By John Gabriel
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.