Client Q&A: Back-to-school season, COVID-19, and leveraging analytics to maintain patient volume
As children head back to school for the fall, pediatric practices go through their busiest season — known for heavy call volumes, full schedules, and last-minute requests. How do they manage?
Mike Milewski, Executive Director of Lake Forest Pediatrics, sits on both the executive board and board of directors, overseeing all departments to achieve organizational efficiency. With 19 physicians, five nurse practitioners, and about 80 staff across three offices, Mike gave us an inside look at how the pediatric group is navigating back-to-school season in the bustling Chicago metro area … in the era of COVID-19 no less. Read on to hear his experience managing practice protocol to keep patients and staff safe.
As students in your area start returning to school, how does that affect patient volume?
This is our crunch time. "Check-up season" runs from about the end of May through the end of August. Everybody comes for well visits, getting their school physicals and sports physicals before they go back to school. Right now, we are running beyond our normal capacity for available appointments. We have some providers coming in on their off days to meet the volume of patients we have needing to come in.
How did the pandemic impact your ability to see patients in person last year?
When the pandemic first hit last March, we basically closed our office except for essential well visits. Those patients went through strict screening protocols to make sure they were not showing any potential symptoms, and we had everybody masked and gowned up.
A lot of patients were hesitant to come to the office because this was all new, everybody was on lockdown, in quarantine, and afraid to go out. As we developed COVID protocols and secured PPE in the office, we started opening back up for additional well visits aside from the essential ones.
As we hit summer and the numbers started to go down slightly, we opened for normal well visits and conducted outreach to get patients in who either missed their appointment due to their own concerns or our appointment restrictions. We saw about 98% of our normal well visits in last summer compared to our norms. Most of the first quarter and beginning of the second quarter last year started out a bit slow compared to our norms, but it really averaged out as we hit the summer.Mike Milewski, Executive Director of Lake Forest Pediatrics
Tell us more about your patient outreach. What worked well to help you get back up to 98% of your normal well visits this summer?
We engaged in a patient outreach campaign for children that were more than a month or two beyond their immunization schedule or their normal well visit timing. To do this, we run a report in Practice Analytics, which shows us the date of their last appointment and the type of appointment. We can either run that off a specific immunization or a type of well visit, such as a five-year visit, in addition to the last time the patient was in the office. We hand that report to our front desk staff, as well as our patient educators, to make outbound calls to say, "We noticed you're past due for your well visit. Please feel free to call us back to schedule."
During the pandemic, there was a backlog of patients that were past due, so we had a higher volume of outreach. But most patients were pretty receptive because things started opening up a little bit that summer, and COVID cases started going down. We had a great COVID protocol in our office that we felt very comfortable with, our patients felt comfortable with, and we were able to get most of our patients up to date on their appointments.
How did your practice keep up with changing guidelines amid the pandemic?
We developed what we call the COVID committee, which is three physicians and myself. We reviewed guidelines from the CDC, American Academy of Pediatrics, and the Illinois Department of Public Health to see what we needed to be screening for and what protocols to enact in order to keep our staff safe during visits.
We would meet virtually three times a week at the beginning of the pandemic to make sure we were following safety protocols. That tapered off to about once a week or so and has lasted throughout the pandemic. We still meet on a regular basis to see what guidelines have changed, what the risk for transmission is in the area, what the hospital rates are, and how local hospitals are responding.
What policies or procedures changed because of these meetings?
We've modified our appointment reminder system to request patients check for COVID symptoms using the symptom checker on our website to let us know if they're experiencing any issues. That way, we can properly screen them. And the nursing staff runs through that list one more time before we bring a patient in.
We changed our safety protocols to reduce aerosolized-generating procedures. We reduced the number of nebulizer procedures that we were doing in our office to keep patients and staff safe.
We've changed our policies regarding room sanitation and how long a room needs to be closed if there is a suspected or positive COVID case in our office. We've had many positive patients but have had zero transmission in our office, and we're very proud of that.
Tell us how your COVID committee helps ensure things go smoothly in this ever-changing time.
Our general philosophy is to discuss any and all topics, and then discuss them again and try to look for potential downfalls in order to make sure that we have a smooth rollout of the new policy or procedure. We really try to avoid confusion for either our staff or our patients. We run trials before we go live to make sure we identify any obstacles or potential problems before they happen.
We try to come up with an ideal policy while trying to avoid unnecessarily updating or modifying the policy shortly after it goes live. We discuss everything quite thoroughly. It's not perfect all the time, but we give a lot of energy to make sure it goes as smoothly as possible.
As a Greenway client using Intergy EHR, Practice Analytics, and Patient Portal, can you share how you have used these differently in the last year?
We've relied heavily on our patient portal to message with patients. During the check-up season, our front desk staff are on the phone all day long, and we bring in some temporary help. It almost never seems like it's quite enough, but we're certainly doing everything we can to minimize frustration and wait times.
We try to keep wait times under five minutes, but for the summer check-up season, it goes up to 15 to 20 minutes sometimes depending on volume. It's a marked increase. Using the patient portal to send messages or having a patient request lab results really reduces the volume of calls and the amount of time patients wait on the phone. The portal's a fantastic tool that patients can use to get in touch with us.
Convenience has become increasingly important to parents who have had to juggle more during this time, and they’ve appreciated the telehealth option which we’ll continue to make available as well. Our front desk and nurse patient educators are constantly signing people up for the portal, requesting that they use the applications and messaging features, and the patients have been quite happy to do that. I mean, who wants to wait on the phone?
We field a lot of late-night messages from parents, lab result requests, and some prescription refill requests. When patients can submit a message to the portal and don’t have to call into the office and wait on hold, that generally adds to patient satisfaction, which is definitely our goal.
Thank you, Mike and everyone at Lake Forest Pediatrics, for your dedication to the safety and health of your staff and patients, while using technology in unique ways to drive patient satisfaction and ensure continuity of care. It’s an honor to partner with you!