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Problems with patients? Fine-tune your front desk

Training in customer service and billing can improve patient satisfaction and office efficiency

From the March 2001 ACP-ASIM Observer, copyright 2001 by the American College of Physicians-American Society of Internal Medicine.

By Bryan Walpert

Collections are up at Affinity Health Group, a multispecialty clinic in Tifton, Ga. Days in accounts receivable are down.

And it’s been years since Joe M. Turner, FACP, who founded the practice as a solo office in 1964 and watched it grow to more than 30 full- and part-time physicians, has heard anyone around town complain about rude or brusque treatment at the clinic.

The reason? The practice stepped up efforts to train front desk staff in back-office billing and collections. Now employees know why they need to collect certain types of information and understand how inaccurate information affects their back-office colleagues.

Moreover, the clinic boosted the frequency of customer service training sessions from about four times a year to once a month. As a result front desk employees always keep in mind that “people who are sick are not normal people. They want things done quicker,” Dr. Turner said. “We try to train them to appreciate that fact and be kind and courteous and treat them as sick people ought to be treated.”

The front desk, it turns out, critically affects both patient satisfaction and the bottom line. “It makes you or breaks you,” Dr. Turner said.

Dr. Turner isn’t the only physician coming to that conclusion. Practices increasingly acknowledge that the first impression front desk employees give to patients can determine whether those patients return.

Moreover, front desk employees collect and enter demographic and insurance data, which is crucial to accurate billing and quick collections. Elizabeth Woodcock, an Atlanta-based physician practice consultant, recalled one practice where registration errors—inaccurate subscriber numbers, for example—resulted in 15% of claims being denied.

She put the blame squarely on the constant distractions and stress of the front desk environment. “When you think of the front office, you think of chaos—phones ringing, nurses coming for charts,” Ms. Woodcock said. “Chaos creates errors.”

Although some physicians have gotten the message, many practices still overwork and underpay their front desk employees. Statistics show widespread job dissatisfaction: Half of medical practice receptionists left their positions in 2000—compared to only 7% of nurses and 16% of medical assistants, according to a survey by The Health Care Group, a consulting firm in Plymouth Meeting, Pa.

Reducing the chaos is one way to improve front desk moral. Another is helping all employees understand their place in the team. Often “No one takes time to explain to the staff what their role is in the overall business of a physician practice, how important their work is,” said Stephen Sadowski, senior manager with ECG Mangement Consultants, a health care consulting firm in Wakefield, Mass., that focuses on physician business affairs. “These are people who just want to do a good job. We all do a better job if we understand the context of the work we are doing.”

Here are some ways to make front desk positions manageable and improve your office’s efficiency:

  • Hire qualified people and give competitive compensation. Seem obvious? Receptionist pay averaged between $9.57 and $11.72 an hour nationally last year (depending on experience), according to The Health Care Group. But many receptionists earned as little as $5.25.

    “Some practices pay the absolute minimum,” said Dorothy R. Sweeney, vice president of The Health Care Group. “No wonder turnover is high.”

    Turnover generates hiring costs and undercuts efficiency. “It takes time to get to know the patients, the idiosyncrasies of physicians and the system of patient flow,” Ms. Sweeney said.

    Consider offering a few thousand dollars more than the average salary for your area. It will cut your after-tax income by only a few hundred dollars a month. “If that’s what it takes to have a first class person representing you at the front desk…it’s worth it,” said C. David Carpenter, partner with PCSi HealthCare Consultants in Southern Pines, N.C.

    Hire enough people to handle the practice’s ebb and flow. Because patients tend to flock to primary care practices on Mondays and Fridays, you may need an additional person to help check patients in and out those days, experts say. And offering such a two-day schedule may be a way to retain a valued employee who needs more time for family responsibilities.

    Bill Przybysz, senior associate with Health Management Resources, a consulting group in Richmond, Va., suggests that practices hire a separate receptionist for each doctor so that scheduling goes more smoothly. He also suggests establishing a “concierge” system for practices with at least four physicians: The concierge simply greets the patients and asks them to be seated.

  • Train your employees. A formal orientation and training session for front desk employees is critical because “you can teach them your system,” Mr. Carpenter said, “and they don’t just invent their own.”

    Before putting new front desk hires on the firing line, trainers at Pinehurst Medical Clinic, a 31-physician multispecialty practice in Pinehurst, N.C., walk new hires through the software system, show them how to input insurance information, and give them a script so that all receptionists ask patients for the same information. The coordinator of patient accounts, who helped set up the computer system, oversees new front desk employees for the first few days on the job.

    Mr. Sadowski from ECG Management Consultants suggested giving the front desk employees “usable documents”—for example, sheets that summarize copayments, pharmacies, information about laboratories and requirements for each insurer. The information helps the front desk collect copays and helps ensure patients aren’t aggravated later when they learn their carrier won’t cover a certain lab or pharmacy.

    Among other recent changes, George Washington University Medical Faculty Associates, a 220-physician multispecialty practice in Washington created a managed care reference manual for its front desk employees. The manual contains about a page for each of its approximately 70 insurance carriers in alphabetical order, with information on each carrier. It also includes a glossary of common terms.

    The practice also created a flow chart for typical front desk procedures. It directs a receptionist, for example, to ask for copayments and gives instructions for dealing with patients who don’t bring their copayments. (For more on collecting copays, see “Afraid to ask patients for copays? Try these tips”.) Alan Wasserman, MD, a cardiologist and president of the practice, notes that since 1998 these and other front desk changes have reduced accounts receivable times.

    “The front desk is the key to everything we do,” Dr. Wasserman said. “If you get proper referral information and the data goes into the system clean, we will get clean bills.”

  • Invest in equipment. Investing in good employees involves more than wages—you also need to provide them the best tools for the job.

    Charlotte Kohler, president of Kohler HealthCare Consulting outside Baltimore, has seen practices that require two front desk employees to share a computer. Or receptionists must walk two offices down to use make copies of insurance cards or to use the fax machine. She has found that when practices are reluctant to invest in equipment, it ends up costing them, because front-line staff can’t function effectively.

    Similarly, it’s best not to skimp on telephone lines. If patients call “and get busy, busy, busy, you’ll never know if you missed an emergency or potential visit. The patients will get frustrated and go somewhere else,” Ms. Kohler said. “The last area you want to be chintzy is the front desk.”

  • Cut the number of required tasks.Requiring front desk employees to answer phones at a busy practice increases the bottleneck and takes their attention away from the patients in front of them.

    “My crusade is to get phones away from the front desk,” said Evelyn Eskin, MBA, president of HealthPower Associates, a Philadelphia-based practice management consulting and education firm. “Absolutely the most important thing for the front desk staff is not to have to answer phones when they are checking patients in and out.”

    Put those phones—and staff to answer them—in a separate office. It’s even worth having physicians share one consultation room (two physicians usually don’t need it at the same time) to convert a second into a phone room, Ms. Eskin said. Even in the tightest office, the practice can usually partition the front desk area.

    Reduce the phone burden with a voicemail phone tree that provides a series of options to spread calls to different areas of the practice, Ms. Kohler said. For example, some practices have a system that directs patients who need refills to leave their information on voicemail for nurses to pick up, she said.

    Choose such a system carefully: Give a bail-out option (such as by pressing zero) in the first sentence of the recording for emergencies or for patients—especially elderly patients—who dislike voicemail, Ms. Kohler said.

    Too impersonal? In some practices, an employee answers the phone but then directs patients to voicemail—such as the prescription voice mailbox, Ms. Kohler said. That still saves that time of taking and transmitting a message; it also reduces the chance that information will be recorded incompletely or inaccurately.

    Ms. Sweeney at The Health Care Group suggests practices with multiple physicians also segregate check-in and check-out. “Patients checking in and out at the same time creates bottlenecks,” she said.

    A practice can also pre-register new patients by either mailing registration forms, or providing online forms that patients can submit electronically or print, fill out and send by mail or fax. A pre-registered patient who arrives for the appointment with only a minute to spare won’t cause a backup while sitting in the waiting room with a clipboard.

    Remember that the front desk is a customer service position. Burdening receptionists with too many tasks impinges on their ability to deal with each patient in a calm, friendly manner. The unrealistic number of tasks assigned to the front desk has led many practices to rely on a sign-up sheet or even a take-a-number system at the front desk—systems free up receptionists’ time but make your office unwelcoming.

    “One of the primary responsibilities of the front office is to greet patients— period,“ Ms. Woodcock said. “If you’re using a take-a-number system or a sign-in list there is absolutely no customer service happening.”

    Or as Mr. Carpenter put it: “You never have a second chance to make a first impression.” n

Bryan Walpert is a freelance writer in Denver.

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