PPC-1 -- Access and Communication

Element A -- Access and Communication Processes

• Data Point 2 Coordinating visits with multiple clinicians and/or diagnostic tests during one trip
• Data Point 3 Determining through triage how soon a patient needs to be seen
• Data Point 5  Scheduling same day appointments based on practice’s triage of patients’ conditions
• Data Point 6  Scheduling same day appointments based on patient’s/family’s requests

Southeast Texas Medical Associates (SETMA) has dedicated a separate department (Appointments) to ensure that all patients have access to care in a timely manner. All patients can access this department by calling one number regardless of which clinic location they are visiting.

When a patient calls, the next available operator will answer the call, with calls being rotated among all operators. To ensure a timely response the department is staffed with 6 employees that perform this function during daily business hours. In addition, SETMA’s website (www.SETMA.com) allows access by all current and new patients to:

1. Request a non-emergent appointment,
2. Communicate with their provider or
3. Pay a bill.
4. Access educational materials about all of SETMA’s electronic patient management tools
5. Review SETMA’s Public Reporting of provider performance on all quality metrics being followed by SETMA.
6. Enter the web portal www.NextMD.com

Patient’s now have access through a web portal www.NextMD.com for these services including and also for:

• Receiving lab reports,
• Viewing parts of their record,
• Completing pre-visit information on any acute illnesses, etc.
• Participating in self-guide health education programs

All patients needing urgent or immediate care are given an appointment the same day. In addition all of SETMA’s locations accept “walk-in” visits. To ensure that the information requested from the patient is standardized a policy for this department was written and is used to train each of the operators.

Nursing Coordinators monitor voice mail messages hourly to make certain that all messages are respond to within two hours.  Urgent calls are dealt with immediately. Because we have a common, digital phone system at all locations, we can monitor hold time, call frequency and activity and we can investigate complaints to see if patient needs are being handled appropriately.

Same Day visits are available on the basis of:

• Urgent need
• Patient request
• Family request
• Practice triage protocols

The policy is as follows:

POLICY: To ensure patients phone calls are accepted in a timely manner, transferred to the correct location, and all appointments scheduled correctly.

PROCEDURE:

I.          Phone Calls

a.         All calls are received at the main number 833-9797 and are answered by the appointments staff.
b.         The greeting to be used is:

1. “Thank you for calling SETMA. This is ______, how may I direct your call?”
2. “Is this for an appointment, or a medical question?”
3. If it is for an appointment, then follow these steps.

1.         “Who is your primary care physician?”
2.         “For what symptoms or medical condition do you want to see a physician?
3.         Always ask the patient’s date of birth and correct name to ensure the appointment is being made for the correct patient.
4.         Find out if there is a preference as to when and what time they are seen.
5.         Check for any future appointment already made.
6.         Try to accommodate their specific requests for date & time.
7.         If their provider is not available, offer another provider or a nurse     practitioner.
8.         If the patient has not seen a physician within the past 6 months or last 4 visits (whichever comes first), then make an appointment for them to see their PCP.

4. Always inform the patient of the actual date and time of their appointment.
5. Appointments are entered into NextGen EPM.
6. Make sure they have no further needs or any medical questions that need to be addressed at this time.
7. Always end the conversation with “Thank you for calling SETMA.”

c.         If the call is for a medical question ask “Who is your primary care physician?”
d.         Inform the patient you will be transferring their call. Use the following script, “I will be transferring your call, please hold.”
e.         Inform the patient they may get voice mail. Use the following script, “You may get the voice mail. If you do please leave a message and the staff will return your call within 2 hours.”

II.        New Patients

a.         Always find out what insurance the patient has before making the appointment.
b.         Follow that by finding out if the patient needs to come today or can the visit be scheduled for later.
c.         Enter the correct demographic information into the system.
d.         Make the appointment.

III.       Rescheduling Appointments

a.         If an appointment has to be rescheduled, always document the date and put your initials.
b.         Note how the call ended, either confirmed, left message, or no answer.

All phone calls that require input from a provider or nurse will be forwarded to the appropriate person. The staff associated with each of the providers will make sure all phone calls are answered in a timely manner either in person or by return call after a voice mail is left. To ensure consistency within the organization a standardized process is followed and is used to train all new employees. A policy for responding to phone calls and electronic communication is as follows:

POLICY: To ensure timely communication and follow up with SETMA patients

PROCEDURE:

1. Any communications that need to occur between SETMA employees and patients are to be given top priority.
2. No patient should be placed on hold to answer another line, unless it is the emergency line that is ringing.
3. Any message left on voice mail by patients must be returned within two hours.
4. It is acceptable to inform patients that the physician has not provided the answer but we will call them back as soon as we receive the information.
5. After documenting the call, forward to the providers work flow for their answers.
6. Return responses via work flow from the provider will be called to patients as soon as they are received. If the provider has not responded back within 24 hours the unit clerk or nurse will personally speak with the provider to ensure the patient gets a timely response to their question.
7. The oldest phone messages should be addressed first as those patients have waited the longest length of time for a response. The only exception would be a message that is urgent and needs prompt attention.
8. When at all possible, it is recommended to send the patient an information card in the mail. When taped, the card is appropriate to send via mail and meets HIPAA regulations.
9. Once completed, delete the call from the workflow.
10. In order to decrease the number of calls received to each work station, be proactive in returning calls to patients before they have to call us seeking test or lab results.
11. Work flow will be routinely monitored by management staff. Employees who are not consistently keeping their workflow updated will be counseled as necessary to improve performance

SETMA monitors provider schedules to make certain that:

• There are openings for same-day appointments
• Routine, non-emergent, non same-day appointments are available in a reasonable time.