We don’t charge for medical records. And here is why:

When people ask for their records, nine out of 10 times, it is because they are leaving the practice. And the way I look at it people leave for two reasons.

1. They are upset at the practice
2. They are leaving as a result of a situation beyond their control (eg insurance, moving, etc).

Collecting payment from somebody that is upset at you or your practice is very uncomfortable and somewhat difficult. People don’t like to pay people they don’t like, regardless.

So what is our approach?

We kill’em with kindness and put as little barriers as possible for them to leave the office. Trying to collect 30 or 40 bucks from someone that is on their way out is a battle not worth fighting. What is the upside?

For those in group number two, as a customer service gesture, we print their records for free as well. We express how sad we are that they are leaving and wish them the best of luck in finding a great pediatrician. No need to penalize them for changing insurance or moving.

I know, there is a cost to printing and mailing the records, and it is also a bit of a hassle, specially if you don’t have electronic medical records.

But unless you have a mass exodus on your hands, it shouldn’t be too much of a burden. And if it is, deciding how much to charge a patient is the least of your worries. You need to address why you are having a mass exodus.

For the records, I’m not suggesting that you are doing something bad if you charge patients for their records. I understand each office is different and each has their own way of doing (justifying, just like I justify) things. All I’m doing here is explaining why WE don’t charge for medical records.

Do you charge for medical records? Why? Why Not?

“What absolutely irritates customers to infinity and beyond is when the perception is established that not only did you fail to get it right…you also failed to care about it. They feel taken advantage of, and this naturally will cause them to not do business with you again — and to tell everyone they know how badly you screwed up.”

We are going to make mistakes, and people for the most part will be OK with that. But what they don’t like is when a mistake has been made, and we play it off,  blame someone else or worse yet, don’t take responsibility for it.

When we make a mistake, even if it wasn’t you, make sure to care about it. Your customer, your parents, your patients, or employee will deeply appreciate it.

If you haven’t picked it up (it is free by the way) I wanted to give you a little nudge to do so. Not everything in the ebook is going to work in your practice. But at the very least, I think the ebook will spark ideas that you would have not had otherwise.

If you are still not convinced, then let me share this little something that I got from a reader of PediatricInc recently that got the ebook.

Hi Brandon

Thank you soooo very much!

I  shared your book  with my staff, as the template for our practice meeting today, as we are forging ahead to re- engineer our practice, and I must say , afterwards our way forward became crystal clear.

In one day, we have created a Facebook page, developed an email template to thank new patients for visiting our medical home, and created three mini videos using myself and my nurse to welcome patients to Frontier Kids Care!

We have a new excitement about implementing our changes.

We are also looking at recalls, and the financial status of the practice.

We looked at our mission and are working on the charter.

Our improved website is due to be released next week, but we are going to be wasting no time in putting our new status on Facebook etc now.

I invite you to preview our before and after website at frontierkidscare.com

In Trinidad, obviously our needs are much simpler, we definitely do not have practice managers, but my solo practice has a nurse and a receptionist, and we cross train.

I definitely am challenged on  the business side, so I realize I need a business manager in some form or fashion.

So again thanks, and I wonder if your book has been published so I can purchase one.

Your practice is blessed to have you!

Take good care.

Rose Marie

I don’t know how else to put this, but my ebook is kind of a big deal. Pick it up for free by going here.

The funny thing is that you can teach people most any skill, but you can’t teach them to smile. And for people in the service industry, smiling is probably the most important skill of all.

While researching a talk, I came across this little story that Tom Peters told in one of his presentations.

I once said to a Starbucks regional manager, “I’m stunned that almost all of your store people, from the U.S. to Saudi Arabia, always sport a smile. What’s your secret?”

She smiled as she answered: “We hire people who smile!”

And to keep them smiling?

“We promote the ones who smile the most.”

Could it be that simple?

I can see some people saying, yeah, but Starbucks is different than a medical office.

Oh yeah, how so?

Whether we want to admit it or not, those of us that work in private practices, we are in the service industry just as much as Starbucks is. If anything, we ought to be more emotionally connected with patients, than Starbucks is with their customers, yet we are probably the industry that hires less on smiles and more on skills.

Smiling is the only expression I can think of that is understood by everyone despite culture, race or religion. It’s a sign of pleasure, joy, happiness, or amusement. It is also an inviting expression; one of welcoming or politeness and friendliness. In fact, research shows that smiling correlates with greater trust, greater financial earnings, and increased interpersonal cooperation.

We are not hiring right now, but when we do, I’m going to make sure I look for that smile before I evaluate their skills. Because we can always teach them how to do things in our office, but we can’t teach people to smile spontaneously. That comes from within.

Dr. Richard Lander, pediatrician extraordinaire and Survivor Pediatrics contributor, was nice enough to share with me a presentation that he created with the intent to inform residents and new physicians a little bit about medical coding.

The presentation is not comprehensive and by no means is it intended to replace a good coding class or seminar, but at the very least, it will give you a starting point.

I’ve uploaded the file to SlideShare. You are able to download it if you’d like. Or you can tell others about this awesome blog and they can see it here.

While you are here, make sure to check out all the awesome blog post and don’t forget to also check out my ebook: 101 Ways To Transform Your Practice.

Dr. Lander has been practicing pediatrics for 32 years in New Jersey and is the immediate past chairman of the American Academy of Pediatrics Section on Administration and Practice Management.  He says if he had to do it all over again he wouldn’t hesitate to be a pediatrician.

If you are not a CCPA member, I’d suggest to become one. They are a great GPO. If you dont’ know what a GPO is or how it can help your practice out, click on THIS link to learn more about how a GPO can save you serious money.

And to learn more about the CCPA specifically, visit this link. In this post, I interview Paresh Patel, National Sales Manager for CCPA. I think he makes a compelling argument as to why you should join CCPA.

If you do make it to the meeting, make sure to say hi. I’d love to meet you.

As a result, the IL Department of Public Health issued a requirement that all children entering the sixth and the ninth grade will be required to provide proof they received Tdap. The letter they sent to parents made clear that if they didn’t have proof that the child received the shot, the child would be excluded from school (the letter did have certain exceptions like religious exemptions).

Now, what does a patient centric, profit driven private practice supposed to do when faced with a mandate like this?

In our practice, we are very clear with our two main priorities. Priority number one? Doing what is in the best interest of the patient. That is a given. Second priority, which is just as important as priority number one… profitability.

So this is what we did:

1. - We identified children between the ages of 11 – 12 and 14-15 that had not received their Tdap vaccination. How many kids showed up in our query? 110 6th grades and 48 9th graders.
2. - We made a safe assumption that if they didn’t have a Tdap, they probably haven’t been in for their physical recently.
3. - We wrote a letter to the parents of the these patients. In it, we advised the parent about the mandate, we let them know that their child hasn’t been vaccinated, and that they were probably due for a school physical so they should give  us a call and make an appointment.
4. - Start accommodating patients that call in.

This is perfect. You know why? Because it meets both of our priorities. By reaching out, we are taking a proactive role in the healthcare of children. Sure, curing people of fevers and sore throat is important. But you know what is better medicine? Prevention.

Second, we are fulling our profitability objective because we are actively brining in children for their wellness visits that would have most likely never come again for physical until they enrolled into college.

What are you doing to take an active role in the healthcare of children and increasing profitability at the same time?

I always say to our team members, “the Amoxicilin we prescribe in this office is the same Amoxicilin that the practice down the road prescribes. The Prevnar we give out here is the same Prevnar other practices give out. For the most part, we treat ear infections the same way other docs treat ear infections. The only thing that differentiates us is, us.”

The thing is, customer service is very difficult to provide in a health care settings. For starters, people are already apprehensive about the visit. Nobody wants to visit the doctor’s office, even if it is for a wellness visit. And then we have the kids. They are terrified.

It is not like going to Disney where people’s happy meter is at 12 on a scale of 1 – 10. We are in the same boat as the lost baggage claim desk at the airport. Nobody wants to visit the lost baggage claim desk. Nobody is down there thanking the agent for not loosing their luggage.

So to provide exceptional service, we have to go above and beyond because we start out in a hole, so to speak.

So, what are the different ways one can improve with customer service?

The best way to improve your customer service, is by going directly to the customer and asking them. Right? But if your practice is anything like ours, it is hard to get people to answer surveys and mail them back. And if you give it to them as they are checking out, they usually brush through it as if we  only give them 20 seconds to complete.

Here are four tips that perhaps may help you engage parents to provide constructive criticism:

 1. Handing Parents a Questionnaire with an addressed pre-paid envelope.

The prepaid envelope is the kicker here. This way, parents don’t have to search for a stamp and remember your address. Also, they don’t have to feel obligated to answer the questionnaire right then and there.

2. Send a SurveyMonkey (or any other service like SurveyMonkey) link to a questionnaire you have already prepared.

Sending an email with a link is another idea that may work for your office. Especially if you have young, Internet focused practice. Another advantage of a service like this is that the results are collated.

3. If you are a manager, work the front desk or answer the phones for a day or two or maybe even a week.

This tip reminds me of the show called Undercover Boss. For those that haven’t heard of it, the show highlights a different CEO of a major corporation every week, going to work for his own company while undercover. During that week, the undercover CEO works front line type position within the company getting to know employees, how they do things and what are their thoughts on the company, life and other things.

After a week, the CEO reveals to the the participants that he is in fact the CEO and that he was there to get a better idea of how the company worked from the perspective of a front-line employee. The CEO also reveals many of the changes that the company will do as a result of what the CEO learned during his undercover stint. The CEO even incorporates many of the suggestions of the employees he worked with during the undercover stint.

The take away from this tip, and the show, is that when one works the front line, one gains a completely different perspective on the business. This perspective will give you keen insight into how to better service both your internal, as well as, your external customers.

4.Post a sign in your waiting area that reads – Our goal is to provide the best service we can provide. If you are not satisfied with the service you’ve received, please give me a call. I’d like to know about it – Manager

We don’t do this, but as a result of writing this blog post, I’m going to put up a sign, with my email address so that parents that are not happy with our service can reach out to me and let me know first hand their issues.

I think this is a powerful tip because it addresses several issues at once. For starters, I think it shows people, both staff and parents that we are serious about providing excellent customer service.

Secondly, the idea of having a sign out front with my email so that people can reach me will also have a psychological affect on that the staff. It is a good reminder for them to button up their attitude because anyone could send me an email to complain about them.

Clarification

I think it is worth mentioning that when I refer to customer service, I’m not mixing what the patient needs and what the parent wants. I’m not suggesting that the doc disregard his/her medical judgement to please a mom for the sake of customer service.

The way I differentiate it is like this. The patient is the patient and should be treated as such. The parent, on the other hand, is the customer. For the customer, we will go above and beyond to meet their needs but not at the expense of the patient’s needs.

Do you have any ideas that could help others improve one’s customer service?

Photo Credit: http://barrtek.com/

First, the most effective means of communicating with your patients when they aren’t in your office is still a person-to-person phone call.

I’m sure you all realize that, but I sometimes work
with practices who have the capacity for an individual or two to make calls.  If you have a nurse with time to be on Facebook, you have a nurse who can make calls.

Second, I **strongly** encourage any “electronic” patient communications to be done using a third party and NOT directly from the server that hosts your PM or EHR.

The example I use most is to ask, ”So, when you send out those 1000 flu shot reminders, whose mailbox gets all the rejection notices?”  More importantly, when your ISP sees 1000s of emails come from your office, there’s a good chance they’ll shut off your service.  It happens to a PCC client about once a year when they figure out they can send emails “for free.”

Another advantage of the third-party process is that many of them are invested in making your contacts look more professional. Constant Contact, for example, offers really helpful templates for email communication, making the messages that go out with your name on them more effective and impressive.

Third, after person-to-person calls, the next most effective _reminder_ tool is texting!

Depending on your local area, email and postal mail are second/third.  The important thing to realize is that a) there are pros/cons to each contact method and b) they should not be considered exclusive!  That is, just because you’ve got a great system for sending texts doesn’t mean it’s time to abandon auto-calls or email.  Do them all.

There are, literally, dozens of vendors who will help with these services.  Some do email, some do robo-dialing, some do texting. Some do all three.  PCC and our clients have worked with a number of them and, no shocker, there are pros-and-cons to each of them as well.  The Big Fish in the pond right now is Televox.

When it comes to pricing, I’d ignore that.  Really.

If you have 50000 patient communications in a year (which is a lot) and one service is 2 cents more than the other, that’s, what, $1000?  When  you’ll easily save/generate a multiple of that difference?  No, go with the service that most easily fits your existing process.  I’ve seen too many practices go with “cheap” only to spend extra money on employee time to make it work.

ONE CAVEAT: most of the vendors make you sign a time- or unit-based contract.

You can’t dip your toe in.  One vendor I *really* like is ”callemall.com” – you can sign up, do a trial run of however many contacts you want…and then never use them again.  At the NCE, I did a presentation walking through signing up to callemall.com and sending ”my” list of overdue patients a well visit text in >5 minutes.

Easy.

And a $20 experiment for anyone.  [I have no relationship with callemall.com, they don't even know who I am - I just like their contract philosophy.]

So, to save you some google time, here’s a list of vendors I know:

• televox.com
• callemall.com
• ifbyphone.com
• callpointe.com
• phonetree.com
• blimessaging.com
• www.inphonite.com
• patientprompt.com
• kwikcall.com
• voicent.com
• cloudreminder.com
• promptalert.com

1) It allows the practice to engage patient outside of the practice which is appealing to parents.

2) It creates a sense of community which shows what the practice is about.

3) It gives parents/patients a platform to share their positive experience about the practice; which is critical in the context of potential patients/parents evaluating one’s practice from online reviews.

4) It allows your medical practice to address questions by parents and have your Twitter, Facebook or Blog followers also benefit from the answer.

5) Conversations and interactions happen on your online platform as opposed to online physician review sites.

What other advantages do you think that having an online presence brings to a medical office?