Virginia Urology Reduces ER Usage with 24-Hour Hotline

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Headquartered in the Greater Richmond region, Virginia Urology has eight locations and two surgery centers spread throughout its service area. It also holds a joint venture with a local hospital system for radiation oncology.

Originally established 75 years ago, a merger in 1995 left the company poised for organic growth through physician recruitment. Currently, Virginia Urology employs 44 providers with 30 being urologists. The other represented specialties–six radiation oncologists, two radiologists, one pathologist, four anesthesiologists, two physical therapists, one gynecologist physician, and one urogynecologist—all provide support for the urologists. In total, Virginia Urology has 320 employees.

By taking a collaborative approach with its physicians, Brigette A. Booth, M.H.A., chief executive officer, said the company encourages innovative ideas. In fact, these ideas often plant the seeds for some of Virginia Urology’s most successful initiatives, one being the 24-Hour Kidney Stone Hotline.

Keeping patients out of the ER with a phone call

The 24-Hour Kidney Stone Hotline was established in 2007.

“The need arose out of an increased number of calls we received from the emergency-room physicians seeking follow-up care for their kidney-stone patients,” Booth said. “The Hotline served as an efficient conduit to close the transition of care from the emergency room to our office. The Hotline not only created a more efficient workflow for both sets of providers, but also minimized the costs of care for the patients.”

If a patient is suffering from kidney stones, they simply have to call the 24/7 Kidney Stone Hotline, where a patient representative will take their information. If they’re a new patient, the patient rep will initiate the process for entering them into the Virginia Urology system.

For existing patients, the rep has access to the organization’s EMR. They will look at the patient’s history, view the physician’s last plan of care, then inquire with the on-call physician for a recommendation on whether or not the patient should go to the ER.

For a majority of the cases, the on-call physician will instead choose to book an appointment for first thing the next morning. Additionally, a CT or imaging study will be scheduled and the patient will arrive NPO. In fact, most patients will receive everything they need on the same day, whether it’s lithotripsy or a ureteroscopy. They are usually able to return to work within the next one to two days, Booth said.

This process is in sharp contrast to the ER, where it can take a couple of days to work the patient into the schedule for tests or surgery.

“We’re able to reduce costs for not only the patients, but also the healthcare system, and we’re able to provide better care and access,” Booth said. “That’s something that has been extremely beneficial to the practice.”

She added that referring physicians and ERs love the Hotline, because it can be called at any time.

Earning success through marketing and referrals

When it was first established, Virginia Urology was aggressive in marketing the Hotline, investing a great deal of money in a variety of media. Since then, the number of office visits generated from the Hotline, not including downstream revenue from the surgical procedures or imaging the organization provides, has given it a rapid return on investment.

Keeping the Hotline in-house has also benefited this growth, Booth said, and patients have embraced the convenience of it and love the fact that they no longer have to wait for the physician to return their call as they would with an answering service.

Furthermore, area hospitals have promoted it, and Virginia Urology’s director of marketing meets frequently with ER departments around the Richmond area, providing resources and literature on the Hotline. Billboards and buses have even carried advertising for it.

But referrals from ERs and urgent-care facilities have contributed the most to the Hotline’s success, Booth said.

The effectiveness of this Hotline is given more weight in light of a recent NIH study that found kidney stones are among the top five costliest ER admissions. As further proof of its necessity, Virginia Urology’s 24-Hour Kidney Stone Hotline has saved the system an estimated $3 million during its short lifespan.

Realizing the importance of the patient representative

In setting up the Hotline, Booth said the first challenge was realizing a clinical staff member could not man the lines. It was innate to their nature to try to diagnose and treat the patient, which is explicitly not the Hotline’s purpose.

“We thought at first it would have been good to have a clinical person in that role to answer all that patient’s questions,” she said. “But after further thought and review, it turned out that it had the potential to create more issues, so we had to take a step back and remove the clinical person from our plan and add a clerical person, which actually worked out a lot better because they’re familiar with our scheduling system and they know how to go ahead and generate the prior authorizations.”

The level of empathy and compassion needed by those manning the Hotline, not to mention their willingness to be awakened and contacted at all hours of the day, has garnered the patient representatives prestige within the organization.

In the early stages of the initiative, Virginia Urology selected its top performers to function as these patient reps. The same employees have been handling the Hotline since its inception.

As the company looks to the future, Booth said the team is exploring ways in which the Hotline model can be applied to other urological conditions. She advises her colleagues to always be willing to explore fringe ideas or ideas that aren’t exactly trendy, but will improve their customer service.

“With the way healthcare is changing, it’s additional ways we can enhance customer service and enhance the patient’s experience, and I think this certainly does it,” Booth said. “But I would think in doing so you have to have the right people on the bus to be able to handle it and that will either make it or break it.”

-by Pete Fernbaugh

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