Policy on patients reaching you by phone in an outpatient setting

[Horners]

For all of the folks who do outpatient here… how do you manage this usually?

Do you give patients a phone number where they can call you directly? And then bill that time?

Do you return calls?

Do you answer emails?

How is this usually managed in an outpatient setting?

Curious on your thoughts. Thanks!

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[wolfvgang22]

For all of the folks who do outpatient here… how do you manage this usually?

Do you give patients a phone number where they can call you directly? And then bill that time?

Never. Patients get the front desk or nursing triage number. Nursing lets me know if there is something that requires my help. Otherwise I'd be doing nothing but managing phone calls. The patient is not billed for routine inquiries (ie; "when/how do I take my meds? can my med be renewed, what are the side effects again?, when is my appointment again?, etc.). If it involves me calling the patient and doing some evaluation and decision making, I bill. There are CMS rules about when to bill.

Do you return calls?

Nursing answers routine inquiries. If it requires my intervention, I call do my best to call the patient back the same day. Always within one business day. Crisis calls are immediately assessed by the triage nurse and suicide prevention social worker.

Do you answer emails?

No. Patient emails go through the patient portal. Nursing answers routine inquiries and asks me if any question exceeds their knowledge. If my input is needed, I give the instructions to the nurse, who relays it to the patient.

How is this usually managed in an outpatient setting?

Curious on your thoughts. Thanks!

This may sound uncaring, but it isn't. Patients often have poor emotional regulation and want to extend their time with me, and will encroach on other patient's time if allowed unfettered access. I work in the VA most of the time, so I have nursing and social workers available to help.

 

[comp1]

Short answer, no to all of that. Long answer, there's the possibility you might have to return some phone calls if really clinically indicated, but you should never be the first in line to be called and it should be rare.

 

[FlowRate]

I'm employed in a big group so I'd prefer if pts call so that they get routed to nursing first. My patients message more often and unfortunately messages go straight to the docs. But if it's at all complicated or needs a decent amount of follow-up I usually route to nurses to call the pt or ask pt to schedule an appointment.

 

[calvnandhobbs68]

I’m in a PP where we don’t really have a nurse, just front office staff. However all calls, refill requests, etc go through them first and then they give the messages to me. If it’s something I need to call the patient back about I do (ex side effects) if it’s something stupid like wanting a sooner followup appointment or refilling meds or whatever, I just write a note back to admin staff telling them what to do.

No patient ever gets my direct phone or email. Once people learn they have that direct line where you’ll pick up on the other end, there’s definitely people who abuse it (call you every time they have a right with their sister or their kid throws a temper tantrum). Even having that lag time of a few hours/day to respond is helpful for setting expectations that we’re not available all day every day just for them.

 

[splik]

I give my number to patients. They usually have it before they meet me (since they either call to schedule the consultation or I call them). I very rarely receive calls from patients. They can also message me. Again it's infrequent that I get emails/messages from patients. I will mention I primarily do consults and therapy so I am usually seeing pts weekly or twice weekly. I have few pharmacotherapy patients. If you are seeing patients frequently, they have no need to contact you out of session. If patients do call and need to talk for too long I will convert it to a telephone or video visit and bill for it, otherwise it is the cost of doing business. I am also very selective about which patients I take on.

I also consult in a clinic and there the pts usually contact my medical assistant or NP for any issues and they will fwd on to me as needed. That is pretty nice as I don't have the executive function to deal with lots of medication related issues. If you are doing primarily meds, you definitely need people to help with that kind of thing.

 

[Jules A]

My out of network private practice:
-Do you give patients a phone number where they can call you directly? yes but thankfully most text or email
-And then bill that time? Have never done this nor felt a need. Generally speaking they are respectful of my time and I feel it is a perk of a concierge practice to be able to contact me when necessary.
-Do you return calls? Yes, although it is generally texts but I will call if its long, confusing or consent related
-Do you answer emails? Yes, as above

Private Practice accepting insurance practice as employee:
-Do you give patients a phone number where they can call you directly? No. We had excellent office staff who would triage phone calls and email us the patient's question/concern. If it was something truly urgent the office staff would text or call us.
-And then bill that time? n/a
-Do you return calls? Very rarely, in fact I could count on 1 hand the number of times in a year that I would return calls in between appointments
-Do you answer emails? I didn't accept emails from patients

 

[wolfvgang22]

I give my number to patients. They usually have it before they meet me (since they either call to schedule the consultation or I call them). I very rarely receive calls from patients. They can also message me. Again it's infrequent that I get emails/messages from patients. I will mention I primarily do consults and therapy so I am usually seeing pts weekly or twice weekly. I have few pharmacotherapy patients. If you are seeing patients frequently, they have no need to contact you out of session. If patients do call and need to talk for too long I will convert it to a telephone or video visit and bill for it, otherwise it is the cost of doing business. I am also very selective about which patients I take on.

I also consult in a clinic and there the pts usually contact my medical assistant or NP for any issues and they will fwd on to me as needed. That is pretty nice as I don't have the executive function to deal with lots of medication related issues. If you are doing primarily meds, you definitely need people to help with that kind of thing.

Wow, we have very different patient populations.

 

[calvnandhobbs68]

I certainly think there’s a different expectation too with a cash practice vs insurance based/employed practice/VA/CMHC.

Like NOBODY would ever get a direct line at any CMHC or VA i've ever seen...the patient population is just so much more complex overall that you'd have people calling you directly trying to fill out disability paperwork or emotional support animal stuff or asking about meds like every week.

On the other hand, a higher functioning cash population likely comes with the expectation that it's more of a concierge service for the money they're paying with a direct line to their doctor at all times if they're paying 200 bucks an appointment to see you.

 

[deleted456421]

I certainly think there’s a different expectation too with a cash practice vs insurance based/employed practice/VA/CMHC.

Like NOBODY would ever get a direct line at any CMHC or VA i've ever seen...the patient population is just so much more complex overall that you'd have people calling you directly trying to fill out disability paperwork or emotional support animal stuff or asking about meds like every week.

On the other hand, a higher functioning cash population likely comes with the expectation that it's more of a concierge service for the money they're paying with a direct line to their doctor at all times if they're paying 200 bucks an appointment to see you.

Physicians, including attendings, were expected to provide direct extensions to patients at the VA I rotated through during residency. Was honestly the worst part of the job since I got inundated with voicemails. We also directly responded to secure messages through MyHealthyVet. I guess it was something of a learning experience, though, since I ended up doing a ton of risk assessments as a result of messages with suicidal content.

 

[romanticscience]

My practice is similar to splik’s, more frequent follow ups and more selected population.

Patients are welcome to send me direct messages on my portal. The expectation is that I reply by the end of the day or between 5:00-7:30p on weekends/holidays. Most patients communicate with me this way. A few email but I reply with a secure message.

No one gets my direct phone #, however, they do have the option to connect with me for an urgent matter. My main phone number has an option for “current patients and health care providers,” from which they can connect with me (forwards to the # that rings) or leave a message for non-urgent.

Those voicemails are transcribed and emailed to me. Most times , if answer is discrete, I’ll secure message them or do a “straight to voicemail” message (really fools some old folks!). Very rarely am I making calls.

 

[clausewitz2]

I find myself somewhere between @romanticscience and @splik . Patients can send me direct messages through my EMR as well, and I actively encourage them to do so in preference to phone or email. I reinforce this primarily by making a point of responding to direct messages within one business day while taking more time with emails and voicemails. Obviously if a voicemail is really emergent then I will do something to address it, but usually that is either encouraging someone to make use of emergency services or scheduling an urgent follow-up. Patients have a direct option to me in the phone tree but I almost never answer these calls contemporaneously, partly because I usually can't when they ring and also as reinforcer of secure messages. I make exceptions for a couple of people who for whatever reason really do seem to be trying but just can't figure out the secure message thing, mostly older folks.

Iprescribe will send SMS notifications of scripts being sent to the pharmacy so if requests are just for refills or what have you I don't even need to send a message in response half the time.

The STVM feature on Doximity is a godsend.

I agree that close followups seems to make communications less of an issue. I get maybe 4-5 messages per day, for a panel of around 180, and most of them are just simple scheduling or med questions. For anything more complicated I usually try to offer an appointment the same week to address the issue and people don't have a problem with that. When they can have your attention in a timely fashion, the need to bombard you with demands and requests seems to decrease sharply.

 

[trophyhusband]

For my wife's PP no there is no way to directly contact her via phone. In fact the only way to reach a person (me) is to call the new patient line and if an existing patient does I tell them to leave a voicemail on the appropriate line or send an message via the patient portal. All of the other lines on the listed phone number go to voicemail. We only set up appointments via patient portal messages.

She will call patients back and talk to them but the phone # is blocked by Google Voice and she never texts them (there is no way to block the number when texting). She has it in her documentation that she'll charge for calls over 15 min but she hasn't done it yet since she's usually the one causing the call to go long.

 

[tr]

Phone calls go to front desk mostly. I do have a line in my office but try to avoid giving it out since I'm only on site 2 days/week and it's a pain to check messages remotely. Almost nobody ever calls me on that line. I only give it for insurance/prior auth where they need some kind of number. I mostly encourage patients to use the secure messaging system in the EMR since it's fastest for me to deal with issues that way. A lot of them do email instead (my email is on my profile page from my institution so it's pretty easy to find); I try to redirect them to the EMR messaging system, or to call the front desk if it's a scheduling issue, when that happens. If it's something that can't be easily dealt with over EMR I'll call them using the Doximity dialer to show the front desk's number. I don't usually bill for phone calls since it's pretty rare they would go over 10 min.

 

[clausewitz2]

She will call patients back and talk to them but the phone # is blocked by Google Voice and she never texts them (there is no way to block the number when texting).

Just as an FYI if she uses the Doximity app she can spoof whatever number she wants and can also send a text from said spoofed number.

 

[calvnandhobbs68]

Just as an FYI if she uses the Doximity app she can spoof whatever number she wants and can also send a text from said spoofed number.

Yep I do this all the time so it looks like I'm calling back from the office from my cell. Awesome feature.

 

[romanticscience]

Also helps if you have google voice and don’t want # to say anonymous. I have the Doximity # show my main/auto attendant #.

 

[trophyhusband]

Just as an FYI if she uses the Doximity app she can spoof whatever number she wants and can also send a text from said spoofed number.

Tried it but couldn't get it to work with the listed # for some reason.