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How text messaging improves patient recall and practice revenue

Article

To successfully navigate these turbulent times, physician practices will need to look for ways to increase revenue and decrease costs to help offset losses and increasing expenses.

Growing revenue and reducing expenses are essential for healthcare organization success — and one could argue that they're even more critical in 2023. It's impossible to ignore the news reports about organizations, even those considered industry leaders, declaring substantial losses due to increasing operating costs. Significant financial challenges lie ahead, including those associated with rising labor and supply expenses, high levels of inflation, and the upcoming end of the Medicare payment increase for hospitals for treating COVID-19 patients.

To successfully navigate these turbulent times, physician practices will need to look for ways to increase revenue and decrease costs to help offset losses and increasing expenses. Perhaps one of the simplest ways to accomplish both is to improve patient recalls, such as those for routine mammogram, colonoscopy, and prostate screenings and annual physicals and Medicare annual wellness visits (AWVs), and to do so using text messaging.

Before I explain why texting is key here, it's helpful to understand a few reasons why recalls represent a low-hanging revenue growth opportunity. First, these are patients already familiar with the provider organization who have traveled to the organization and hopefully had a positive care experience. Second, these services are usually covered largely — if not entirely — by insurance. Third, if patients have come in for these services before, this would suggest they understand and appreciate the importance of preventive care. These factors would suggest it shouldn't require substantial effort on the part of a provider organization and its staff to get these patients to come back for these services. Every successful recall helps an organization's bottom line and helps patients get the preventive care that can keep them healthier and reduce their risk.

One of the biggest obstacles to recall program success has been the manual labor required for patient outreach. Traditional recall programs have largely relied upon a combination of phone calls and letters for this outreach, but phone calls are no longer a reliable way to reach people (Research from Pew indicates eight-in-ten Americans won't generally answer their cellphone when an unknown number calls) and letters are expensive to send and slow to reach patients. Both outreach mechanisms require significant staff time — time that's also become more expensive.

Enter texting, and more specifically HIPAA-compliant, conversational two-way text messaging. Two-way texting enables information to be pushed to and pulled from patients and healthcare facility staff. In other words, recipients of texts can respond with a text of their own and engage in a conversation with the sender. Adding two-way texting as a communication mechanism is simple as it does not require any special hardware — just your facility's existing computers and an Internet connection.

Understanding the value of two-way text messaging for recall programs

What makes conversational text messaging so valuable for recall programs? Consider the following benefits that explain why texting should be the communication method driving your recall programs.

Text messaging is familiar. With more businesses using texting to communicate with customers, your patients are likely accustomed to receiving and interacting with text messages from organizations they engage with. It's also likely that many if not most patients will appreciate communicating via text versus other communication methods.

This includes those patients who receive preventive screenings and services and generally fall in the age range of 45-75. Pew research tells us that nearly all these patients own a cell phone and most own a smartphone. AARP found that more than 90% of those 50 and older use texting to help them stay connected with others, and about two-thirds using text messaging daily.

Since patients' mobile numbers rarely change, once the numbers are in your organization's database, perhaps captured during an initial screening, you have what should be a highly reliable means of reaching patients to arrange subsequent screenings.

Patients may not answer phone calls, but you will. While patients are increasingly ignoring calls from numbers they do not recognize, physicians are not likely to do the same. When a text message includes a phone number for patients to call to arrange their preventive service, they just need to click the number to initiate the inbound call to your organization. Making it easy for patients to speak with a staff member will increase the likelihood that patients will schedule their appointment. As we like to say, "Want someone to call you? Send them a text."

Automate outreach and scheduling. One of the most compelling reasons to turn to texting for recalls is the ability for practices to pre-schedule text messages to go out to patients reminding them to schedule their next preventive service. Since preventive services typically follow a predetermined schedule (e.g., annual mammogram), practices can use their texting system to automate that reminder message. By automating texting, physicians can better avoid falling behind and needing to catch up on a backlog of outreach efforts and patients are more likely to stick to the recommended preventive care schedule.

If your organization has a platform or portal patients can use to schedule their appointment, texting can further automate the scheduling process. You can include a link to this platform or portal in your text message. Smartphone users can click this link and schedule their appointment from their phones while cell phone users can type in the link on a computer. The more patients who schedule their own preventive services, the less work you need to do to capture that volume.

Verified delivery. There's essentially no way for your staff to know if a letter was read, a voicemail was listened to, or an email was read unless they hear from the recipient of those communications. Such uncertainty creates further uncertainty on when to perform subsequent outreach. Texting solutions provide near-real-time confirmation of whether a text message was successfully delivered to a mobile phone.

This information allows physician practices to build better follow-up processes. If patients receive but do not interact with a two-way text message, providers can automate a follow-up message(s) or choose to reach out to patients using another communication method. If a text message is not successfully delivered, providers know quickly that they should use a different outreach method and then work to capture an active mobile number from that patient.

Substantial cost savings. Not only can texting increase billable service volume, but it can also help practices greatly reduce the costs associated with recall program outreach. The time to type up, print, and mail a letter adds up fast — and that's on top of the cost for the stamp and envelope. Most outreach efforts require multiple phone calls and take up precious — and increasingly more expensive — staff time. The cost to send a text is measured in pennies.

On top of this easily measurable cost savings, there's also the cost savings and/or increased revenue that comes with improvingstaff productivity.Text messaging may help you reduce expenses associated with overtime or part-time work and/or allow staff to focus on completing other tasks that can help strengthen your organization's bottom line.

Combatting no-shows, no-goes, and cancellations. Once you have a patient on the schedule, you want to work to ensure the patient shows up and is ready for their appointment. What's also noteworthy about adding text messaging for your recall program is it can be leveraged in ways beyond just reminders about scheduling. You can send a text message reminding patients about the time and date of their appointment and include hyperlinks in messages to direct patients to your website for other purposes such as preparation education and directions to your facility. These messages should help reduce no-shows as well as no-goes due to non-compliance with preparation requirements.

With a two-way reminder message, you can ask patients to confirm their appointments via text. If patients need to cancel, this makes it easy for them to do so. Assuming you learn patients must cancel far enough in advance, you may be able to backfill the now vacant appointment slot with a new appointment. You can also note that this canceled patient requires follow-up communications so you can get them in for their preventive service.

Evaluate recall program and outreach performance. Since text messaging is delivered through a technology solution, physicians and other providers should gain the ability to monitor and measure key recall and outreach metrics. Among them: how many patients are subscribed to a recall program, how many patients you have mobile numbers for and can reach (which you can work to update and increase), how many patients received your text reminder, and how many scheduled their next appointment because of the text message. With this data, you can further refine your recall outreach efforts and better leverage texting.

You can also use texting to conduct post-appointment surveys to learn about patients' experiences and identify ways to improve your recall program and preventive services.

Recall text messages as a win-win

Patients who come to you for an initial screening demonstrate that they know the importance of the service. Thus, getting them back for subsequent visits and services may not require much convincing. The more you can do to simplify the scheduling of future appointments, the more likely it is that you'll be welcoming back those patients. Text messaging can improve recall success that helps keep patients complying with their recommended screening schedule and your billable volume growing.

Brandon Daniell is co-founder and chief revenue officer of Dialog Health, a provider of a HIPAA-compliant, conversational two-way texting platform to organizations which they can leverage as a communication and engagement channel.

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Jennifer N. Lee, MD, FAAFP
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health