This week I worked with a large group of physicians on their patient experience and online reputation. In this engagement, I dug a little deeper and did some work on concepts of customer service and loyalty. As such, I thought to share a brief word on Net Promoter and the definition of “Passives”.

Passives are people with indistinct feelings. They are patients who will rate their experience as a 7 or 8 on a 10-point scale. They might like the physician, but not enough to recommend them. Passives will likely pay their bills, but we see patient “churn” with Passive patients. So, while passive patients are not a direct liability (they are not going to write a bad review) they do limit practice growth; And they may be more easily turned to negative with other practice factors.

For a growth minded physician, it is important to think about how she/he can more effectively connect with these patients. Without a focus on improvement, Passives are at risk of becoming Detractors. At QM2, we help drive an approach for physicians to convert Passives into enthusiastic Promoters.

The first group of e-mail or text message communications went out to active hearing aid wearers and within a week, 146 patients initiated HIPAA-compliant E-visit communications with the practice.

The patient responses were prioritized and fit into the following categories: (1) I’m fine, thanks for giving me a way to connect, (2) I need supplies or batteries, (3) My hearing aids seem broken, (4) I would like to buy new hearing aids, and (5) I have an illness/condition requiring a physician evaluation.

Although audiology cannot bill for an E-visit under the CMS guidelines, the use of the patient-initiated, E-visit technology is proving to be very positive in expanding the practice’s ability to communicate, provide care, and drive excellent patient outcomes.

Within three weeks, the practice collected $18,000 through their newly created remote service delivery channels. The provider team scheduled and is working on completing the 256 additional follow-up visits between the audiologists and physicians at a direct value $25,000. Medium term follow-up revenue is expected to generate a minimum of $32,000.

Overall, ENT Hearing Associates of Florida E-visit program is estimated to generate $75,000. And it is just a beginning.

“The results of E-visits are real. We are proving that we can improve hearing aid patients’ lives while generating revenue through virtual delivery channel,” Ramos said.

ENT Hearing Associates of Florida continues to evaluate the results of the initial efforts and is developing plans for how to better implement virtual visits.

“In the last six weeks, clinics have rushed to address patient and business needs,” said James Benson, President and Founder of QM2 Solutions. “The new normal requires providers to focus on quality to thrive in the future by focusing on the right patient, the right intervention, at the right time, and now, the right communication channel,” Benson said.

As providers continue to implement virtual visits, we will work with clients to share results.

To request a demonstration of these and other QM2 Solutions services, click this link: www.qm2solutions/evisits.

Over the past several decades, research audiologists have created and validated an abundance of self-reports that measure a variety of patient-related outcomes, including hearing aid use time, benefit, satisfaction, and quality of life improvements that may be impacted by recommended interventions. Although the use of outcome measures has been recommended by opinion leaders for decades, their popularity among rank and file audiologists is low. According to survey data¹, less than 20% of clinicians routinely (“always” or “almost always”) administer any type of self-report of outcome. Why have outcome measures not been a part of audiology practices? Often, established outcome tools are too long or do not capture the audiologist’s needs at the practice or individual patient level. At the same time, the amount of operational effort to continue to engage patients is also seen as barrier.

Yet, as value-based care takes center stage, along with the move to over-the-counter hearing aids, there has never been a more important time to document patient outcomes and the audiologist’s role in achieving those outcomes. Broadly defined, outcome measures, now commonly known and PROM (Patient Reported Outcomes Measures) enable audiologists to quantify the effec-tiveness of their treatments. Different from verification procedures, which attempt to ensure that hearing aids are meeting a prescribed performance standard, a validated outcome measure answers the following questions:

• How did the recommended intervention affect the patient and their communication partners?

• How much did the recommended intervention improve the communication abilities of the individual?

• Were the goals, identified at the initial assessment appointment, successfully met?

As all healthcare professionals become more cognizant of increasing access to care, lowering costs of care, and improving the over-all quality of care, it is imperative for audiologists to identify ways to systematically and routinely measure a broad range of out-comes. Specifically, there are at least three reasons for popularizing the use of outcome measures within the profession of audiology:

• As healthcare becomes more consumer-driven, there is added emphasis on the individual’s point of view across time and across different modes of service delivery (e.g., face-to-face, telehealth, over-the-counter, etc.).

• Traditional lab measures, like soundfield audiometry, don’t capture everyday experiences. Real-world experiences cannot be accurately measured in the test booth or clinic.

• In an evidence-based practice model of care, the perceptions of the individual are the gold standard, and the use of well-designed self-reports allow for a comparison of outcomes across similar demographics.

The outcome of audiological intervention is multi-faceted and complex. No single self-report captures the wide array of possible outcomes of the patient experience. It is simply not feasible to measure all the dimensions of patient outcome with a short, easy to administer questionnaire. However, audiologists must not let the perfect be the enemy of the good. Outcome metrics experts recommend a short self-report, comprised of fewer than ten questions, that pulls questions from several existing outcome mea-sures already used by researchers in the field.

It is common for audiologists to encounter patients, with similar degrees of hearing loss, who are impacted differently by their condition. Persons with hearing loss experience their condition differently depending on the types of activities they engage in, their overall health, their role in society, and the environment in which they communicate.² Thus, outcome measures need to account for and respect these individual differences across patient populations.

These are among the main reasons some outcome metrics experts have chosen self-reports that attempt to go beyond hearing aid benefit and performance metrics to measure the impact that hearing loss (and treatment of it) has on the individual’s participa-tion in daily activities, including the limitations hearing loss may place on daily living.

Accompanying this brief article is a self-report (Figure 1) that has taken four questions from the International Classification of Functioning (ICF) Measure of Participation and Activities Screener³, two questions from the International Outcome Inventory for Hearing Aids (IOI-HA)⁴ and two additional questions that measure overall quality of support and the patient’s willingness to recommend hearing aids (and other similar treatment options) to family and friends.

As tele-audiology services and over-the-counter hearing aid sales become a part of the audiology landscape, this outcome mea-sure can be adapted to reflect these new modes of service delivery. Our goal is to encourage all audiologists to adopt this tool as a pre- and post-intervention metric for measuring the impact their treatment recommendations have on daily communication. By operationalizing this tool, audiologists can quickly and easily compare the results of each individual patient to similar demo-graphics. Thus, using data collected in their clinics to make better, more effective treatment decisions, which is a cornerstone of patient-centered care.

James Benson is the president and founder of QM2 Solutions, 900 Elm St, Peshtigo, WI 54157.
He can be contacted at jbenson@qm2solutions.com.

REFERENCES

Kirkwood, D. (2010) Survey probes dispensers’ views on key issues raised by Consumer Reports.

Hearing Journal. 63(5): 17-26.

International Classification of Functioning, Health and Disability: A potential service delivery model for audiological practice. Seminars in Hearing. Guest Editor; Mridula Sharma, August 2016

Meyer, C., Grenness, C., Scarinci, N., & Hickson, L. (2016). What Is the International Classification of Functioning, Disability and Health and Why Is It Relevant to Audiology?. Seminars in Hearing, 37(3), 163-86.

Cox RM., Alexander, GC. and Beyer CM.. (2003) Norms for the International Outcome Inventory for Hearing Aids. Journal of the American Academy of Audiology, 14(8): 403-413.

Google is likely your largest single referral source. Seventy-seven percent (77%) of patients complete an on-line search prior to booking an appointment while 44% of Internet users look for information and ratings.   

At the same time, commercial and government payers’ commitment to value based reimbursement in provider contracting is affecting reimbursement and patient steerage. BCBS has over 500 different quality programs and United Healthcare will tie $60 BILLION dollars to value based payments by 2018. 

The bottom line: No new patient selects the fifth worst doctor online. And payers are using patient experience to create networks and modify provider payment arrangements.

What does this mean to you and your practice?  Collecting, managing, and acting on patient experience data may be one of the most important business initiatives you can conduct this year.  Fifty-four percent (54%) of healthcare executives indicate patient experience is among their top three priorities.   

SEngage® is a comprehensive experience patient engagement solution that digitally measures patient experience and identifies your biggest fans. With its reputation engine, SEngage® automatically connects the right patients to physician rating sites. The immediate results are more ratings, increased star rankings, greater patient flow, and growing revenue.

SEngage® does not stop with maximizing your on-line reputation. Your group will receive valuable insight to what your patients think about your practice, identifying areas you can improve, and promoting what you are doing well. Through both internal and external benchmarking, SEngage® gives you the information to leverage results for negotiations and marketing.

Please call QM2 Solutions (888-580-5282) for more information and a free evaluation of what SEngage can do for your practice, or request a demo on our website.

A five (5) doctor practice, with four mid-level providers, practices in a metro area of a Midwestern city.  They are generally happy with their group, and report feeling good about the quality of service they provide.  

Three of the physicians are over 55, while the group successfully recruited a physician, who is now 2 years out of training.  The busy doctors have seen their incomes stay steady, on average, over the last few years, as they compensate for insurance changes, through expanded ancillary services, and new in-office procedures.  

The Challenge:

The group has concerns about the future as they continue to struggle with the ever increasing demands on their time.The physicians’ mean professional production, plus ancillary service revenue is $1.8M per year with each physician seeing 2250 distinct patients per year. Their practice has some competition as there are 60 Providers within a 40-mile radius of their main practice location.  While most of their competition are physician owned practices, there is a university training program in their market, and there are two community based hospitals/multi-specialty groups that also employ their own physicians.

One-third of the patient appointment slots are set aside for new patients, the group spends marketing dollars on yellow page ads, and recently updated their website. To track their marketing results, their administrator has started Google analytics and word accounts. Through these sites they now know that they see about 170 searches per month.Each of the doctors have ratings on Healthgrades (and or other rating sites). Two of the three senior physicians have 3-star ratings averaging 5 responses with one having 2.4 stars.  The youngest physician has 15 responses and an average star ranking of 4.5/5.  Cumulatively the practice has a practice average of just under 3.2 stars.  

While each of the doctors have at least one 5 star rating, due to the low numbers, negative reviews have a significant effect on their averages.  Sixty percent (60%) of the 60 physicians within their market have equal or better on-line ratings.  

The clinic has done experience surveys in the clinics, but it has been off and on and the doctors are not really aware of any effect.  They have not had any discussion with payers about experience scores.

Before SEngage®? If we are conservative and only 20% of shopping patients select another provider due to suffering in comparison to their completion, they are losing up to $30K per month in potential business.

Read More about SEngage Implementation

One-hundred and twenty (120) delighted patients link automatically through SEngage®, and complete ratings on Healthgrades, and Vitals. The new ratings make the physicians among the most reviewed physicians in the market and the overall star ranking average for the group goes from 3.2 to 4.4 stars.  The net marketing affect would be $130K per year!

After 6 months, the practice has over 1000 ratings collected.  SEngage® satisfaction rating system demonstrates that the practice average is 4.5 stars and shows that the top box score for the group is in the 80th percentile as compared to CMS data. 

This knowledge empowers the group, who begin contract negotiations with their four largest commercial payers.  (50% of the net revenue) The practice begins by offering to share their group’s satisfaction information.  In exchange for the information, they agree that if they maintain a mean score within the upper two quartiles, the payer would provide a 2.5% bonus.  Working with one payer at a time, the group successfully secures agreements with three of the four companies that make up $4M in annual revenue.  

Experience Bonus Pool Earned:  $100,000

Finally, their new payer agreements identify that if they maintain high ranking for two consecutive quarters, they earn “preferred” provider status.  Preferred status means additional patient referrals from a large self-insured employer in their area.  

This agreement creates an additional 10 new patients per month.  

Preferred provider status:  $9K per month, or $108K per year.  All total, a focus on contracting nets the group an additional $208K in additional annual revenue.  Through managing reputation on their own site, on commercial rating sites and contract negotiations, a five doctor practice could see over $300K per year!