Predictive dialers save time, boost morale
Collections, insurance, preregistration cited
Collections efforts in hospitals throughout the country are being streamlined through the use of predictive dialing systems, and some cutting-edge operations are applying the technology to preregistration and other access functions as well.
The improvements in productivity are "exponential" and can be a boon for access departments increasingly called upon to do more work with fewer staff, says Wayne Gill, EDI manager for ScrippsHealth in San Diego.
The technology - which is available in several levels of sophistication - involves an automated phone dialer that is loaded with a "campaign," or a set of phone numbers that have something in common. The campaign might consist of all the people who owe the hospital money, those who need to be preregistered for appointments next week, or women who need to be reminded they're scheduled for a mammogram.
Depending on the degree of complexity, an automated dialer may run unattended. A computerized voice tells whoever answers the phone that he or she has an appointment with Dr. Jones at 9 a.m. Monday and asks the person to call back if there is a problem. An attended dialer, on the other hand, may be programmed to call patients, screening out "no answers," busy signals, and answering machines, and have a patient on the line when the next access employee is ready to handle a call. In some cases, the patient's record pops up on a screen in front of the employee as he or she begins talking to the patient.
At present, ScrippsHealth contracts with Computer Collection Systems (CCS) in Los Angeles to produce bills and provide predictive dialing for its internal collections department, Gill says, with the focus on "courtesy calls," rather than hard-core collections. "We download data from the patient accounting system for all accounts over 45 days old, and we group the accounts into different categories, or campaigns, each with different criteria."
The data are uploaded into the automatic dialer, which dials a telephone number and, when there is a connection with a person, transfers the call to a customer service representative, who's looking at a screen that shows the patient's name, address, and date of service. The representative can set up a payment plan or take the payment over the phone via credit card, Gill notes. "The system keeps track of the results of the phone call. If there's no pickup, it may dial again in 15 minutes, or four hours, or whatever. If there is a resolution, it updates the database so the person doesn't get called again."
Although the health system hasn't compiled hard data on the efficiencies gained through predictive dialing, Gill says the results have been dramatic. "One of the key benefits has been the ability to define campaigns based on certain criteria, so that we can target specific groups." After deciding what target group might yield the highest rate of collection, the hospital can plan a campaign aimed at, for example, all the accounts past due for longer than 45 days, all the accounts in a particular region, or all those with the same zip code.
ScrippsHealth has four employees handling the predictive dialer calls and another 15 who take inbound calls, Gill says. The next step up in technology would be to fully integrate the predictive dialing module to allow "load balancing," so incoming callers would have only a short wait before reaching a customer service representative, he explains. As needed, employees would stop taking the predictive calls and immediately switch over to help with the inbound calls - patients who want to know the status of their bill or physicians who have a billing question.
Predictive dialing is based on a high-level algorithm that predicts, based on a customer service representative's previous call history, when it will be most efficient to send a call through, explains Kevin Bottoms, director of sales for the health care division of Syntellect, an interactive communications company based in Roswell, GA. The predictive dialer dials two customers, predicting one of those will say "hello" at the same time the customer service representative is available.
If the dialer reaches a person and the representative is not ready to handle the call, the dialer hangs up and calls again later, he adds, noting that the person being called doesn't know who called. Most organizations that use predictive dialers want the percentage of calls that are "dropped" in this way to be between 5% and 10%, he says. Adjusting the system to a dropped call rate of 0% would reduce significantly the productivity gained from using a predictive dialer, he says.
Using predictive dialers in preregistration can increase productivity fourfold, he says. Registrars in a manual environment, using a paper list, typically reach one patient for every five calls made, meaning they're gathering information from a patient only about 18 minutes of every hour. By weeding out busy signals, answer ing machines, and disconnected numbers, the predictive dialer can increase that talk time to 50 or 55 minutes. "If a [registrar] is registering an average of five people an hour in a manual environment, she can do 20 in a predictive dialer environment."
Thomas Jefferson University Hospital in Philadelphia reports similar productivity improvement from using Syntellect's predictive dialer to collect insurance information from patients who have been classified as "self-pay," says Gina R. Burton, MBA, director of the patient financial services call center. Ten days after service, using the predictive dialer, a collections employee contacts all the patients who are listed as self-pay, Burton says. The employee thanks the patients for selecting Jefferson, asks them if they have any questions, lets them know they've been designated self-pay, and offers to bill the insurance company for them if they have insurance. In about 50% of the cases, she points out, the employee is able to collect valid insurance information.
"We have a large organization with a lot of registration sites and often either the patient doesn't have the insurance information or the registration area may not have collected it," Burton notes. "Although you think the person will call with their insurance information, they don't always call."
Collections employees complete about 20 calls per hour using the predictive dialer, including obtaining the appropriate information, entering it into the computer, and rebilling. Before they began using the dialer, only about five calls per hour were completed.
The hospital also uses the predictive dialer for the following purposes:
· Between billing cycles, calls are placed to the homes of patients who owe the hospital money. If the person is unable to pay and wishes to request free care, an application for financial help is sent immediately. This practice has increased cash collections by 15%, she says. "We're able to reach more patients and communicate more efficiently, rather than working the report, hanging up, and calling another person."
· Patients who set up payment arrangements and fail to follow through become part of the "broken promises" campaign, meaning they broke a promise to pay a certain amount per month toward satisfying their outstanding bill. A call is made to remind them to keep paying.
· If an account remains unpaid at the end of the billing cycle, the hospital sends that patient a letter saying the account is about to be turned over to a collections agency. The predictive dialer queues up the appropriate accounts and prints the letter, Burton says. "We just have to mail it out."
Plans are in place to extend use of the dialer into the realm of preregistration and precertification, she notes. Campaigns have been created to target patients seven days before they are scheduled for admission or an outpatient service. If the patient has been seen at the hospital within the past 60 days, the caller will simply review the financial or insurance issues. If not, the caller also will verify demographic information.
Using the predictive dialer to queue up all patients coming in within seven days who are covered by Aetna insurance, for example, an employee will make one phone call - rather than potentially dozens - to verify coverage, she says.
To help eliminate precertification denials, the dialer also will be used to queue up, by financial code, a list of patients who are due to be admitted to the hospital through the emergency department (ED), she says. Staff will run this campaign first, to meet the authorization time frame set by third-party payers for ED treatment and admissions.
"Hot keys" enable staff to flip quickly to one screen to enter the information into a patient's record and then back to the list of patients being called, Burton notes.
In addition to increasing efficiency, use of the predictive dialer has been a boon to staff satisfaction, she points out. Employees leave work each day knowing they've accomplished something, that they haven't been on hold on the telephone all day, Burton says. "It's a creative way of doing business, and it's a more productive way."
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