Tag Archives: medical answering service articles

Pairing Nurse Triage with Medical Answering Service

By Ken Bleakley

After-hours telephone services for physicians must be able to address both administrative questions and clinical concerns from patients. Both physician and patient need to be confident that all inquiries will receive a prompt, caring, and authoritative response. This requires the deployment of two different skill sets: medical answering service and registered nurse triage.

Medical Answering Services: An efficient answering service can provide superior value to its clients by conveniently servicing callers through a compassionate and accurate response, including:

  • Answering and messaging services
  • Appointment calls
  • Conference calls
  • Client satisfaction surveys
  • Initial screening for clinical concerns

The staffs who provide these services need not be medical professionals, but they do require medical knowledge. Emphasis is on speed, efficiency, and accuracy in responding to a wide variety of situations using specialized operating systems.

Nurse Triage Services: When the caller requires clinical information or advice, licensed registered nurses using established guidelines and protocols become necessary. Using a dedicated operating system and their own clinical skills and experience, they triage, record, and document clinical calls from patients. Accreditation, insurance, and rigorous quality assurance programs add to the cost and complexity of these services, but provide dependability and confidence in the end result.

Integrated Services: As each of these types of services become more developed to support the medical practice, the need for a simpler, single service to provide the complete after-hours coverage for the busy physician become increasingly desirable. The ability to contract with one unified entity with single billing and a mutually compatible functioning becomes a valuable enhancement. The search and evaluation process are simplified. The service becomes the after-hours extension for each medical practice. On nights, weekends, or whenever physicians need a break, they are able to flip incoming calls to a single number and receive:

  • A compassionate response to patient needs, answered in the practice’s name
  • Committed medical answering services
  • Accredited medical advice and triage by registered nurses when required
  • Medical encounter reports immediately and aggregated reports monthly
  • One predicable monthly bill for services
  • A dedicated representative to address any concerns
  • Optional scheduling and referral services

Meeting the Need: Medical answering services and nurse triage services have responded to the challenge in different ways. Some simply provide parallel services to medical practices that contract them separately. Others offer informal pairing arrangements with different levels of integration. A few provide both services under a single company. While there are advantages to each model, there are also disadvantages.

Parallel service models provide maximum flexibility to medical practices and frequently combine local answering with nationally accredited medical call centers. However, the handoff from one service to the other and from one operating system to the other can be problematical, as can fixing responsibility for errors or delays. Separate billing complicates the task of practice administrators.

The combined service company is automatically equipped to provide a single number to connect the patient to an integrated answering/triage service with a single bill and to assume responsibility for outcomes. However, this model may generate an incentive for the answering service to refer patients to the company’s more expensive nurse triage, even when the call may not be truly of a clinical nature. As the two different functions may not even be in the same location, it does not necessarily assure a smooth handoff between them. In addition, a nurse triage service that is also competing for medical answering business will find it difficult to build cooperative relationships with medical answering services already providing answering services to their own clients.

Optimizing the Roles of Each Service: Once it becomes clear that neither the answering service nor the nurse triage service has any interest or desire to enter the substantially different business of the other, they become natural allies. They can concentrate on providing the one call/one service/one price model desired by medical practices and patients. They can concentrate on making their respective systems as compatible as possible, while enhancing the quality of their respective services. They can also develop joint sales programs focused on mutual specialized or local markets.

The result of these alliances is better and less costly service for the patient and physician alike. More physicians will be able to afford turning over their practices after-hours to reliable professionals. The pairing of local and national capabilities also helps to maintain the personal relationship between doctor and patient during the hours when medical practices are closed. Patients are able to schedule visits to their providers and avoid unnecessary visits to over-crowded emergency rooms.

Ken Bleakley is CEO of Fonemed, whose mission is to connect people by telephone and Internet to health information, services, and products. Fonemed provides nurse advice throughout North America and the Caribbean. For more information, call 800-366 3633.

[From the February/March 2007 issue of AnswerStat magazine]

Streamline Your Medical Answering Service

By Nina Fernandes

Some years ago, I called the telephone answering service for our medical practice. I was resigning as practice manager for a thriving internal medicine group and wanted to advise them of my replacement’s name. Speaking with a supervisor, I advised her of my pending resignation and the new manager’s name for their records. She asked where I was going and I responded that I hadn’t decided. I had several opportunities and would make up my mind in the coming weeks. To my surprise, she asked “Why don’t you come here? We need a good manager and I’m sure you would fit right in!” Taken aback, I politely declined and thanked her for the thought.

Little did I know that that brief conversation would be the beginning of a major career change. The owners of this answering service called the next day. Admittedly, the idea of having my own answering service to play with was entertaining.  After almost 20 years in healthcare, I couldn’t count the number of times I thought “Can’t the answering service get it right? How hard can this be? Answer the phone and follow the instructions. Sheesh!” After several preliminary conversations with the owners, we agreed to meet. Telling myself I was motivated by curiosity and contacts weren’t bad to have, I walked into the most amazing place. Modems firing, lights blinking, a room full of agents wearing headsets and typing like the wind as they moved from caller to caller – I was fascinated. Where were the boxes of Bonbons, women in curlers, slippers, and so forth? What a contrast this was with the image I had in my mind for all this time!  The frightening part was that I knew I wasn’t alone. Most healthcare managers have never seen an answering service and many share similar images. The answering service was often a topic in managers’ meetings or even over lunch.

On my way home I realized I was hooked. My mind was racing with the possibilities. The image of the answering service staff at work was vivid. Who knows about these people? Why didn’t I know about them? Is it a wonder “they can’t get it right” when we don’t know about them and they don’t know about us? Visions of growth and change, bridging the gap between the medical community and the answering service flooded my thoughts. There was so much to be done and someone had to do it.

That was more than 10 years ago. Since that day, I’ve been privileged to work with some of the most knowledgeable and innovative people in the industry sharing tips, tricks, and tools. This is a dynamic industry in constant motion, yet it is probably one of the most undervalued, unrecognized, and misunderstood of all the integral support services available to the clients we serve.

Misguided complaints and misunderstood comments are all too common. They include: “You’re just the answering service,” “You must be understaffed,” “I want you to answer our phone in one ring!” (How quickly does their own staff answer the phone?), “What’s wrong with you people?” and “You know that I don’t wear my pager to bed!  Are you stupid?”

If this sounds familiar, then change it or at least reduce the occurrence. An integrated plan to elevate the professional presentation, product quality, and profitability can change your medical answering service. Successfully done, not only can a medical telephone answering service become more profitable, but it can also open the door to securing a higher level staff with compensation comparable to skilled clerical employees in other industries. The cost savings for retaining versus replacing agents would provide a handsome savings. It is possible.

An aggressive approach to positive change involves tackling several focuses at once:

  • Improved individual agent performance via training and incentives.
  • Improved quality of message presentation (brevity and formatting).
  • Development of a cost-effective staffing model.
  • Review and transition all low or no profit accounts to an acceptable status.

The long term impact includes:

  • Increased professional presentation.
  • Higher service level with less staff.
  • Improved product.
  • Improved gross margin.

Performance may vary greatly among agents. Effective hiring, training, and the initiation of a performance incentive program will enhance individual performance. This will ultimately allow better traffic management and higher service levels.

Does your medical answering service have a “standard format” for messages? Is it followed? Have abbreviations been standardized? Defining message and abbreviation standards will provide an improved product and reduce agent errors while minimizing communication problems. Establishing norms for agent performance, aggressive implementation of call control techniques, and continued “customer care” training will enable your medical answering service to meet or exceed industry staffing and call volume standards. These changes will increase overall profitability.

Is your medical answering service operating in a reactive or proactive mode? “Putting out fires” too often becomes the mode at many medical answering services and results in decreased service levels and caller satisfaction. Operating in a response mode can negatively affect the ability to ensure adequate training and development of staff. Lack of available time and energy for effective training and monitoring of performance standards all but ensures ongoing service problems. Service issues generate complaints. Complaint resolution requires time and energy from key staff. Key staff is needed to ensure training and monitor performance. It’s necessary to break the cycle; start today.

[From the February/March 2006 issue of AnswerStat magazine]

Medical Answering Service Technology

By Robin L. Davis and Julie Deyett














[From the February/March 2006 issue of AnswerStat magazine]

Telephone Answering Service Systems

By Peter Lyle DeHaan, Ph.D.

Peter DeHaan, Publisher and Editor of AnswerStat

Telephone answering services are by definition a subset of the call center industry. However, while the greater call center industry has a history spanning more than 30 years, telephone answering service has an 80-year history. In the 1920s, and the decades that followed, enterprising entrepreneurs began opening localized telephone answering services around the United States. In those days and until around 1980, calls were largely answered when an operator plugged into a ringing line, client data was in paper form, messages were handwritten, and calls were placed using a rotary dial telephone.

With the advent of affordable computer technology in the late 1970s, a new breed of entrepreneurs, the technologists, began harnessing the nascent microprocessor to automate, control, and organize portions of the call handling process. Thus was born the first-generation Computer Telephone Integration (CTI) systems. Although primitive and basic by today’s standards, they represented a fundamental shift in the call processing mindset. These systems allowed calls to be answered with a single keystroke and a basic repository of client data would be automatically displayed on a computer screen.

Second generation CTI systems allowed messages to be entered into the computer, giving way to a plethora of distribution methods, including alphanumeric paging, faxing, and eventually email. Today’s leading-edge answering service systems are third generation CTI platforms. These systems dominate the market, offering laborsaving automation, client conveniences, agent-assisting features, scripted call processing, integration with remote databases, and Internet access to web-based tools and information. “The evolution of CTI systems has helped the telemessaging industry grow into a sophisticated industry capable of much more than just answering the phone and taking a message,” stated Linda Osip, Executive Director of the Canadian Call Management Association. “We have so much information at our fingertips that we can now act as a true representation of our clients to their callers.”

Among the benefits afforded by these third generation CTI answering service systems, labor savings is a frequent and well appreciated result. Jim Geary, the owner of Complete Answering Service, in Jackson, TN, stated that with his Startel 5700, he “was able to handle the same amount of call traffic with over 50% staff reduction.” He also cited “a massive reduction in errors” as another important benefit.

Tom Gelbach, owner of Answer Connecticut, in Newington, CT concurs with the labor saving aspect. His center uses an Amtelco Infinity system. “We are barely scratching the surface of its capabilities,” he stated. “We have found that in our dispatching operation alone we have been able to reduce the time per call by 31 percent.”

Julie Barr, Call Center System Director at Banner Health, is equally enamored. “With the help of Amcom’s Smart Center, we’ve transformed operator services. By combining independent call centers into one centralized center, we’ve improved efficiency, reduced operational expense, and enhanced customer service.”

Call center managers of other telemessaging systems are also quick to applaud the features, efficiencies, and effectiveness of their respective call center technology.

Please refer to our updated listing of the major telemessaging system vendors in the industry.


[From the Summer 2004 issue of AnswerStat magazine]

Hospital-Based Telephone Answering Services

Karen Kiley of Allina Hospitals and Clinics in Minneapolis, MN had this to say when asked about how messaging is evolving in the medical field.

“More than twenty years ago I started a hospital-based doctors’ answering service. Back then, it was a big deal to have a digital pager. Several year’s later we thought it was a cutting edge technology to get a physician to use an alpha pager! Today we look at how call center technology can interface with the automated patient medical record systems. How can we attach messages from the call center to that record? How can our hospital call center push the medical information out to the community?

“I think, if they’re not already doing so, hospital’s today will be revisiting why they are in the after hours answering service business. This is due to operational expenses in providing a 24 x 7 staffing requirement and the rising cost of healthcare benefits for employees. I believe hospitals will come to the realization that commercial services can do it for less. You will more than likely see outsourcing of hospital answering services and partnerships between hospitals and private call center businesses.

“I see a new trend in hospital medical contact centers with the focus shifting towards looking at how they can best utilize the communications technology to support internal hospital departments via one call “hot lines” to their call centers. This includes providing online patient class registration, HEICS (Hospital Emergency Incident Command System), physician referral, nurse triage, appointment scheduling, patient placement, and call processing consolidation. This will result in reducing expenses by requiring less FTE’s (full time equivalents) across the organization and at the same time increasing productivity while improving customer service.

“Today’s leading-edge call center systems are innovative and allow each organization to be creative and customize special needs, while keeping things exciting and manageable for the users. They help create operator efficiency and reduce the opportunity for potential errors, which is critical in health care, and provides a powerful tool for today’s medical communication’s initiative.”

Allina Hospitals and Clinic uses the Amtelco Infinity system. For more information visit Amtelco at http://1call.com.

[From the Summer 2004 issue of AnswerStat magazine]

The Trouble with Medical Answering Service

By Joseph Sameh

Nationally, the medical answering service industry has a problem. Typically, when a person purchases a service, there is a perceived notion of value gained through that purchase. Housekeeping, snow removal, tow truck services, and office janitorial services are just a few examples. Physicians’ point of view towards answering services once fell into that category as well. But that was then and this is now.

The Problem: Managed care, by changing the one-to-one relationship between patient and physician to a triangle of physician, patient, and third-party payer has caused medical answering services to be perceived as a cost-center rather than a valued service. Each evening for more than 60 years, answering services have been providing overnight backup telephone support for physicians. Before managed care, most patients and their physicians had a one-to-one relationship that lasted throughout their lives. Most physicians were sole proprietors in private practice. When a patient called the doctor after office hours, the doctor naturally had great insight into the patient’s history and medical needs. The two grew old together. The invoice amount paid by the physician to the message service was viewed as part of the overall cost of maintaining good relations with patients in an era of increasing economic advantage for healthcare providers. A fee-for-service insurance reimbursement model characterized the era. As such, the patient and the provider were both beneficiaries of the after hours call. The patient received around the clock care that was expected and the physician knew the patient would be a loyal customer in return.

With the advent of managed care, certain concurrent events changed the landscape of medical practice management. One change that exerted great influence on the patient-provider relationship was managed care itself and the impact of its lists of network providers. No longer was the relationship between patient and provider under the control of the patient and the physician. It was suddenly under the influence and control of the insurers and employers.

Managed Care Organizations (MCOs) began to apply downward financial pressure for reimbursements to physicians. As a result, the patient/provider relationship hit a low point. Patients began to complain that not enough time was spent with them in the office. Sometimes physicians were no longer readily available after hours. Physicians began to complain that they couldn’t treat the individual appropriately due to managed care oversight. Physicians also began to experience income stagnation and even contraction. Consequently, physicians no longer perceived themselves as the beneficiaries of the after-hours transaction. The new beneficiaries of after-hours services became the patient, the answering service, and occasionally the pharmacy.

Unfortunately, the physician still has to retain 24-hour coverage, and therein lies the problem; physicians still must pay for answering service. Today, answering services for physicians are considered a necessary evil. When patients call after hours, the physician may be contacted by the answering service. If so, the physician and the patient discuss the crisis at hand and map out a strategy. For all the commitment, hard work, and effort of the call center staff, the only thing the physician perceives today is an invoice from the call center at the end of the month – that is with the exception of the middle of the night wake up call to treat the patient. How would you feel if you were a purchaser of this service?

Along with the emergence of MCOs and due to some of the same pressures, solo practices began to disappear as ever increasing group size became an unpleasant fact. This trend benefited the physician in some quality of life measures. Permitting and supporting a nightly call coverage scenario, one in which physicians began to experience evenings off on a regular basis, is one such benefit. The era of sole proprietorship was largely over. Now we have the day of the physician-employee. This further inflamed the breach in the patient/provider covenant as patients lost control over who would manage both their daytime and after-hours needs.

Development of large, multi-disciplinary groups led to another tension: the successful management of on-call coverage schema by the message center. Due to human error or lack of understanding, often the wrong physician may be paged or no one at all is contacted for urgent matters. Indeed, industry experts agree that incorrect message dispatch is the most daunting issue for physicians utilizing medical answering today.

Adding to this challenge, outside market forces have inevitably affected every provider to the health care field. Answering services are no exception to this reality. In terms of inflation-adjusted dollars, the rates for answering services are significantly lower today than they were 20 years ago. Labor costs are higher as a percentage of overall costs than ever. An abundance of high-tech equipment and a search for lower paid, entry-level employees answering phones for physicians is the result. When one adds the cost to adequately train and retain quality employees there is scant room for error on the employer’s part.

To add insult to injury, regulatory pressures on the health care delivery system have created more paperwork for every medical practice. Consequently, office staff has a greater burden than ever before. According to Howard Wolinsky, co-author of Healthcare Online For Dummies and a veteran medical and technology reporter for the Chicago Sun-Times, “If we could get physicians and their patients to communicate via email and avoid voice mail jail, we could save loads of time and even squeeze out more time for docs to spend with their patients face to face. Now that would be a breakthrough.” According to Wolinsky, “with the availability of broadband and new technologies, the pieces already are in place.”

Other sources, including Harris Interactive, reported that the results of a survey conducted in April 2002 indicate that 95 percent of patients want to exchange email with their physicians. However, a much smaller percentage of physicians do. This suggests that many patients hope physicians will take advantage of Internet technology to improve patient outreach efforts, but that physicians themselves may still be ambivalent. According to the results of the Harris Interactive survey, people are accustomed to using the Internet for customer self-service. Customers can now track package shipments, pay bills, order books, and do numerous other tasks without the participation of a customer service representative. More than 90 percent of people with Internet access would prefer to communicate with their doctor via email while only 15 percent of physicians would want to do so.

The most significant use of the Internet in the teleservices industry is in the self-management and maintenance of on-call schedules. As a result, many call centers have been reclassified into contact centers.

The Threat: A number of organizations are providing email access to physicians. Understanding the threat of this technology is crucial. These new providers will unquestionably grow and this trend has the potential to destroy the medical answering service industry as we know it.

These companies are well organized and superbly financed; some even have the support of pharmaceutical companies and massive electronic medical records suppliers. One such company, Medem, is endorsed by the American Medical Association. Think back to the introduction of voice mail and remind yourself how that technology changed the commercial telemessaging business. In a similar way, cable TV has hurt the broadcast networks. For those providing medical answering services, this is an even bigger threat.

The Opportunity: Admittedly, these players have the significant advantages of access and money but many don’t fully understand the operational dynamics of the health care call center market, the patients, and the practices. Many companies intend to charge patients to use their service. Why patients would flock to a “pay-for-email” model when they could place a phone call instead is hard to imagine, unless the office hold times are so staggering that any price is worth avoiding the wait. Banks have successfully implemented pay-for-service by providing notoriously poor service to their client base. Now banks charge for everything. In the U.S. we have what many believe is the best health care system in the world, but access can be a challenge. These new players are addressing the aspect of patient access.

Most of these companies rely on the physician as the contact point for the patient. Stated differently, if the patient’s call results in a physician requiring the patient to come in to the office, the doctor ends up asking the patient to call the office to schedule an appointment. The physician becomes the secretary for the secretary. Physicians answering phones at the front desk is not a viable option, yet these companies think physicians will want to answer all email messages.

However, there are some successful Internet self-service models. Federal Express successfully offered its clients an easy-to-use system. Customers can augment live customer service with Web-based self-service. This process saves millions of dollars annually in reduced labor and the more it is used, the more valuable it becomes. This is known as the “role of network” effect. In order for medical teleservice companies to survive in the age of managed care, they must adopt successful Internet strategies and capitalize on their industry experience before they are passed by.

Joseph Sameh is the founder of Mediconnect, Phone Screen, and NeedMyDoctor.

[From the Summer 2003 issue of AnswerStat magazine]

Hospital Answering Services Could Be Risky

By Mike Wilson, JD




Medical Staff Incidental Benefits: This exception has eight requirements, all of which must be met (when reading the quotes from the regulation below, substitute “answering service” for “compensation”):




Mike Wilson is an attorney and author. He teaches at Sullivan University in Lexington, Kentucky.

[From the Summer 2003 issue of AnswerStat magazine]