better able to make staff flexible, like sending them to a branch office if several staff are missing due to vacations or illness.
  • Defects (do it right the first time) — Following evidence based guidelines and using checklists reduces error in treatment and diagnosis.  Errors may result in legal action.  But, less severe errors end up requiring correction or at least explanation.
  • Excess Motion (poor workflow and documentation) A huge problem.  If offices don’t have labs, x-ray, a pharmacy, physical therapy, and commonly needed specialists it causes wasted patient and staff time.
  • Underutilized People — offices don’t often let nurses or scheduling departments make common sense changes.  Small offices fail to hire computer consultants or patient educators.

Much of the waste currently is due to lack of scale for many providers — they just don’t have big enough facilities.  Also, on a larger scale many towns have excess capacity in certain specialties.  Like supporting one neurosurgeon when all the neurosurgery should be done at a regional center to keep the providers busy and competent.  Likewise, not every hospital should be a high level trauma center.  Not every town or hospital needs a cancer treatment center.

Simply treating more patients over the phone is probably the greatest method to find hidden capacity.  If a visit is just to consider a blood sugar record that can be done without an office visit.  The second best efficiency boost is to incorporate NPs and PAs as team members.  Third, a high functioning computer record helps to prevent reworking and reduces excess motion.  Above all, constant monitoring of efficiency and quality with continuous improvement is essential.

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Creeping Spread of Electronic Health Records

snailDelinquent, delayed and diverted the electronic health records in the US are missing.   According to the Washington Post two Presidents set 2014 as the target for all medical records to be electronic — so has American medicine hit the target?

According to a study by the Robert Woods Johnson Foundation US healthcare has been very slow to adopt the technology.  RWJF reports 50% of office practices have a “basic” system and 59% of hospitals have at least a “basic” system (25% of hospitals have a comprehensive system).  To give perspective, a “basic” system contains medical reports and medication lists but no physician notes.

Barriers stand in the way of progress:

  1. Medical data is a very valuable business asset.  EHR companies are threatened if such data could be easily transferred to a competitor.
  2. Fear of losing control.  Doctors and hospitals don’t want their data to be too available to insurance companies or regulators.  Quality problems could be easily exposed.
  3. Self-determination.  Health care entities want to make their own systems — the CEO would rather manage than cooperate.
  4. Lack of governmental action.  Doctors and hospitals are licensed by States — just putting the license at risk is all that is needed to make EHRs mandatory.
  5. High cost of building an EHR.  Every office practice and hospital needs a financial system.  But, really, only one EHR is needed in a State or perhaps only one in the entire US.  Hundreds of EHRs across the country is a waste of money — they all do the same thing, and they can’t “talk” to each other.
  6. Failure to embrace a “cloud” computing solution for a large scale EHR.

Ask your doctor:

  1. Please show me my chest x-ray on the computer screen in the office exam room.
  2. Please electronically send all my records to a specialist across town.
  3. Please show me a record of all the prescriptions I had filled this past year and which pharmacies filled them and how much they cost.  (surely you can trust your doctor with that small bit of financial information).
  4. Can I send you a secure email and expect a response?
  5. Can you securely send me the results of my tests?
  6. Can you easily look up the discharge instructions from my recent hospitalization on your office computer?
  7. Do all the doctors and hospitals and pharmacies in town share the same medical record system — why not?  It would be very good from a patient standpoint.

NO answers exemplify the current data problem.  The US has a far better tax system than a medical record system and a far better post office than a medical record system.  Contrary to the story in the Washington Post this is NOT OK.


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