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To Outsource or Not to Outsource Part 2

By John Gabriel

This is part two of a two part blog entrystaff 1 sm

Hiring the Expert

As I stated in Tuesday’s blog (8/28), adding a nurse triage service in my mind can be compared to remodeling a house. You have to have a big wish list vision and keep it in mind. In remodeling our house, my wife and I hired Ralph as our general contractor after interviewing a dozen or so contenders. I classified those general contractors into four categories that can easily be applied to nurse triage service providers.

1. Assume the sale: These contractors showed up at the interview (!) with tools and materials in tow, ready to work. They asked what we wanted to accomplish and where they should start. There was no preplanning and they wanted a commitment and down payment on the spot.

2. Cookie cutter: These plug and play contractors had a pamphlet of their offerings and little flexibility for customization. They could accomplish what we wanted but would need to hire sub-contractors to accomplish it. As such, they could not provide us with a true estimate on overall cost.

3. “We know what’s best”: These contractors looked at the house and told us how they thought our house should be remodeled. Our input was met with reasons why it couldn’t or shouldn’t be done. They followed up their recommendations with reminders of how long they had been in business and inferred that if we didn’t agree with their recommendations, they weren’t the contractor for us.

4. Partnership/Consultant: These contractors were consummate listeners. They listened to what we wanted and developed a plan to get us there. They also developed contingencies for roadblocks and made recommendations for cost and time containment.

As I said earlier these categorizations can apply to nurse triage outsource providers as well. In the nurse triage arena, there is an array of providers. Some of these are well-established legacy companies that require hefty monthly minimums and require you to adapt to their model (We know what’s best). If you are a large practice with a very established patient base and you anticipate high utilization of your nurse line, this very well might be the type of provider for you. Others are newcomers to the medical call center industry who are eager for the work. They want the commitment without fully understanding your requirements (Assume the sale). The upside of these providers is that they can be very customizable to your needs, albeit you have to be very hands-on with them. The downside can be that they do not fully understand the cost of operating a medical call center and by default pay their staff in the lower percentile, resulting in high turnover.  Then there are those who present you with a low priced package for a basic nurse triage service (Cookie Cutter). Anything beyond this is found on the a la carte fee schedule. This is not to say that this type of provider is not right for you. Consider using the 80/20 rule when considering this type of provider. If 80% of your patient base falls into their standard services cost, this might be the provider for you. If your patient base falls below the 80%, your overall monthly cost may make this provider’s cost prohibitive. It comes back to knowing what you need.

The final type is the Partner/Consultant provider. They seek to be an extension of your practice and not merely a vendor. They assess your needs and determine how they can better complement your practice. As industry experts, they can educate you and position your practice to respond to changes within the industry. They will also ensure you are positioned for growth or changes within your practice. We saw this relationship with Ralph on our home remodel. When we determined we did not have the money in the budget to add the additional living space, he still built out the infrastructure of the rooms to accommodate adding onto the house at a later date. He positioned windows, wiring and plumbing so that a future change would be less costly and not require a major overhaul. A nurse triage partner should have the same approach. As the expert, they should position you for changes in your practice and the industry.

We started with the concept of beginning with the end in mind. In debating the idea of outsourcing nurse triage that means you have to know what you want. Once you know what you want to accomplish, you can create a map of what it will take to get there. You can then pick the appropriate partner to meet your needs and accomplish your vision.


By |August 30, 2012|Blog, Outsourcing Services|Comments Off on To Outsource or Not to Outsource Part 2

To Outsource or Not To Outsource Part 1

By John Gabriel

This is part one of a two part blog entry.ques mark 2

 The motivation for outsourcing an after-hours nurse triage service may vary. It might be to meet the 2011 NCQA Medical Home certification requirements or the Meaningful Use Phase I requirements or perhaps it is simply to reduce non-urgent after-hours calls to the on-call physician. You’re doing some sort of “after-hours” now, whether it’s alternating nurses for lunch coverage or rotating physicians at night. So the question is what is your big vision for the future and how are you going to accomplish it?

In the summer of 2003, my wife and I purchased and renovated a 40 + year old home. We embarked on one of the largest projects we could ever imagine. Ralph our general contractor jokingly commented that if our marriage survived this project, it could survive anything. His pearls of wisdom and more importantly his keen ability to “begin with the end in mind” proved more invaluable than we could ever have imagined. Ralph understood that we had a “wish” list of things we eventually wanted, but couldn’t swing at that moment. He remodeled with our list in the forefront, laying the groundwork for items we wanted in the future, but couldn’t have right now.
Somewhere along the way, it occurred to me that while home remodeling and nurse triage may seem miles apart, from a life impact and life cycle standpoint, they are quite similar. It’s a remodeling of your services. Whether you are a medical group, healthcare plan ACO, or single physician practice, implementing a nurse triage service requires having a vision of the end result, knowing what you need and building it. It’s an added value extension of your business and your services and as such it needs to compliment and augment your existing system. In other words, healthcare companies seeking to expand their nurse triage service would benefit from the “begin with the end in mind” approach that Ralph took with our remodel.

Weighing Effort and Effectiveness
I started my career as a tradesman and still have an active general contractor’s license, thus I considered doing the remodeling project myself. I mapped out everything that needed to be done and quickly realized I could not focus on this remodel and still effectively perform my primary 9-to-5 job. Simply put, taking on the remodel would take me away from my core competencies. My efforts were better spent on breadwinning and outsourcing the remodeling by hiring a general contractor.

When looking at whether to outsource a nurse triage or run one in-house, the same logic applies. What’s the big picture, what does it take to get there and does the effort of running an in-house nurse triage enhance or reduce the effectiveness of the primary practice? For many practices, nurse triage is an option at lunch that can be achieved by staggering nurse lunches or maybe staff absenteeism or office patient queuing makes this an unreliable option. Nights and weekends present a separate issue since the volume of calls may not justify hiring a full-time nurse and you may have to over hire to support absenteeism, vacation and turn-over. And perhaps the physicians don’t want to be on call every other weekend. There is also the consideration of how to document the triage interaction and what system will be used to ensure the triage experience is thorough and consistent for your patients. Some practice management systems offer basic triage functionality. However, they may not provide care advice and rely on the triage nurse’s experience and training for providing care and documentation. Dedicated nurse triage software is available, and it can be costly. And there’s the question of where the in-house nurse triage will reside. There is a cost associated with providing after-hours nurse triage support – facility operations cost, computers and equipment, a call distribution or multi-line phone system. Nurse supervision may also be a concern if your state prohibits non-management employees to work unsupervised.

What is your wish list vision for after hours nurse triage coverage? Keep your end vision in mind as you sort through the needs, options and costs. Don’t be afraid to dream big and scale back. It’s your practice that you’re remodeling.


By |August 28, 2012|Blog, Outsourcing Services|Comments Off on To Outsource or Not To Outsource Part 1

The Telephonic Edge of Patient Coaching

By Karen Brown, RN

How many times has my mother been unable to relate her care plan back to me after a physician’s visit because she didn’t remember the instructions or forgot to ask questions? While she may have received the information from a skilled professional, the anxiety and distraction of new information impaired her ability to retain the information or ask for clarifications. I don’t want her to know this, but I also think that she is a little embarrassed to admit that she just doesn’t get it the first time!Patients are not accustomed to the new move toward patient engagement, self care and responsibility. Certain populations require additional follow-up measures to ensure their compliance. Telephonic coaching is proving to be a winning strategy in patient engagement. After all, there is comfort in being in one’s own home, even with medication bottles and instruction sheets. In their own space, patients open up and reveal issues that impair their compliance.

Patient coaching calls are enhanced by call center collaboration with both inpatient and outpatient providers. Some tips for providers in ensuring an effective follow-up call are: • Let the patient know that they will be receiving a call within a specified time period • Ask them to write down information about their condition or any questions they would like to ask their telephone nurse • Reassure them that the nurse is there to ensure that they are comfortable with their treatment plan. The call is not a pass or fail test.

Let the patient know they will receive a follow-up call and give them information about it. Perhaps give that information on a handout with a section for them to jot down things they would like to discuss when the call comes. Some providers also offer an inbound Nurse Advice Line for their populations in case they have a need before the nurse calls.

TeamHealth Medical Call Center nurses start out every call by asking the patient what they would like to discuss. This is a vital part of the call and establishes that important rapport and gives the nurse valuable information on the patient’s need for coaching and learning style. Reinforcement of the care plan and provider-specific information requirements are other elements of the call. It is important to resolve any issues, even if it takes a call to the provider with a follow-up back to the patient. The objective is for the encounter to result in a motivated, informed patient who knows you care.


Karen Brown, TeamHealth Medical Call Center Leadership, VP of Business Development

Karen Brown, RN

Karen Brown, RN, is the VP of Business Development for TeamHealth Medical Call Center

By |August 22, 2012|Blog, Patient Engagement|Comments Off on The Telephonic Edge of Patient Coaching