Southeast Texas Medical Associates (SETMA) has dedicated a separate department (Appointments) to ensure that all patients have access to care in a timely manner. Each patient can access this department by calling one number. 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 request a non-emergent appointment, communicate with their provider or pay a bill. The Appointment staff is responsible for monitoring this function and returning a phone call the next day with an appointment.

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.

The following is a weekly report which is produced for SETMA’s COO.   Any patient who needs to be seen on the same day can be and slots are left open on PCPs’ schedules to accommodate their patients daily.

The triage 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

Requirement Number 5.      The practice collects data to demonstrate that it meets standards related to appointment scheduling and response times for telephone and electronic communication (up to 5 specific factors)

Southeast Texas Medical Associates (SETMA) is committed to giving our patients a same day appointment when requested. Each provider’s schedule has the capability of adding double books and even on the busiest of days there is always excess capacity in case an additional appointment needs to be added.

On a weekly basis a series of reports are generated and sent to the supervisor of Appointments and Scheduling for review. These reports consist of the following:

• Total Staff Time (Amount of time logged onto phone system)
• Total Ready Time (Amount of time waiting for a call to come in)
• Total Ring Time (Amount of time the phone rings before answered)
• Total Talk Time (Amount of time spent talking on the phone)
• Average Talk Time (Average amount of time spent on phone per call)
• Total Hold Time (Amount of time the phone is put on hold)
• Total Work Time (Not used)
• Total Break Time (Amount of time the phone is put on break)
• Total Calls Answered (Number of calls answered)
• Total Calls Transferred (Number of calls that are transferred)

The following is a sample of the detail we track:

The data is then used to determine if each of our patients received a timely response, if there is a need for additional staff, or if there are any operational issues that would impact the ability for us to expedite the scheduling process.

In addition, we ask patients on our quarterly Patient Satisfaction reports how effectively we have met their scheduling needs as well as their level of satisfaction for any returned calls in which the immediate needs could not be met.  These reports are then forwarded to the COO and other key management staff to review and make recommendations.

The following is a sample report of a summary of our patient satisfaction survey.

Fourth Quarter 2009 Aggregate
All SETMA