How to increase patient visit volumes right from your EMR

Here’s how to increase patient visit volumes right from your EMR – noshows, cancellations, no-encounters, community outreach etc

Categorized as Marketing

I recommend running the following campaigns from data within your own EMR. It helps provide higher, managed levels of care.

It also helps you spend more time retaining existing patients rather than always chasing after acquiring new patients.

  1. No shows campaign
  2. Reactivation campaign
  3. Cancellations campaign
  4. No encounters campaign
  5. Community outreach campaign

General process to run these campaigns

  1. Decide on the return of investment you expect
  2. Identify the people, processes and technologies for your campaign
  3. Define your campaign
  4. Prepare your campaign’s data
  5. Execute your campaign
  6. Monitor your campaign and improve

Return on investment calculations

Here’s a simple way to calculate your expected return on investment.

  1. Each day, a single agent can dial about 200 patient phone numbers. They could dial a lot more if they are using the right call center software.
  2. Out of 200 patients called per day per agent, I found that about 20% (i.e. 40) patients pick up the call. So, each agent is going to talk to 40 patients a day.
  3. In my experience, out of the patients that agents talk to, about 50-70% agree to be re-appointed. So, each agent can re-appoint about 25 patients a day.
  4. Net-net, out of 200 patient calls per day per agent, you win 25 patients back, lose 15. This means that your agent is left with 160 patients per day to add to the next day’s calling workload / queue.

Using this math, you can decide how many agents you need to hire.

How many return patients do you need for this campaign to break even?

Make sure that you know how many patients need to show up from this campaign per month before you breakeven.

Do not start without defining this. 

Technologies

I highly recommend not running these campaigns straight out of your EMR.

Instead, you should use a HIPAA compliant patient CRM that ties into your EMR.

Your staff can certainly use their deskphones to do all the calling, but my recommendation is to use a healthcare call center software for this purpose.

The productivity gains are TREMENDOUS (we have seen it ourselves). For SMS, please do not use your cell phone.

I recommend using a software for SMS texting. It gets impossible to manage the volume of SMS sent if you are using staff cell phones to send SMS.

If you want to send a bulk SMS, while still being HIPAA compliant, you can do so as well. This is for handling patient cancellations, but you can modify your SMS message a little bit for each patient broadcast message you want to send and still use the same technique.

If you have staff that are experienced in recalling and reappointing patients – you might not need scripts. However, if you are hiring brand new staff to run these campaigns, you should prepare calling scripts for these agents to use/leverage while they dial patients in bulk.

Daily Process

Define the daily process that your staff must follow. You can do it anyway you prefer. Here’s our recommendation.

  1. Start of campaign – prepare the backlog of patients to be called. 
  2. Start of the month, give the next 2 weeks’ data to the agents. This way, each agent will have 250 calls (target) per day * 10 days = 2,500 patient records to call.
  3. End of each day, each agent should hand over their daily updates to the staff member dealing with data and reports.
  4. At the start of the next day, the data person should take the previous day’s agent spreadsheets and update the EMR + the baseline spreadsheet with the agents’ dispositions.
  5. At this time, the data person would also pull all updates from the EMR (for these patients that are being called on) and rework each agents’ spreadsheets if needed.
  6. At the end of 2 weeks, the data person would hand over a new spreadsheet to each agent. This will contain the patients to call over the next 2 weeks. This spreadsheet will be prepared by shuffling the patient phone numbers randomly between all calling agents so that each agent doesn’t get into a rut of calling the same patient. This also helps because the patient sees a different phone number dialing in.

Get daily reports for no-show patients

We all struggle with no-show patients. Here’s how you can re-appoint patients per month simply by mining the data in your EPM.

Try to be diligent about calling your no-show patients in the same week as their appointment.

At a minimum, you can start with exported reports of daily no-show patients.

If you want to take this initiative seriously, consider using a healthcare focused CRM that helps you with outbound dialing and is always in sync with your EMR.

If you do not have a dedicated team to make these calls, hire a BPO team that does the calling and reporting for you.

how-to-get-no-show-patients-to-come-back
how-to-get-no-show-patients-to-come-back

Identify the people, processes and technologies for your campaign

Your first step is to identify the right staff, the processes you are going to follow to run the campaign, monitor the campaign, the outcomes you are expecting from this campaign and also the technologies you are going to deploy in the campaign.

Keep in mind one very important point – the older this data gets (i.e. the longer it has been since your patient was a no-show), the harder it is to get these patients back to your door.

So, make plans accordingly and staff your team accordingly.

A simple math that you can follow is thus:

  • Typically, every day, an agent is going to be able to call about 200 patients once.
  • Out of these 200 patients called, they are able to connect with about 20% (i.e. 40) patients.
  • Out of the patients they talk to, about 70-80% agree to be re-appointed (about 30+)
  • So, effectively, out of 200 patients, you win 30 back, lose 10. This means that you are left with 160 patients to add to the next day’s workload.
  • Do the math accordingly and size your team correctly. The benefits are tremendous if you multiply each patient visit with your revenue per visit.

Define at least a call few dispositions before you get started

We use the following (you can have your own):

  • DONE – this means that the patient was re-appointed
  • NOANS – this means that the patient did not answer the phone. I recommend that your team calls them back next week (i.e. it goes into next week’s backlog)
  • LVM – this means that the agent left your patient a voicemail. This is a bit tricky because if the patient calls back and books an appointment, usually another agent answers the call. You need to ensure that this agent also updates the spreadsheet with the fact that the patient now has an appointment hence should be removed from your no-shows campaign.
  • WNUM – this means wrong number. Yes, it happens ALL the time.
  • CBACK – this means that the patient has asked for a call back at a certain date/time or both. The agent needs to be able to set a reminder for themselves to call the patient back.
  • LOST – this means that the patient has either found another doctor or has decided that they do not want to come in for an appointment (i.e their need has been met). Usually, I put these patients in another campaign to try and win them back.
  • DCONN – this means that the patient’s phone number is disconnected. The patient population that my clients work with tends to have this happen to them (obamaphones).
  • UNAVLBL – this means that for whatever reason the patient is not available, but the phone number is correct (e.g. someone from their family picked up the phone but your agents are not allowed to book appointments unless they speak to the patient directly)
  • HUNG UP – this also happens wherein a patient simply hangs up. Don’t call them back immediately but try reaching out to them the week after.
  • DNC – this happens (for whatever reason) when the patient does not want to be called any longer. They tell your agent to not call back again – these are a separate category of patients that are lost. DNC is something that I consider as non-recoverable, where as LOST patients is something that I consider as LOST for now, but will try to win back later.
  • RECONFIRMED – sometimes due to data errors, the agent runs into situations where the patient has already called in and made an appointment to come back, but the agent’s spreadsheet does not reflect this new appointment. In that case, the agent simply confirms the new appointment date/time.
  • DUPLICATE – happens all the time where the patient record is a duplicate in the spreadsheet they are working off of.

Define max attempts to be made per patient

You also need to make sure you define the maximum number of attempts your team is supposed to give towards reappointing a patient before they mark that patient record as unrecoverable. 

I have typically defined this as five(5) – ie our BPO team should call the patient at least five times before they give up on that patient.

Prepare your campaign data

Almost every EMR allows you to get data from it. Here are a few ways:

  1. Export data as spreadsheets or CSV file – keep in mind that as soon as you download the data, it is obsolete because within 5 mins, your staff could update the EMR and one or more of the records you downloaded, would be stale. This is usually free.
  2. Connect via APIs – as per CMS mandata, each EMR is expected to have API connectivity into their data for ONC certification (typically this is free as well). Keep in mind that when you connect via APIs, you pull data as and when needed. As soon as you pull data, that data might be obsolete as well, since 5 mins after pulling the data from your EMR via APIs, someone from your staff might have updated the EMR with changes.
  3. HL7 integration – this is true, real time integration. As soon as a change happens in your EMR, the data is pushed via secure FTP as a new record so your application can act on it. This means that you always get the latest and greatest changes pushed to you. 

Here are more details on EMR integration

Understand the following logic so you can prepare your spreadsheets (or your HIPAA compliant CRM accordingly)

  1. Your EMR has patients.
  2. Each patient has appointments.
  3. If a patient shows up, that turns into an encounter. If they do not show up or cancel, then this does not turn into an encounter.

This means that one patient can have 10 appointments, but 5 encounters.

Based on the understanding above, prepare your data

  1. Baseline data – where you start with a lot of data from the day your campaign begins
  2. Daily updates – where you update your EMR with the agents’ data and update your agents’ calling sheets / workload based on data changes from your EMR

Enhance your agent’s call sheets with the following columns

COLUMNDESCRIPTION
DISPOSITIONThe outcomes as we discussed above
APPT DATEThe appt date (if the patient was re-appointed)
REMARKSAny call notes/ remarks / patient insurance updates etc
CALL DATEThe day of today’s call
LAST CALL DATEThis is important for other agents to understand how many more calls have been made to the same patient phone number
REQUIREDTHESE COLUMNS ARE REQUIRED TO DO A GOOD JOB
LAST ENCOUNTER DATEThe last encounter date of the patient. This helps drive the campaign.
LAST APPT DATEThe last date when the agent had an appointment – doesn’t matter if they cancelled it or were a no-show. Hopefully this is the same as the last encounter date.
NEXT APPT DATEThis is very important to know because you don’t want to be trying to re-appoint a patient that already has an appointment within the upcoming 3-4 weeks
PatientPhoneCo-payPayer
Appointment DateReferring PhysicianBalanceReferral Source
Appointment TimeChartStatusEligibility
ProviderDOBCommentsResource
LocationPolicy TypeCancellation ReasonChief Complaint
Nature of VisitMember IDCancellation Comments

Enhance your spreadsheet/ healthcare CRM

Enhance your combined spreadsheet with some columns to “sort of” make it like a CRM (this allows your staff to be laser focused on working the list). I tend to include columns like these (yours can be different to suit your needs).

  • Assigned Date – the date this patient account was assigned to the agent. I want to monitor if they are actively working the accounts given or not.
  • Disposition – outcome of the call
  • Call date – 1st call date
  • 2nd call date – self explanatory
  • 3rd call date – self explanatory
  • 4th call date – self explanatory
  • 5th call date – self explanatory
  • Notes in your EMR – whatever be the outcome of the call, the agent puts this in EMR as an “after call work”.

Now that you have a defined spreadsheet, schedule an EMR report every day (end of day) of all patients that were deemed no-show/cancelled.

This data will be added to the sheet you prepared in the step above.

Execute your campaign 

You can decide to set aside a few hours each day, start dialing, dispose the call with an outcome, notes and follow up if any required.

Since my clients work with at least 3-4,000 patient appointments per month, this usually requires multiple full time employees. 

Keep adding to the list, keep working the list (never ending process). Understand the basic math as mentioned above.

In one week, the backlog of calls to be made does add up significantly.

Do not let patient data get stale. If you need more people to add to this team, do so and you will reap the rewards.

Monitor your campaign

Monitor the performance of your efforts and fine tune calling times if needed.

I have noticed that certain kinds of patients tend to pick up the phone early in the morning, around lunch time and then again around 4 PM onwards.

Another set of patient demographics seems to pick up the calls throughout the day. 

I have also experienced that the conversion rate seems to decrease as the total number of calls to the same patient increases (just our observation).

This means that if the patient picks up the phone in the first try, the chances of reappointing them are close to 100%, if they pick up at the second try, the chances go down a bit to around 70% or so, if they pick up on the 3rd try, it reduces further etc. 

Fine tune the number of calls to be made before you give up on that patient.

I have vacillated between 3-5 calls, but we don’t ever truly give up on a patient.

I simply move patients from campaign to campaign – if they have not rebooked within 3 calls, then we might move them to a completely different campaign altogether. 

Play with power dialers (not robocalls) vs dialing manually – you can achieve a lot more calls per day but it does increase your phone bills significantly. 

Good luck with this – keep at it and you will see HUGE monetary rewards. If you need any help, let me know.

In addition to no-shows, use this method to recall patients fallen out of care (more than 3-4 months)