Lesson 17 – How to increase patient visit volume by recalling patients

Let’s look at how to increase patient visit volume by recalling patients fallen out of care. <./p>

You can grow your medical practice tremendously by recalling patients. This is a whole lot easier if you use a healthcare CRM and an automated communication solution like ours.

  1. Attacking the low hanging fruits

    Here’s how we added about 5,000 new appointments in 2 months – you can do so as well and it is very easy. We were so successful that in fact, we had to slow down this campaign because we didn’t have enough providers to service the patients that we were bringing in.

    We started on June 3 with about 2,200 appts per month and ended up with 5,300 appts/month within 2 months. We ran that campaign heavily in the first 2 months, then pulled back a lot because we ran out of office space and providers.


  2. Get started

    As we have said before – Make sure that you know how many patients need to show up from this campaign per month before you break even. Do not start without defining this.

    You are simply going through your EMR to identify patients that have fallen out of care, calling them back to your practice and re-establishing a relationship with them.

    Just be diligent about this and do not give up on patients that do not pick up the call. You will notice that the more time that a patient has been out of care (i.e. your practice), the harder it is to reach them and to recall/reactivate them.

    If you want to take this initiative seriously, consider using a healthcare focused CRM that helps you with outbound dialing and is always in sync with your EMR. If you do not have a dedicated team to make these calls, hire a BPO team that does the calling and reporting for you.

  3. Do the return on investment math

    In our experience, we noticed that every day:

    – An agent is going to be able to call about 200 patients once.
    – Out of these 200 patients called, they are able to connect with about 20% (i.e. 40) patients.
    – Out of the patients they talk to, about 50-70% agree to be re-appointed (about 25)

    So, effectively, out of 200 patients, you win 25 back, lose 15. This means that you are left with 160 patients to add to the next day’s workload.

    Do the math accordingly and size your team correctly. The benefits are tremendous if you multiply each patient visit with your revenue per visit.

  4. Define your recall campaign

    When we first started this campaign, we decided that we are going to recall all patients that have fallen out of care for more than 6 months (do keep in mind that every day, more patients keep being added to the list).

    Define how many attempts you are going to make. We don’t recommend calling the same patient more than twice a month.. That means, every month, a patient will get exactly two calls from our staff. Keeping in mind that the older the data, the harder it is to reach the patients, you’d arguably want to try the older patients first – BUT a very important point to keep in mind is that your team will not be as motivated when their conversion rates are on the low side (bound to happen with older data).

    Play with a mix of such patient data – mix older data with newer ones so that it keeps everyone happy.

  5. Define reports/ KPIs before you start

    Define your reports BEFORE you start (fine tune later). Before you start, you are also going to need to define the various legends that you are going to use in your campaign.

    Here’s a sample spreadsheet for recalls you can use for your work. Understand that it becomes a lot easier if you use a healthcare crm instead.

  6. Define call dispositions

    As an example, what are the various outcomes / dispositions that you are going to accept from your calling team? I use the following (you can have your own):
    DONE – this means that the patient was re-appointed
    NOANS – this means that the patient did not answer the phone. I recommend that your team calls them back in 2 weeks
    WNUM – this means wrong number. Yes, it happens ALL the time.
    CBACK – this means that the patient has asked for a call back at a certain date/time or both. The agent needs to be able to set a reminder for themselves to call the patient back.
    LOST – this means that the patient has either found another doctor or has decided that they do not want to come in for an appointment (i.e their need has been met). Usually, I put these patients in another campaign to try and win them back.
    DCONN – this means that the patient’s phone number is disconnected. The patient population that my clients work with tends to have this happen to them (obamaphones).
    UNAVLBL – this means that for whatever reason the patient is not available, but the phone number is correct (e.g. someone from their family picked up the phone but your agents are not allowed to book appointments unless they speak to the patient directly)
    HUNG UP – this also happens wherein a patient simply hangs up. Don’t call them back immediately but try reaching out to them 2 weeks after.
    DNC – this happens (for whatever reason) when the patient does not want to be called any longer. They tell your agent to not call back again – these are a separate category of patients that are lost. DNC is something that I consider as non-recoverable, where as LOST patients is something that I consider as LOST for now, but will try to win back later.
    RECONFIRMED – sometimes due to data errors, the agent runs into situations where the patient has already called in and made an appointment to come back, but the agent’s spreadsheet does not reflect this new appointment. In that case, the agent simply confirms the new appointment date/time.
    DUPLICATE – happens all the time where the patient record is a duplicate in the spreadsheet they are working off of.

    Define how you are going to monitor the efforts and try to understand what the calls amount to. E.g. here’s a sample

  7. Prepare your campaign’s data

    We are going to give you an example with Carecloud – just because our client uses Carecloud as their EPM (their EMR is on EMA).

    Preparing the baseline data is going to require some work. Export the patients from your CareCloud analytics tab (in your case it could be some other tab of your EMR). Make sure that this spreadsheet gives you the following info:

    Last Encounter Date
    Last Appointment Date
    Next Appointment Date
    Move patients to a new spreadsheet where the following conditions are met:
    Last encounter date is > 6 months before today
    Last appointment date is either the same as last encounter date or is, still, > 6 months before today (e.g last encounter was 7 months ago and last appt date where this patient was a no-show was 6 months ago). You do not want to take the patients whose last appointment date is within the last 6 months because they might be part of your no-shows campaign (if you are running one). If you are not running a no-shows campaign, then you can include those patients.

    Now, filter out patients that have a next appointment date in the future (as I am sure you will catch those in an appointment reminder campaign)

    Keep in mind that you will have to run this kind of an export / report every week (or every day) and add more patients that have fallen out of care. You can very easily schedule a report every day to get fresh data (in carecloud, you simply schedule a report from the analytics tab).

    Save this somewhere that you have designated as HIPAA compliant.

    Enhance your combined spreadsheet with some columns to “sort of” make it like a CRM (this allows your staff to be laser focused on working the list). I tend to include columns like these (yours can be different to suit your needs).
    Disposition – ie. the outcomes we discussed above
    Appointment Date – if and when an appointment is booked, that appointment date.
    Remarks – usually we use this for what the patient said, the insurance details (if updated)
    LAST CALL DATE – so that each agent knows when the patient was called last (this is super important as you don’t want multiple agents calling the patient and ticking them off).

    The following, you will get from carecloud exported CSVs anyway.. Some (not all) of these are needed for your agent to be able to effectively talk to your patient when they do answer the phone…
    Appointment Date
    Appointment Time
    Nature of Visit
    Referring Physician
    Policy Type
    Member ID
    Cancellation Reason
    Cancellation Comments
    Referral Source
    Chief Complaint

  8. Execute your recall campaign

    You can decide to set aside a few hours each day, start dialing, dispose the call with an outcome, notes and follow up if any required. Since my clients typically hand us more than 20K patient records, this usually requires several FTEs. You can go ahead with lower FTE count but as the data gets older, it is harder to connect with patients.. So, you are better off with a much higher FTE count initially to avoid data getting further more stale.. Once you have “caught up” with the entire backlog (maybe over a year or so), you can reduce the headcount.

    Keep adding to the list, keep working the list (never ending process). Understand the basic math as mentioned above. In one week, the backlog of calls to be made does add up significantly.

    We allow agents to call the patient twice a month and have a target of 200 patient calls per agent per day. So, in 2 weeks, they have a target to call 2,000 patients. Let’s say they are able to re-appoint back 10% of the patients. That means they have converted 200 of those patients.. So, they are left with maybe 1800 patients from these 2 weeks. I add these 1,800 odd patients plus get 200 new / fresh new patients from the larger backlog and run the same campaign over the remaining two weeks of the month.

    How long does this go on? If you decide that you will give up after 4 contacts with a patient, then this list will be refreshed once in 2 months.

  9. Monitor your campaign and improve

    Monitor the performance of your efforts and fine tune calling times if needed. We have noticed that certain kinds of patients tend to pick up the phone early in the morning, around lunch time and then again around 4 PM onwards. Another set of patient demographics seems to pick up the calls throughout the day.

    We noticed that around 60-80% patients that we talk to, want to be re-appointed. The % of patients that pick up the call still remains the same (maximum 20%). So, you really need to increase the number of calls you are making.

    Fine tune the number of calls to be made before you give up on that patient. We aim for 3-5 calls, but we don’t ever truly give up on a patient. These patients are simply moved from one campaign to campaign.

    e.g. if they have not rebooked within 3 calls, then we might move them to a completely different campaign altogether.

    You can experiment with power dialers (not robocalls) vs dialing manually. With power dialers, you can achieve a lot more calls per day but it does increase your phone bills significantly. Be careful with extremely high volume of calls. You need to plan for the total number of outbound numbers you will purchase.

    Good luck with this – keep at it and you will see HUGE rewards. If you need any help, let us know.

    Next, let’s see how to increase patient volumes by calling patients that never showed up

  10. Do not let patient data get stale..

    We also found that the older the data, the more chances of the phone numbers being incorrect (at least in our patient population – hello Obamaphones?)
    If you need more agents to add to this team, do so and you will reap the rewards.

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