Improving Front Desk Operations with NextGen

2. NOW PRESENTING…
Presenter(s): James Muir
Topic: Improving Front Desk Operations
with NextGen
Level: 100

3. SESSION GUIDELINES
• Turn off all cell phones & pagers.
• Questions will be addressed at
the end of the presentation.
• Refrain from personal discussion.

4. Warning!
Too much content alert!

5. Efficiency Areas
• Phones
• Appointment Scheduling
• Registration & Check-in
• Miscellaneous

6. Phones
Managing telephones and
call demand can be one of
the most fruitful areas for
improving operations at
the front desk (and entire
clinic).

7. Strategies for Improving Phone Efficiency
• Measure
• Right-Staff for Call Demand
• Reduce Call Demand
• Be More Efficient on Each Call

8. Measure Twice. Cut Once
• Before you make changes, measure where you are now.
– Phone System Reports
– Manual Tracking
• Things to Look for:
– # of incoming calls
• Established Patients
• New Patients
– Call volume over a week period
– Inbound call by topic
• Prescriptions, Scheduling, Billing, Referrals, Test Results, Nurse/Physician, Other
• Repeat calls
– Target areas with high repeat call volume first
– Outbound call volume
• Use EMR reporting
– If possible:
• Time on hold
• # of calls dropped to voice mail
– Low-tech method – count
• # of abandoned calls
– Do mystery shopper calls & review results

9. Phone Statistics & Staffing for Call Demand
• Call Volume
– Primary Care – 100-200 calls per physician per day
– Specialists – 75-100 call per physician per day
• Mondays & Fridays are the days with the highest call-in volume
• After-lunch call demand is high
– Solutions – take calls during lunch, stagger lunches
• 65% of calls occur between 9am and noon.
• Abandoned calls are most likely to occur between 12:15 and 2:00 pm.
– Because of too much demand
• Calls that drop to voice mail require on average an additional 1.5 minutes to
address
– Better to handle the call the first time
• Check-in times peak between 10:30 am and noon. An then again between 2:00
pm and 2:30 pm.
– How does this relate to phones?
• These are the same peak times for phone calls.
• Solution – front desk staff should not answer phone. Have dedicated phone staff

10. Reducing Call Demand
• Look at other options before adding more
resources to solve telephone problems.
• You may be unintentionally causing many of
your current telephone challenges.
• Consider changing how you manage
– Scheduling
– Prescription Renewals
– Referrals
– You website
– Etc.

11. Reducing Call Demand (cont)
• Set a callback policy. (Example: 2 hours or less)
– This will eliminate repeated call backs
• Train triage staff to make appointments
– This eliminate transfers
• Schedule follow-up visits at checkout
– Eliminates inbound calls caused by open-ended follow-up practices
– Avoid “Call us back and…”
• Set up your scheduling templates 3+ months out
– Ask physicians to stick to schedules
– Limit rescheduling to just emergencies
• Use an appointment reminder system
– Eliminates inbound calls & reduces no-show and late arrivals as well
– TeleVox
– PhoneTree
– QSI Service (Worklog)

12. Reducing Call Demand (cont)
• Teach patients to call the pharmacy for med refills & do ePrescribing
– Eliminates interruptions & time fielding med refill calls
– Nothing is faster than ePrescribing refills
• Consider a voice mailbox for prescription renewals & be diligent about handling
those requests
– Eliminates interruptions & time fielding med refill calls
– Allows you to incorporate refill requests more efficiently into your workflow
• Ask patients about med refills on the intake form & have providers ask about
refills at the end of each encounter
– “Refills I need to discuss with my doctor today:”
– Eliminates calls after the visit about medication refills that could have been handled during the visit
• Ask Patient about refills when they are roomed
– “Do you need any prescriptions refilled today?”
– Eliminates calls after the visit about medication refills that could have been handled during the visit

13. Reducing Call Demand (cont)
• For Surgical Practices – Proactively Call patient 1-2 days after
service.
– Review medical instructions, evaluate the patient’s improvement, adjust meds
if appropriate & reinforce discharge instructions
– Prevents calls from the patient for the same things
– Also improves customer service & improves marketing
• Consider an automated test results retrieval system
– Eliminates call time addressing test results
• NextMD
• PhoneTree, TeleVox, etc.
• Letter
• Set patient expectations about test results timing during encounter
– Prevents the patient from calling for results too soon

14. Reducing Call Demand (cont)
• Studies show that up to half of calls a medical practice receives about clinical
matters come from patient that were just seen in the office.
• Provide education about:
• Medications
• Test results
• Procedures
• Appropriate health topics (diseases, exercises, etc.)
• Payment
• Provide a Patient Note
• Anticipate questions & answer them in advance
• Website
• Patient education
• Maps
• Locations, hospitals, lab, etc.
• Welcome Packets
• Use the phone template for incoming calls.
– Track & report on the reasons for the call and the questions asked.
– Then devise ways to answer these questions in advance.

15. Reducing Call Demand (cont)
Communicate
with patients
using alternate
means such as
NextMD.
– Eliminates calls in
favor of secure
email
– Allows you to
incorporate
responses more
efficiently into your
workflow

16. Be More Efficient on Each Call
• Get the patient to the right person & empower your staff
to solve the problem
– Avoid “pass the caller”
• If you use an auto attendant
– List no more than 5 options. Example:
1. Schedule an Appointment
2. Speak with a Nurse
3. Discuss your Bill
4. Refill a Prescription
5. Speak with an operator
– If you make “operator” an option make you actually have an
operator available
• Make the most of the EMR Phone Template
• Coming – integrated Workflow & Worklog tasking

17. Appointment Scheduling
• Template Design & Physician Preferences
– Check-in times and patient loads
– Simple preferences vs. complex preferences
• Hover Tooltip
• Use Event Definitions to Improve Efficiency
– Simpler vs. More Complex
• Use Appointment Book Tabs
• Search Ahead vs. Manual Searching

18. How to check access
with Search Ahead
• Assess Your Access
– Time to Next Available New Patient Appointment
• NG Search ahead feature
– Time to Next Available Established Patient Appointment
• NG Search ahead features
– Appointment No-show rate
• Statistical Analysis of Appointments Report
– Appointment “Bump” rate
• % of appointments that physician bumps
• How to do this in NG?
– Cancelation Conversion Rate
• % of cancelation slots that are filled after a cancelation
• Avoid scheduling follow-ups on Mondays.
– Open/Advanced Access will require more slots to be available on Monday.

19. No Shows
• 15 minutes or so is spent taking all the steps for a
visit even if the patient does not show up
• The cost of that 15 minutes ranges from $4-$7.
• Experiencing just 10 no-shows a day will cost a
clinic between $10,000 and $19,000 a year not
counting opportunity cost.

20. Strategies to Reduce
No-shows
• Improve your relationship with patients
• Create stronger nurse-patient relationships
• Provide good access
– The average time a patient must wait to see a physician is 9.5
days (Source – AMA)
• Consider Open/Advanced Access Scheduling
• Do internal monitoring
– Statistical Analysis of Appointments

21. Strategies to Reduce
No-Shows
• Establish a policy for repeat no-shows
• Remind Patients
– Recalls
– Services
– Interfaces
• Ask for a call back to confirm for procedures
• Don’t schedule too far in advance
• Charge patient for no-shows?
– Remember the goal is reducing no-shows not collecting $

22. Registration & Check-in
• Scanning Insurance Cards
• Required Fields
• AutoFlow for Check-in
• NextMD
• Instant Medical History
• Capturing the Patient’s Picture
– Drivers License
– Photo
– Allows calling the patient back without announcing
their name in the waiting room

23. Registration & Check-in (cont)
• Right & Wrong Ways to Ask for Patient Registration Information
Info Needed Right Way Wrong Way
Current Phone # Please confirm your home phone Are your phone numbers the
numbers for me. same?
Current Address Are you still living at 123 Banner Drive? Is your address the same?
Employer Are you still employed by the City of Have you changed jobs?
Nashville?
Insurance Is Aetna Preferred still your primary Do you have the same
insurance? insurance?
Insurance Do you have secondary insurance Not asking.
coverage with United Healthcare?
What secondary insurance do you have?
Insurance Is this visit due to a worker’s Not asking.
compensation or auto injury?

24. Registration & Check-in (cont)
• Make staff accountable with Worklog
• Printer location
– Printer Preferences
• Insurance card scanner
• Eligibility
• Search for insurance by address
• Registration detail via phone or at check-in?
• Possible Pre-registration staff
– Scheduling -> Pre-registration staff
• NextMD
• Waiting room kiosk

25. Registration Methods
Pros & Cons
Method Pros Cons
Register on Appointment Call -Timely Information -Patient’s may not have all needed
-Advanced Verification Possible information handy
-Staff spends more time on phone
Transfer patient to “Pre- -Pre-registration is more efficient -Requires sufficient staff & phone
registration” unit immediately after -Advanced Verification Possible system
they schedule -Patients will hang up if forced on
hold for long times & less info is
gathered
Call Patients Back -Allows practice to control workflow -May be difficult to track down
of callbacks patients
-Advanced Verification Possible -Patient’s may not have all needed
information handy
-Patient’s may view callbacks as
inconvenient
Register Patients via NextMD - Convenient for patients and practice -Not accessible to all patients
-Will not capture 100% of
registrations
Register via Kiosk at Practice -Keeps registration separate from -Patients must be directed to Kiosk &
check-in so lower staffing costs may need instruction to use it
-May require early arrival

26. Pre-Registration
“Although the pre-registration process itself is
optional, collecting the information is not.
Doing as much of it as possible before
patients walk in the door will make their flow
through the practice smoother and reduce
administrative burdens on front and back
office staff.”
- Elizabeth Woodcock, MBA, FACMPE

27. Signature Pad
• Assignment of Benefits
• Medical Records Release
• Insurance Coverage Waiver
• Financial Policy
• Advance Beneficiary Notice (ABN)
• Notice of Privacy Release

28. Collections
• Define your collection policy & goals
• Develop & Train Scripts for Collecting
– Co-pays
– Privately owed money
• Roll-play with staff
• Make staff accountable

29. General
• Start the day on time
• Policy / Instruction Manuals
• The Importance of Staffing
• Using Worklog
– Referring Physician
• Edits -> registration errors – feedback loop
• Reporting

30. General (cont)
• Workflow
– Status & Color
• RTS
– Eligibility Checking
• Demand
• Batch
• Background Business Processor
• For just New Patients & Procedures?

31. Selected Best
Practices
• Scan Insurance Cards
• Have dedicated staff for reception and scheduling
• Provide telephone coverage during lunch hours
• Change provider scheduling templates to stagger new
patients
• Prepare staff for phone & collections by employing scripts
• Consider open or advanced access scheduling
• Reduce missed appointments. Consider a call reminder
system.
• Reduce Call Demand (various ways)
• Use new tools to speed check-in (Instant Medical History,
NextMD)

32. Thank you!