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Denise Reich shares powerful insights as a patient advocate, highlighting the importance of front desk staff, accessibility, accurate billing practices, and the impact of small changes on patient care. This episode dives into the disconnects between patient expectations and systemic practices and offers actionable steps to improve the overall patient experience.
Denise Reich is a patient advocate.
She discusses the KevinMD article, “4 hacks to improve patient experience in your practice.”
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome back Denise Reich. She’s a patient advocate. Today’s KevinMD article is “Four hacks to improve patient experience in your practice.” Denise, welcome back to the show.
Denise Reich: Hi, thank you so much for having me back.
Kevin Pho: All right. Tell us what this latest article is about.
Denise Reich: It’s really focusing on the front office experience. Before a patient ever gets to see the doctor—or after they have seen the doctor—at the practice, that can be very disruptive to continuation of care or to the overall patient experience because there are a lot of things that happen outside of that exam room that can really make an impact, to the point of even driving away a patient from the practice.
Kevin Pho: All right. And I think that this really needs to be highlighted because when a lot of physicians see patients in the exam room and receive patient satisfaction surveys, a lot of times it is for reasons outside of the exam room—and that could really influence, good and bad, the whole patient experience. So tell us about some of the issues that you face as a patient before seeing the clinician.
Denise Reich: Well, a big one is overall accessibility. And this is something we’ve touched on in the past, specifically with immunocompromised patients, but it’s something that affects a very wide range of disabilities and access needs.
A big one that I don’t think they think about is if a patient is hard of hearing, can they even hear their name being called? Because I’ve been in waiting rooms where they come to one door and they almost whisper your name, or they have several doors, so you don’t even know where the medical assistant is going to come from. And if you’re sitting on the other side of the exam room and there’s even a moderate amount of noise, people might not be able to hear that.
Another one is actually navigating the space from the front entrance to the practice back to the exam rooms. Can a person using a wheelchair get through there? Can a person using a mobility device get through there? Sometimes in waiting rooms, it’s very narrow, and it’s very hard to navigate around those spaces.
Another one is forms. I’ve been to doctors where the forms that they have you fill out are really hard to read, or the font is very small. And that’s fine for people who don’t have vision issues, but if you have somebody who’s older or has low vision, they couldn’t read that form. Also, a lot of practices are going to tablets or asking people to check in on their phone, and a lot of us can do that, but there are people who can’t. Even just with arthritis, holding a tablet is not necessarily going to be easy for somebody—especially if it’s the practice’s tablet and not an accessible device that they have set up for themselves.
So, in those cases, is there somebody to assist that patient? Do you have a paper form that you can give them as an alternative? Things like that. A lot of the time, the front office doesn’t necessarily know how to deal with it, and they don’t have anything set up. Obviously, you’re never going to be able to anticipate every single access need that might arise, and I don’t think anyone can ever expect that as a reasonable request. But knowing how to deal with very common accommodation requests that might arise, and also having protocols with your staff in place—here’s what to do if somebody comes in and they’re hard of hearing; here’s what to do if somebody says they can’t read the form; here’s what to do if there’s an immunocompromised patient who comes in—makes life easier for everybody. Rather than what you get in a lot of offices now, which is, “Oh, I don’t know,” “Oh, we can’t do that,” you know, very dismissive, and that’s a really bad tone from the beginning.
Kevin Pho: Now, have you personally experienced some of the things that you described that negatively shaped your patient experience?
Denise Reich: Pretty much everything in the article that I’ve written about is something that I’ve experienced firsthand. As an immunocompromised patient, I’ve definitely been blown off when asking for accommodations. Even when I try to arrange it in advance, there are times I’ve shown up for an appointment, and even though the person on the phone assured me that everything could be taken care of, the person at the front desk has no idea what I am talking about—”Oh, we don’t do that.”
Another thing I talked about is doing paperwork, doing the insurance forms, and that is—I’m not going to lie—I think we all know that’s a situation we would love not to have. It takes a lot of time. It’s very frustrating a lot of the time, but the patients can’t do it themselves. And last year, for example, I had an experience where I had been prescribed an orthopedic brace, and it actually was approved by insurance without prior authorization. All the practice had to do was send it to a durable medical equipment provider, and they didn’t want to do it. The doctor expected them to, but the front office staff blew it off. I called the DME providers myself, and they told me, “We deal with the doctor’s office,” so they couldn’t—even though I tried to work it out myself, I couldn’t.
To make a long story short, it took literally six months of going back and forth with the doctor, asking them to do it several times, the patient advocate getting involved, to get them to fax something over to the DME provider. And once they did, the brace was provided with no questions asked. There was no argument; there was no need for peer-to-peer or anything of that nature, but they literally did not want to send the fax.
Things like that can really deter a patient from wanting to return to a practice, because it’s just not doing what is needed to ensure that whatever treatment the doctor orders has actually occurred or has actually been set up.
Another one is the text messages, when I talked about “make sure your invoices are legit.” The text message that I described in my article, where I got something that literally looked like a phishing attempt—that was a bill from a dentist—that actually happened. And I actually did call that practice to ask them if they knew they’d had a data breach, because the text message I got, which was just a random, unsolicited text saying, “Click here to pay,” that was totally unverifiable. They had actually sent that, and they thought that was reasonable. Things like that definitely make it harder as a patient to navigate that practice.
Kevin Pho: Now, from a patient perspective, is there any way for you to share that feedback outside of satisfaction surveys that they routinely get?
Denise Reich: I’m—I try to be a problem solver. And so, for instance, when I got this weird text message about a bill that I couldn’t identify, I did legitimately think it was a data breach, which is why I called the doctor’s office. But once I found out that it was legitimate, I did certainly express myself to the staff that I did not think this was a great way to get people to pay their bill. And I always say specifically why I think it’s not a great idea. I said, “I can’t submit a text message as the medical expense. I can’t verify this. You’re asking me to give my payment information to an unknown entity, at a link that I can’t even verify, at a number that I can’t even verify.”
I try to make my feedback very specific. In terms of accommodation requests for immune deficiency, I have asked to speak to the practice manager or I have told the doctors, in some cases, “I came in and they really weren’t helpful,” and I will give my feedback directly to the doctor in a lot of cases because I find that’s a lot more direct. In terms of the paperwork, when it’s been something like the staff just not doing the paperwork, I absolutely will tell the doctor. In the case of this brace that I mentioned, where it took six months to get them to send a fax, I made an appointment to speak to the doctor about it. And I said, “I’m sorry to say there’s been absolutely no progress on our treatment plan, because your staff will not send it, and I can’t work this out on my own.” That helped move it along, because that made the doctor fully aware of what was going on, and I wasn’t going through the staff—I was talking directly to the doctor about it. That’s an extreme situation. I generally won’t make an appointment just to complain to a doctor about the paperwork, but in that case, I did, because I thought that maybe there was an alternative—maybe there was something else that would require the paperwork and so forth.
Kevin Pho: So in your article, you talk about some solutions that practices can implement to solve some of these problems. What are some easy fixes practices can do to alleviate some of these concerns?
Denise Reich: I think in terms of the billing, one thing is just to—especially if you’re going paperless, which is totally understandable and something that I appreciate as a patient, not having reams of paperwork or things that I have to shred at my house—once you’ve established somebody’s preferred means of communication, still send a PDF. Send a PDF in an email instead of sending a text message, or send that PDF to the person’s phone. How would you like to be billed? What is the best way to—they already ask, what is the best way to communicate with you (phone, email, text message)? Ask that question: How would you like to receive your bills?
I think this is especially true in practices that don’t have my chart, where they have the billing all set up and there are ways to verify it independently of a text message. If you’re a small practice where it’s just you, make sure that patients are able to verify anything they receive from your practice and know that it is from the number posted on your website or something that they can trust. Maybe you don’t have the ability to set up your own portal, but you do have the ability to email a PDF invoice to people or have a very identifiable billing system.
In terms of accommodation, I think that the best thing is just to, like I said, try to anticipate very common accommodation needs: vision, mobility, hearing, people who are immunocompromised. Those would be my top four. And then, as a fifth, I would add patients who are not tech-savvy. In the past, I’ve actually had to fill out medical forms for my mom with her on the phone and me on the computer, because they want her to do it online and she can’t. And I think especially with older patients or people who are not quite as tech-savvy a lot of the time, patients who don’t have a lot of these resources—that will need to be worked out, and not everyone has a kid they can call to say, “Please help me fill this out.”
So trying to anticipate having paper forms, I think, is also good, because let’s say the internet in your office goes down. Now how do you check anyone in or get their medical history? You have nothing. So I think just from that perspective, outside of any accommodation, having paper forms works in your favor. Yes, you have to print it. Yes, you have to shred it. Yes, you have to scan it in—it’s extra steps, and I understand that nobody wants that—but have a backup. Because I think that’s a lot of the problem with the accommodation, that there aren’t a lot of backups.
The other one that I mentioned that I haven’t discussed yet is the charting and the coding, and making sure that is accurate. And to be honest with you, I don’t really know what occurs on the back end with how the coding and the charting is done and how it can get so messed up. I do know that there are times when I’ve told doctors about the codes that have appeared, and they just are blank because they say straight up, “I didn’t put that in. I don’t know who did.” So it’s looking at the coders, making sure that the coding is being done accurately and with precision, because it is a lot more of a hassle to get codes excised from the chart once they’re there.
So, to sum it up, be proactive and anticipate that these things might cause problems for the doctors, the staff, and the patient. And try to be as proactive as possible; try to anticipate what the problems might be, instead of expecting that there won’t be any.
Kevin Pho: Now you’ve been to several clinician offices. Do you feel like these problems are universal, or is there a spectrum where one office can be particularly better than others?
Denise Reich: Oh, there’s definitely a spectrum. There’s definitely a spectrum. My cardiologist happens to be independent—he’s not part of one of the medical systems that has connected charts on my chart—but he’s got a portal set up, he’s got very clear messaging, he’s got very clear insurance and billing things set up. His staff is very, very proactive about getting tests and procedures approved. And with cardiology, there are a lot of those, and a lot of the time they don’t want to cover the medications. So he’s very proactive, and he’s very much on top of his staff about getting that done. I’ve never had an incorrect diagnosis appear on my bill, I’ve never had an issue where I’ve received a weird text message from him, and he’s been that tech-savvy for a good 10 years. And if you come into his office as a person with a mobility issue or an immune issue, he’s got it set up. His waiting room is such that a person in a wheelchair can navigate it; they can go to the counter. So it’s obviously something that he’s thought about in advance.
Certain medical systems are better at things than others as well. The biggest medical system that I go to happens to be really, really good about communication and accommodation, but really bad about coding. They’re the ones where I’ve had to get my chart amended several times because they’ve clearly confused me with somebody else. I mean, this past year, there were codes in my chart saying that I was missing part of my digestive tract, that I was on anti-rejection medications for transplants. I mean, it was stuff that couldn’t even be mistaken for anything in my charts; it was obviously confusing me with somebody else. But it got past the coders and got past any quality control they had, and ended up in my chart.
There have also been differences with medical systems in terms of billing. Most of the time, the medical systems that I go to, with precision, they bill the insurance—it’s fine. But there’s one particular medical system where they have forgotten my secondary insurance like four times, despite the fact that they have a portal, and despite the fact that I keep giving them the card and verbally confirming it when I come in. They keep forgetting it. So there’s definitely a difference in the quality and the precision with which things are done from practice to practice and medical system to medical system. And it doesn’t, in my experience, necessarily correspond to how big the medical system is, either. Out here in California, the hospitals are huge—they operate like machines sometimes. Everything is set up very precisely. But the one doctor I see in a smaller medical system—well, we don’t know. So it definitely is a very wide spectrum.
Kevin Pho: We’re talking to Denise Reich. She’s a patient advocate. Today’s KevinMD article is “Four hacks to improve patient experience in your practice.” Denise, as always, let’s end with some take-home messages that you want the KevinMD audience to leave with.
Denise Reich: Thank you, Kevin. I think the biggest message is just to try to be proactive, yes, and to really listen to what patients say if they do come to you with a concern. Even if it is on the patient experience surveys—and we all know that when people are dissatisfied, they’re more likely to fill out a survey; when things go fine, they usually don’t bother—but if you see the same complaint coming up again and again on those patient surveys, maybe take the time to pay attention to it and really think about the areas that are not working in your practice.
If patients are calling you again and again and saying, “I didn’t get my referral,” that’s something with the staff that perhaps needs to be addressed. If patients are saying, “There are things in my chart that are wrong,” maybe that’s time as a doctor to go back and say, “Hey, what’s happening? Who’s doing the coding here, and why are they putting these things in?” Obviously, it’s not something that a lot of doctors can spend a lot of time on, because everyone’s overbooked and everyone has very long days. But I think just taking a little bit of time to be proactive and looking at what you can do to make things easier before problems arise.
In terms of accommodation, a lot of disability organizations are very happy to work with a practice or work with a business to help them with the common accommodation needs. If a doctor were to come to them and say, “How do I make my office more friendly for people with disabilities?” they would not hold back in telling you. Or you could ask patients. Or, you know, look around the office: Are the aisles wide enough? Is the font easy for your 90-year-old grandma to read? Things like that. You know, your grandma that can’t use a tablet—could she come to your practice? Could she hear the medical assistant? Be proactive. That’s the biggest takeaway that I have for people, and also to not bristle when patients express concerns about something that might not be working. Because at the end of the day, I think doctors and patients and the staff all have the same goal. They want to provide care; they want things to go smoothly. Nobody wakes up in the morning wanting to go to a doctor’s office and complain. And certainly, a doctor doesn’t want to come to an office and hear that patients aren’t being treated. And having worked in customer service, the staff doesn’t want to have problems; they want everything to run smoothly. But in order to do that, you have to be proactive, and you have to listen to what people are saying.
Kevin Pho: Denise, thank you so much for sharing your story, time, and perspective. And thanks again for coming back on the show.
Denise Reich: Thank you so much. Have a great day.