SironaHealth's Medical Call Center Blog

This is the third article in a series about Clinical Service Quality Management in Health Call Centers.

Fee-for-Service is a common re-imbursement mechanism in healthcare that is increasingly criticized because it focuses on services and not outcomes. Allowing a fee-for-service mentality into your quality program can produce adverse, unintended consequences.

In the world of telephone triage, a worst-case scenario is to reimburse clinicians for the number of calls completed. Piecework incentives remove the focus from the patient onto the clinician.  This is not to say the clinician is bad in some way – however, the organization is telling the clinician, in fact requiring the clinician, to focus on their own self interests (and the organization’s) over all else.

The amount of time and energy spent on the patient will not be determined by medical need. So, the odds of an adverse outcome increase with each encounter.

Is there another way? Yes. In manufacturing, it has been demonstrated over the past 60 years that a focus on quality increases throughput while a focus on throughput reduces quality and throughput.  It may sound a bit counter-intuitive. But, if we remove all the waste in a process, we are left with what is necessary. This shortens cycle time - for doing things right actually takes less time.

The incentives must be aligned with interests of the patient.  This means no “calls per hour” or “pay per call” metric. Instead, we ensure the clinician is available, the disposition is appropriate, the disposition is arrived at in a timely manner (no delay in care), and the patient is treated with courtesy and compassion.  If these and other quality metrics are met, we will see reasonable throughput.

At SironaHealth, we see wildly different encounter times – from chest pain to suicide calls. Each requires a different response. We do not incent our clinicians to hurry through a call so that they can get that 4th or 5th call done that hour. The nurse spends the appropriate amount of time to address the patient's concern, whether it be a suicide call or a hangnail. We recognize variation in the form of a “call distribution profile” metric. This is one of many metrics that allows us to focus on quality and patient safety. And not surprisingly, the byproduct is increased throughput.

The most critical question to ask when shopping for triage services is: How does your triage vendor's process keep patients safe and how are incentives aligned to meet process safety goals?