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SECRET SERVICE REVEALED: Customer service tips from an "undercover" Mystery Patient!

Ms. Luallin is a 20+ year patient experience consultant. She is a regular speaker for Medical Associations, including MGMA, at both the national and state levels. She and her partner, Kevin Sullivan, developed a patient satisfaction survey system used by hundreds of practices nationwide. To help clients boost patient survey scores, increase patient compliance, and obtain Pay for Performance bonuses, she and her company work with practices to implement Service Quality Initiatives that improve the service performance of physicians and staff members. Physicians and administrators, upset with low patient satisfaction scores, turn to Ms. Luallin for help in identifying the doctor's limitations and recommendations for improvement. As a professional shadow coach, Ms. Luallin has helped hundreds of grateful doctors move from the bottom to the top quartile on their survey rankings. SullivanLuallin is also an AdminiServe partner for patient satisfaction surveys and customer service.

 

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Video Transcription of SECRET SERVICE REVEALED: Customer service tips from an "undercover" Mystery Patient!

Steve: Welcome to our fifth monthly Quill Healthcare webinar. I'm Steve Selbst. I'm joined here today with my colleague, Ms. Regina Vasquez, and our distinguished speaker, Ms. Meryl Luallin. This is our fifth in a series of Quill Healthcare value-add webinars for our practices.

I'm pleased today to introduce today's topic which is "Secret Service Revealed: Customer Service Tips from an Undercover Mystery Patient," which will be presented by Ms. Meryl Luallin, the Chief Executive Officer of the SullivanLuallin Group.

Before I turn the floor over to Meryl, I just have a couple of quick administrative matters that will be routine for those who have previously joined the session and will be useful for those as a review and for those who are just joining a webinar for the first time.

Throughout the webinar, you'll have the opportunity over the course of the next hour-and-a-half to ask questions. There will be two ways that you may go about asking questions.

One is that you can free up your phone line so that you can speak, and once Meryl pauses to take questions, we will do so by having you press *6 on your phone to ask a question. Then when you're finished asking the question and conversing with Meryl, please press *6 again as that will mute your line and enable the finest broadcast possible throughout the session. So you can ask your question by simply pressing *6 on your phone line once we get to the question-and-answer portions of the discussion, and then press *6 again to mute the line.

The other way that you can go about asking questions is throughout the duration of this webinar, simply send your questions to the email ID listed right here, info@healthcents.com. You can do that at any time beginning right now. My colleague, Ms. Regina Vasquez, will pick up your questions and during the breaks she will ask your questions that have come into info@healthcents.com, in addition to Meryl fielding the questions that you ask live through your phone by pressing *6 to open up your phone line.

Secondly, if at any time during this webinar you happen to lose contact, ET can phone home simply by typing join.me/healthcents and that will restore your web session at exactly the point that we're at during the webinar.

In addition, as we do each month, we will provide notification once the recording of this session is available. But during the session at any time if you lose contact in your browser, simply type join.me/healthcents and you will be restored exactly to the point where you left off. Of course, if your phone line disconnects for some reason, simply dial back into the conference line provided.

Introducing Featured Speaker, Ms. Meryl Luallin

A few words about our distinguished speaker, Ms. Meryl Luallin. First, Meryl is a 20-plus year patient experience consultant. She's a regular speaker at MGMA and other venues both nationally and at the state level, and she and her partner, Kevin Sullivan, developed a patient satisfaction survey system used by hundreds of practices nationwide. The goal is to help clients boost patient survey scores, increase patient compliance, and obtain pay-for-performance bonuses.

She and her company work with practices to implement service quality initiatives that improve the service performance of physicians and staff members of practices. Physicians and administrators that are upset with low patient satisfaction scores or just low patient satisfaction in general turn to Meryl for help in identifying the doctor's limitations and recommendations for improvement. As a professional shadow coach, Meryl has helped hundreds of grateful doctors move from the bottom to the top quartiles on their survey rankings.

Meryl's company, SullivanLuallin, is also an AdminiServe partner for patient satisfaction surveys and customer service.

Now, without further ado, it is my pleasure to turn the floor over to our distinguished speaker, Ms. Meryl Luallin. Meryl, take it away.

Meryl: Thank you very much for that wonderful introduction. Very much appreciated, Steve. Here's what we're going to cover today in the next 90 minutes or so.

Program Objectives

First, we're going to look at what professional mystery patients are observing for. What are we actually out there observing? And secondly, what can you do with the information that you get back from a mystery patient?

Before we go any further, let me just give you some of the really interesting experiences that I've had so that it will whet your appetite as to what life is like on the other side of the counter.

I remember going into a dermatology practice one time and being escorted into the exam room by the medical assistant. The doctor came in and reached out to shake my hand wearing rubber gloves. She was wearing rubber gloves. I thought to myself, "Is she afraid to touch me?" Then I thought, "Oh my gosh, who has she touched before me? What was going on?"

It's amazing what you feel as a mystery patient when you're really and truly observing life in reality rather than what you think it's going to be.

As a matter of fact, an article was written about mystery patients. It appeared in the Medical Economics magazine, and Steve is going to show this in the next slide. That's a cover shot of me behind a newspaper taken by the photographer. People have a great interest in what being a mystery patient can tell, what mystery patients can find out for you, in your practice.

Let's look at it in the context of where do mystery patient visits appear or occur, and for what purpose?

Before we go further, everyone today who is trying to achieve as high a reimbursement bonus as possible from Medicare or CMS knows that the Affordable Care Act is also called the Triple Aim. The Triple Aim is better patient care – in other words, better outcomes, at lower cost, with higher patient satisfaction, with happier patients.

Many, many practices these days are totally focused on how to improve the patient experience, and that, by the way, is the new phrase that everyone is focused on. It used to be called patient satisfaction. Now it's called the patient experience, and even further, some folks are referring to it as the care experience.

Steps to A Service Culture

In order to really focus on establishing a culture of service in your organization, there are certain steps that you go through. I'm just quickly going to outline them for you and then tell you where mystery patients fit.

First of all, if you're wanting to change the ambiance and the environment and the culture of your organization to be more service-oriented, you have to know where you stand right now. What is the culture? You do that through a service assessment, and in just a moment, I'll come back to that.

Once you have a sense of how you're doing now – and by the way, the service assessment includes mystery patient visits, mystery calls, patient satisfaction surveys, patient focus groups, staff and doctor satisfaction surveys, and so forth – once you have the results of that kind of an assessment, then you meet with the leadership of your group. If it's a small practice, all you have to do is talk to the key physicians. If it's a larger practice, perhaps the board. You share with them the results of your service assessment, which oftentimes can be an eye-opener.

I don't think that physicians have a good handle on what the patient really thinks. Everyone in this room and on this call knows patients rarely complain to the doctor about anything. They will unload all of that on the front desk. If it's waiting times, they'll complain to the poor receptionist. If it's frustration with a treatment plan, they'll unload on the medical assistant or the nurse.

So once you share the results of your service assessment with the physicians, then you decide, all right, we want to change. We want to improve. Let's determine what we want to achieve. How far do we want to move the needle?

Later in the webinar, I'll show you a copy of a typical patient satisfaction survey that will help you determine where you want to move forward and which element you want to move forward with.

The next step of course is to develop service protocols. The reason they're called service protocols is because we are very familiar with clinical protocols. Everyone understands how to deliver the service, the clinical service, and the requirements to deliver it with quality, but it's rare that people use service performance and put it on par with clinical protocol. It's important to consider establishing service protocols. Once you do that, you tell folks, "All right, here's how you conduct the visits using the service protocols." I'll share with you as we go along some of those protocols.

Finally, the last step is holding folks accountable and rewarding folks who do a great job. If the entire practice has met your quantifiable goals, then you hold a celebration, whether it's a big pizza lunch or whether it's, you know, the doctors wash the staff cars – sometimes I get a little carried away – but it could be everybody gets a car wash coupon if the practice achieves certain goals.

Now you have the overall steps to a service culture, but let's focus on conducting a service assessment.

Conducting A Service Assessment

As I said before, typically you have a patient satisfaction survey. The survey, as you can see, has multiple questions. The survey that's endorsed by the Medical Group Management Association, MGMA, has approximately 34 or 35 questions. The way that it's laid out – and by the way, we are their vendor for conducting the survey.

The survey has dimensions. The first one is making the appointment, our staff and our communication with you. On the back side of the survey, which is the next slide, you can see that Section D talks about the physician, and then there are some other questions as well.

You can get the survey results. However, when you get a score, that doesn't tell you what the flavor of the practice was. It can tell you whether or not the doctor was willing to listen carefully to you, but it doesn't tell you whether or not the doctor was fiddling around with the computer the whole time. It can tell you that, yes, the doctor ran behind, but it doesn't tell you whether or not the staff member . . . my point is that you can learn things from a mystery patient visit that you don't get on a survey.

A survey is very cut and dried, and it's the way everybody measures, but it doesn't tell you what feeling the patient gets when they come to and through your practice.

Question 1: Are you conducting formal patient satisfaction surveys?

Now let's just quickly find out how many folks, whether it's for a service assessment or to just in general assess your practice, how many of you are actually conducting formal patient satisfaction surveys?

There are various ways to do that, so please click on whether you're giving them, and if you do conduct them, whether it's over the counter, which is the least expensive, or on your website or through an Internet site. Many large, large practices are mailing them. Some do it with outside vendors, because as you heard me say, we work with MGMA to do that. I'd love to know how many of you out there are not conducting surveys, so please answer and let us know.

Steve: To answer the question, in your browser in another tab or in another browser, go to healthcents.com/q1, all lowercase, as you see here. To illustrate, you would simply put into your browser healthcents.com/q1 and be presented with the answers and the question. Choose your answer, and we will immediately tabulate the results.

Again, we'd appreciate participation so we can see as a group what the results are to conducting formal patient satisfaction surveys. I'll give you a moment to go to healthcents.com/q1, exactly as you see it in the browser window here, and then we will review the results.

It looks like we have some results. Let's see what came in. We have six participants so far. Meryl, the results are up on the screen.

Meryl: Obviously, you're doing it. The majority of folks here have said they're doing more than one of the options. The least expensive is over the counter, but if you're associating any kind of compensation bonus to physicians based on patient satisfaction – and by the way, more and more practices are doing that – most physicians are very reluctant to use data that's collected by surveys that are handed to patients.

Just as a quick aside, as I mentioned to you earlier, we are the administrative partner for MGMA, which means their preferred vendor for surveys. We have found that there is a difference in the ratings that doctors get from surveys that are handed to patients on-site and completed on-site versus those that are mailed to patients who complete them at home and mail them back.

We make the assumption that patients are more positively inclined to the doctor, whether it's because they're afraid that if they rate the doctor down that they might experience consequences, or it could also be that you tend to remember negative things stronger than when you're on-site. Nothing bad has happened to you, so it's when you get home, you remember how frustrated you were with the waiting time and so forth.

The other area that folks are using these days is Internet. Just in case you're thinking of it for the future, probably within the next three to four years, Internet will probably be the preferred way to administer surveys.

Mystery Patient Assessment – Pre-visit

Let's talk about the mystery patient assessment and what goes into it. First, let me begin by saying most of the time when we conduct mystery patient visits, it's out of town. Someone has contacted us from another state, and so we will have to make the long-distance appointment. They don't know it's long-distance when we're calling to make the appointment, and that's always a very interesting experience, calling to make the appointment.

I urge everyone listening to do that for yourself. Call in or have a friend call in and find out how easy is it to actually get an appointment? In some cases, it's a three- or four-week wait to get the first available appointment for a primary care problem.

Most people want to know why you need to come in to see the doctor. Typically what I will do is I'll say I'd like to come in and see the doctor because I have trouble sleeping at night, and I just want the doctor to tell me if melatonin is okay. So that's a non-urgent appointment. It's interesting to see how long it takes me to get an appointment like that.

Secondly, whether or not the first thing they ask is, "What's your insurance?" before they ask for your name, or if they want to know what your date of birth is or whether you have been seen here before, before asking your name.

The way you connect with people is to find out their name. You heard Steve make a big deal about my name. He used it at least three times before you ever even heard my voice. It's because he's establishing some credibility and connection between us. And yet, when you've got folks that are making appointments on the phone, the first thing they typically will say when you call in saying, "I'd like to make an appointment," they should say, "I can help you with that." But instead, they'll say, "Name?"

I'll share one interesting experience. I called a practice in Illinois. The name will remain anonymous to protect the guilty. The phone rang and rang, and she finally picked it up, and she said, "Super Care of Illinois. May I help you?" I said, "Yes, I'd like to make an appointment." Her immediate response was, "Which physician?" I said, "I don't have a physician there. Who's good?" Her second immediate reply was, "Oh, I can't recommend any of the doctors at this practice." And I'm thinking to myself, "That's probably not the right answer." I mean, it's true if she's been told not to recommend one over another, but the point is that there's a better way.

If I asked all of you – which I will in a little bit – what should your staff say to anybody who asks for a recommendation, you know what the answer is. Be ready to share it.

Having said that, what else goes into that appointment setting? Does your person actually ask, "Do you know where we're located? Do you have any special needs? Is there anything else I can help you with?"

Let me tell you a very interesting thing that sets up this next slide. I made an appointment in Tennessee from San Diego. When I said, "I'd like to make an appointment," her answer to me was, "Well, stop by the office and pick up an application." I said, "No, no, no, I don't want to apply for a job. I want an appointment." She said, "I know, hon, but you need to stop by the office and pick up an application."

Well, to make a long story short, I asked them to fax me the "application," and what it turned out to be was a health history form, a consent to treat form, a payment form, and an advance directive. I couldn't believe it. I hadn't even seen the doctor yet and they wanted me to sign saying I didn't want to be resuscitated or whatever.

That's the one point about this. The other point is this is something that most folks don't focus on. It is not uncommon that when people run out of a form that needs a patient's signature or filling out, you pick the last one on the pile and make a copy. So you make another 10 copies. When you get down to the last one of the 10, you take that one and make another 10 copies. What happens is that you're handing out – not you all, certainly nobody on the line now – but in my experience, many times the forms that are handed to patients as they come in, it's the third, fourth, sometimes fifth generation copy, and it looks terrible, just as this did. This looks bad not just because it was faxed, it was bad at the beginning.

What else does somebody look at when they come in? What about the facility itself? We look at things like the restrooms. Let's look at this next slide. I went into a practice in New York, and this was the bathroom. I walked in and looked at that, and I thought, "My gosh, what is this? Big, giant rolls of toilet paper and this little basket?" I looked up close, and it was potpourri that had to have been there for five years. Somebody probably had a great idea of making the bathroom look upscale with a basket of potpourri, but it was dusty, it didn't have a smell, and the giant toilet paper. I thought, "Somehow they're missing the mark on making the patients feel as if this is an upscale practice."

Mystery Patient Assessment – Visit

What else when we first walk in? Well, receptionists. How does the receptionist greet and treat us? If I were to say to all of you, "What should your receptionist say?" some of you will say she should say, "Hello," but the majority I hope would say the receptionist should say, "Good morning. May I help you?" or, "Good afternoon. Welcome to our practice. May I help you?"

But they don't. Seventy percent say, "May I help you?" The other 30%, when you walk in, will say something like, "Yes?" or more likely, "Who are you here to see?" or even worse than that, "Insurance card, photo ID?" I was just really astounded when somebody said, "Insurance card, photo ID." I thought that was kind of strange.

Next, what about the nurse? What about the nurse performance? Most of the time, and if you're the office manager or the nurse yourself, you know that the nurse or medical assistant typically comes to the doorway and looks out over the waiting room, right? Let me tell you, if there's one thing you take away from today's webinar, it's never, ever, ever call it the waiting room. We know we're going to wait. Patients know we're going to wait. Don't rub it in. Don't say, "Have a seat in our waiting room."

One time I was at a place where not only was I in the waiting room, and then they called me back and took my blood pressure and vitals, and then they sent me back out to sit in a place that was like an alcove with a sign over it that was referred to as the "Sub-waiting Room." I felt sub-human. It's bad enough to be in the full-size waiting room, but the sub-waiting room, I thought that was kind of tacky.

In any event, don't call it that. Call it the reception area. Doesn't that have a nicer feel to it? Reception lobby. Reception area.

Anyway, so the nurse comes to the doorway. Now, again, here's what drives me crazy as a mystery patient and as a regular patient. It is not uncommon that the nurse comes to the doorway, looks out over the sea of faces, and says, "Ethel? Ethel?" Now, I ask you, in your heads, how old is the woman named Ethel? I know what you're thinking. Everybody here is saying old. And yes, probably older, at least probably in her late 70s, maybe early 80s, okay?

Here's what bugs me. The person who's calling, "Ethel, Ethel," her name is Brittany. Now, how old is somebody named Brittany? We're all agreeing that that's somebody who's probably in her 20s. My point is this. If you have somebody who's in her 20s, shouldn't that individual be calling Ethel by her last name, Ms. Johnson?

Better yet, I know what's coming up here. You're going to go, "Oh, but what about HIPAA?" We'll get to that in a sec. If you know Ethel well enough to call her by her first name, why is the nurse standing in the doorway? Why don't you go out to Ethel in the reception area, up close and personal, connect, and say, "Ethel, we're ready for you now. Can I give you a hand?"

The same thing is true in a pediatric office. If you know the mother well enough to call her by her first name, and most young mothers don't mind being called by their first name, why stand at the doorway and yell for the mom and the kid? Why not go out there and offer a hand? That's what sets practices apart.

Let's talk a little bit about the provider performance. I've had physicians come in with a knock ahead of time. That's about 60% to 70% of the time they're knocking. But 30% of the time, docs don't knock.

You all realize that the walls in exam rooms are thin enough that you can kind of hear what goes on next door. When you keep us in the exam room for long enough, that's what the entertainment is, what's happening next door. I actually heard a physician open a door, walk in on another patient, and the doctor said, "Oh, I wish I could take a nap in the middle of the afternoon." The patient said, "You could if you made an appointment with yourself."

So it's always important for the doctor to knock and make a connection. Come in, use the patient's name. Say something kind of warm and friendly rather than just automatically getting right to it and through it, "What brings you in today?"

In other words, the doc ought to say something like, "How can I help you today?" We'll get into that a little farther in a little bit.

Mystery Patient Assessment – Post-visit

Then finally, post-visit, the check-out procedures. I've had people who haven't told me what to do. If I'm supposed to pay at the way out, they're supposed to tell me that. They just make assumptions that I know that. So I have tested the system to see whether or not I can get away with being billed rather than paying cash at the time of visit. It's very easy.

Question 2: Do you conduct mystery calls to your practice?

Now there are some practices that test their systems by conducting mystery calls. You've heard me talk about mystery patient visits. That's in person. Let's take a look at the next slide and see whether or not anybody on the call today has actually ever called their practice to see what kind of service they get.

Steve, do you want to remind folks how to do this again?

Steve: You bet. This is the trust and verify question. It will be interesting to see how many of you have actually placed those mystery calls.

So to answer this question, please go to healthcents.com/q2, all lowercase. Once again, to illustrate for those who may have just joined the session, all you will do is go to your browser and simply open up a tab or another browser, whatever is most convenient, and type healthcents.com/q2, all lowercase. You'll be presented with the question, and you select your answer.

We'll go ahead and take a look at the results in just a moment.

Let's take a look at the results. Meryl, the results are up on the screen.

Meryl: All right. I imagine that the reason you don't is you never get around to it. It's amazing what you can learn when you make mystery calls. It's not just whether or not you're put on hold without being asked. It's not just whether or not a person answers in a friendly tone of voice. It's surprising how much ambient noise in the background comes through if you're trying to make an appointment.

One of the things that we do – and it's not for publication, in other words we don't use it to hold anything against anybody – but we will tape the calls. You can do that with your iPhone. We tape the call so that when we're writing up the report for our clients, we have it verbatim so we can actually share with the client in the report.

There are times when you'll be talking to somebody trying to make an appointment or establish some information with them, and they're distracted by the background noise, somebody calls them and so forth. You won't know that that's what's happening unless you actually call.

It may be that you'd have to disguise your voice or get somebody else to call for you and try to establish an appointment or even nothing more than, "I'm new in town and I just want to see if you take XYZ insurance?" or – and this happens frequently – "How much does it cost for a pap smear? I'm due for a pap smear. I'm new in town, and I want to know. I haven't met my insurance deductible yet. What is the cost of a pap smear?" Do your staff members know that? Is that a question that they'd be able to handle? How would they handle it?

Finally, on the mystery call, here's something that really is surprising. On more than one occasion, we have called over the noon hour, and some offices actually close the phones over the noon hour. Can you imagine if you wanted to check your bank balance and you called the bank and you had to leave a message? It's kind of unfathomable that people would not be available at a time when other people would want to call, which is typically the noon hour.

Then if you do leave a message saying, "Yes, I'd like to make an appointment," and you leave the message, one place I called said, "We return all calls within 24 hours." If I want to make an appointment, I don't want to wait 24 hours. The bottom line is I waited two or three days, and I never got a call back. Finally I called again, and when the lady finally returned my call, after having left a message, I said to her, "I'm so surprised, because it said you were going to be calling back within 24 hours," and her answer to me was, "Oh, well, I have another job." I said, "Oh, you don't work all the time for XYZ?" She said, "Oh, no, no, I do that, but I do other things as well." And I'm thinking, "A patient doesn't want to hear that you're overworked. They want to know why you weren't responsive to them."

Again, it's not that patients are being pushy and demanding when they want an appointment. If you want to go get your hair done and you only have a particular amount of time to get your hair cut and you're taking off time from work, it has to be at your convenience, not at the hair cutter person's convenience. So anyway, that's just a little thought about that.

In about five minutes, I'm going to turn it back to you and ask you if you have questions. But let's go on now.

What Do Mystery Patients Observe and Report – Checklist

You probably want to know what the typical mystery patient looks for. I'm going to suggest that we leave this up on the screen for a few minutes. I'm hoping you're sitting up close at your desk where you can see this on your computer screen. You'll see what we as mystery patients observe and report on.

By the way, this is yes/no. It's either you do it or you don't do it, or it happens or it doesn't happen.

Are directions and signage clear? What about the ambiance? Let me go back to saying something about directions and signage. Recall, please, that a mystery patient is looking at life through the eyes of a new patient, somebody who's never been there before. Oftentimes, if you get a new patient coming to your practice, they're new, and that means they haven't been there before. If they don't know how to get there or your signage isn't real obvious, it's very frustrating.

Let's just say you've got a hard parking problem, and then on top of that, the signage isn't clear. When the patient walks in, they're a little miffed just at the get-go. Then they walk up to the counter and somebody says, "Name?" Think about the first impressions. We've all heard first impressions last. You have to feel as if you've made the right decision to come to this practice and that they're happy to see me. That's what the mystery patient is experiencing. That's what all of your new patients are experiencing.

By the way, the second or third time somebody comes to your practice, they don't have a lot of folks saying, "So, how did the doctor visit go?" It's the first time they come to your practice that they are much more likely to tell other people about their experience.

So think through whether or not if you are new to your community and new to your office, if it's easy to find, and then of course what the environment is like. How about the temperature? Is it clean? What about the signs to the bathrooms? Are the bathrooms even clean, or do you have 10-year-old potpourri on a table thinking that that makes it look really classy?

Then we come up to the registration counter. If the person is on the computer working away, what should she do? Acknowledge the person who comes up. Oftentimes, they'll figure that, well, you know what? The person who shows up at the counter, they have to wait while I finish what I'm doing. That's not exactly making you feel welcome.

How about wearing ID badges? We're going to talk about the importance of ID badges. I have a phrase, a pox, a crazy phrase that means terrible curses and curses on anybody who wears a name tag on a lanyard or those necklace things because when she sits down at the registration counter, who can read it? It's down below the countertop. The point is people should be wearing their name tags up where they can be seen, and we'll talk more about that in a moment.

Did they smile when they spoke with you? Were the staff friendly to each other, or did it look like an armed camp when you walked in?

How about your name? People connect with you when you use their name appropriately, not like a telemarketer, but, "Hello, Ms. Luallin. Do you have any other questions?" Any of that kind of thing.

So that's the receptionist. What about the medical assistant? I've already made one point about the MA coming to the door screaming out the patient's name. So now those of you who are concerned about HIPAA, let me assure you – this was a bigger issue probably when HIPAA first came out five or eight years ago. Most people say, "Oh my God, you can't use the patient's first and last name out there. That's a HIPAA violation." No, actually, that's not a HIPAA violation.

What is a HIPAA violation is using the patient's first and last name and some bit of personal health information. What you cannot say is, "Ethel Merman, Dr. Jones will see you now for your hemorrhoids." That's a HIPAA violation. But you can say, "Ethel, we're ready for you now," especially if you do it up close.

Here's an interesting thing. I was at a practice one time where the patients were assigned a number so that when you sat in the reception area, the MA came to the door and shouted out your number. That is grossly tacky. I haven't seen that too much anymore. I think people have kind of regained some equilibrium with regard to HIPAA.

The medical assistant should be encouraged to go out into the reception area and go up to the patient if they know who that patient is. Here is a way to make that happen in a smaller practice.

Let's say I am a new patient and I happen to be wearing a navy blue blazer. If I show up at the counter, the receptionist who greets me could put on a Post-it, "Blond, navy blue blazer," and then put that on either the chart or whatever paperwork that the medical assistant comes and gets. If there is some way to communicate that to the folks in the back, navy blue blazer, then when Mary Beth comes into the reception area, she looks for somebody female about the age that I would be, and I know you note the age on the electronic record. She could look for somebody with a navy blue blazer, and then actually come out and ask, "Meryl Luallin, we're ready for you now." That's a classy way, above standard, higher than typical. The typical way is the old, "Ethel, we're ready for you," kind of thing.

When I get to the doorway, does she turn, kick the door open and expect me to go running through, or does she actually stop and say something friendly? And I don't mean just "she." I know there are male medical assistants out there. Do they make small talk as they walk me to the exam room?

Then what about the exam room? Is it a comfortable temperature? Was I told how long it's likely to be that the physician will take before coming in? Do you have any other questions?

When the MA is taking my vitals, is she telling me what they are? When she is asking me questions, is she looking me in the eye, or is she looking at the computer screen which prompts her for the next question?

Then finally, what about the doc? Did he knock before coming in? Friendly greeting? Shake my hand if it's appropriate? Did he sit down right away? Was I on the exam table? I shouldn't ever be on the exam table when the doctor comes in unless I'm there for a pap smear and I'm an established patient. Patients should be in the chair so the doctor can give good eye contact while he or she is sitting at the computer. Then the doc helps me up onto the exam table, then does the exam, and then helps me back down so that he can be seated again.

The process of chair, exam table, chair makes it feel like I'm spending more time with the doctor than just me sitting on the exam table the whole time the doctor is there and having the doctor stand as well.

So there you have the first phase, the first page of the checklist. If you take a look at the next page, you'll see that we also write out the actual verbatim experience. How was it with registration, the MA, the provider, and so forth. So that's what a typical – from our company, anyway – a typical mystery patient checklist entails.

How to Score Big With A Mystery Patient

Let's talk about how you can really score big with a mystery patient. There are going to be all kinds of ideas and strategies and recommendations based on previous experience that we've had.

Signage

Let's talk about the first one, signage. You would think signage would be a piece of cake, and it probably is if you've had it done professionally. Look at some of the signs that you might have at your practice. What does it say about your practice?

This was seen outside of an ophthalmology practice. You can only park five minutes. If you're in there having cataract surgery, I would hope that the surgery would take a little longer. So you can imagine what that says.

Many, many practices are very concerned about patients who aren't prepared. I saw this particular sign hanging in a practice in Florida, and I thought, "Well, that's a good idea. It kind of reminds everybody."

Let me make a point about this. You can read it very quickly and easily because it's right up close on your computer. If you hang any sign informing people of something, any kind of a promotional sign or informational sign, two things apply. The best place to put it is the exam room. That's because you have patients captured, captive in that exam room for let's say a minimum of 10 minutes, but many times for 20 minutes and longer. So they get up and walk around and read stuff, whereas in the reception area, people come in, sit down. I've never seen anybody get up and go read the signs up next to your counter.

By the way, just as a little heads-up, after I talk about the signs – we've got about three more signs to talk about – then I'm going to turn it over to you for questions. So if you're thinking of questions or sending some in to Regina to ask, be thinking of them now.

Steve: Meryl, just to reinforce that point, when we do get to the question and answer portion, if you'd like, in the meantime, you can please send your questions to info@healthcents.com and we will be retrieving your questions and asking them during the pauses, and we will also take live questions.

Back to you, Meryl.

Meryl: Thanks. The next slide is a sign that I saw hanging up in a physician's office in Concord, California. "Thank you for your patience." You and I know that patients get very impatient while waiting, and yet sometimes the doc can't move any faster because of the needs of a previous patient. So I thought this was a nice way of conveying to patients that the doctor is aware that you like good, quality service, but everybody gets the same and just hang in there. You'll be getting good service as well. I think this is very well done.

The next one, this was in the exam room. We do workshops for docs on how to get high scores. One of the things that is so frustrating to physicians is when patients have the old "by the way" syndrome. The doc thinks the visit is over, and just as he or she is getting ready to walk out of the room, the patient will raise issues. So this is a sign that I saw in an exam room that kind of prompts the patient as to what to ask the doctor for.

The last sign before your questions is from a practice right here in San Diego. This is in their urgent care department. I thought it was really nice. What you can't really tell is what they say up close. First on the left-hand side is who are the folks that work in the urgent care department, and on the right side are all of the things that patients have said about them. It's kind of a we want you to know we're good, and we appreciate you knowing that.

There's also some little newsworthy information down outside the frame here. I apologize, my camera got a reflection so you can't see the picture at the top. But what they're doing is they are making the urgent care department and the staff members sort of friends, pointing out how friendly and down-to-earth and connectable they are. I thought this was a nice way of getting patients to know who's there to serve them.

Here's a tip from an orthopedic practice in Wisconsin River. I was there as a mystery patient, and they had scrapbooks in the reception area on the end tables. Actually, it was like a coffee table, but they weren't serving coffee. Each page in the scrapbook was devoted to one of the staff members, and they had on the scrapbook page candid photos of themselves and their pets and family members and then a little blurb about their interests.

I thought, "Gee, what a great idea," because as I sat there, I was looking and wondering who was going to be my medical assistant, and it was a nice thing that helped me to connect with the staff. At the same time, it also took up some waiting time.

Hopefully, by now, you should have some questions. Does anybody want to start?

Steve: We are now at the point where the audience is very much invited to join in the discussion. To ask a question, please press *6 on your phone right now, go ahead and identify yourself and please ask your questions. Any live questions, please press *6 at this time.

In the meantime, until we have a live question, I'll turn the floor over to Ms. Regina Vasquez. Regina, do we have any questions that have come in from the audience at info@healthcents.com?

Prioritize Feedback from Satisfaction Surveys Question

Regina: I do have two. They might kind of meld together. The question is how do you prioritize? In your experience as the mystery patient, when you get the feedback from your initial satisfaction surveys, what do you think is the best way to prioritize? How do you figure out what's most important to focus on first?

Meryl: I can tell you right now from our experience what raises all scores is the performance of the staff and the physician. We did a survey for one large pediatric patient who had very low scores. We did a big customer service initiative for them. When we went back and took the survey again, the staff and physician scores were much higher, but so was parking. Parking rated much higher, and they didn't do anything to improve the parking situation.

The key to any practice success is staff performance, how the patient is greeted and treated and the physician's interaction with the patients from not the clinical quality standpoint but from the interpersonal standpoint.

Here's one more thing. Patients will like you and rate you high and recommend others to your practice to the extent they believe you like them. Patients have to believe that they are special to you and that you are delighted to be able to help them and you care about them personally. Then they will be very, very loyal and very responsive in terms of their surveys and likelihood to recommend.

Handling Complaints Question

Regina: Okay. This kind of goes along with what you were saying, that patients will be loyal if they feel like they're cared for.

The other question had to do with handling complaints. Have you done any specific study or review of patients' feedback with regard to handling complaints?

Meryl: Usually, we don't. As a mystery patient, I was just going to say strange experiences. There are enough notable experiences without creating a problem. I can tell you – and I will save a few minutes at the end – to tell you an acronym for handling complaints, but it's not based on mystery patient visits, because again, as a mystery patient, I don't feel personally that I want to put anybody "through their paces." I don't want to go in there and cause somebody to have a bad day. In some cases, they're already creating their own bad days.

Regina: Fair enough.

Meryl: No need to make it worse.

Regina: Fair enough.

Meryl: Okay. Well, let's go on. I'll make some comments on strategies now. We talked about signage earlier. Let's talk about ambiance.

Strategies – Ambience

Glass windows these days are out. I know everybody says, "Yes, but what about HIPAA?" Well, I can tell you the majority of places who have been remodeled lately don't have glass panels, and therefore you just keep your voice down, (a), and (b), there's a sign that says, "Please stand here." Most places where there could be a line forming, they ask the patients to stand about six feet away from the counter to allow for privacy. So have that.

If you're going to have TV, and many places do have TV, have it turned on to something neutral. Not Jerry Springer, not Fox News, not MSNBC, not the flaming liberal or flaming conservative channels. That only causes people to get all riled up. So something neutral.

If you're going to have plants, somebody told me recently that plants are no longer allowed in healthcare environments supposedly because they carry disease or whatever. I can't believe that. I haven't studied it. If you haven't heard that and you have plants, be sure to water them. That's what I'm saying. And dust them. I went into a place in New York one time where the plants hadn't been cared for, and it gave me a whole second thought as to what kind of treatment I was going to get if they couldn't keep their plants healthy.

If you have an aquarium — peds often will do that — scoop out the dead fish. Have it look clean.

For pediatrics, I've seen dry erase boards so kids can keep themselves occupied. One place had this great carnival mirror that the kids could stand up in front of and it made them look skinny and fat and all that kind of thing. It was very, very easy to maintain. It kept the kids and the moms entertained for a while.

In your restroom, if you are a smaller practice and it's a bathroom rather than an institutional-looking restroom, have something in there that looks nice. Have some artificial flowers. I've seen some restrooms where they actually have the wallpaper border around the top. Just something to make it look upscale.

Some people do have coffee and water. A lot of folks don't because of the mess. They think it's messy. But if you have coffee and water, it does add the sense that we're hospitable.

If you can't stay on time and keep your patients entertained, then you can make money while they're waiting. The slide says, "Perhaps you'd like to visit our souvenir shop while you're waiting." You can see all the Dr. Bob mugs, dolls and whatever. I have to tell you, this isn't so farfetched.

I actually did a program for a group of physicians, one of whom was a fellow named Bob Phelps. He happened to be an orthopedist up in Glen Cove, Maine. He said, "Meryl, when I have a patient who has recuperated enough from a joint replacement, I send him or her a baseball cap." He sent me one, and embroidered on the cap, honest to God, this is what it said: "Dr. Bob did the job," with his phone number on it. So all of his patients wearing these baseball caps are advertising for him. I thought that was very clever. I don't know whether or not anybody else does. It's clever, but a little tacky.

Strategies – Registration

We talked about name tags. It's really important that when people come to your practice, they know who they're dealing with. Any kind of a name tag that is on a necklace can turn around. They should be up high, up usually above the breast pocket or wherever.

In some cases, I know that people complain about pinning them on because it rips the clothes. These days, you can get them magnetized where there's a magnet attached to the name tag and then another little bar magnet that comes apart, and you put the badge on the outside of the tunic and the other little bar behind it. As long as your staff member doesn't have a pacemaker, it works pretty well.

The fact that they don't have a name tag on is not an excuse. Here's what a practice in Santa Barbara did. She put this in the break room. It said, "If you do not wear your name tag, I will give you a name tag to wear," and she would put on this, "Hi, my name is," and she'd put their name on it and make them wear it all day. If they forgot it again, she made them go home and get their name tag and docked them for the time they weren't at work.

A name tag is very important. It helps to make the connection, and making that connection is very important.

Let's look at the next one, professional appearance. No cleavage, please. Tattoos, I don't want to get into. People have more tattoos now. Eventually everybody will have tattoos.

When people say, "We need to verify, are you still living at the same address," a lot of patients get very frustrated because they feel that they have been asked that question over and over again, and they haven't moved in 30 years. One practice I was at has a sign that says, "We ask because we care, and we are interested in making certain that we can contact you if at any time we need to."

Then of course, the welcome comment. The welcome comment is nothing more than, "Good morning. May I help you?" It's unfortunate that they don't always do that.

What about late arrivals? Doctors and staff complain about late arrivals. The first thing you have to recognize is that it could be that the doctor has trained the patients to be late. If you know that every time you show up for your 3:00 appointment and you don't get seen until 3:45, you come in at 3:30 thinking that you're 15 minutes early.

The better thing to do is if you have a doctor who wants patients to show up on time, you should insist that the doctor be on time as frequently as possible. There are other things that go into that as well.

What is the patient thinking when they first arrive? How do you make the patient feel special? When I was in Washington, a practice had this on the chart for every patient. This was in the days of paper charts. It doesn't have to necessarily be a paperclip. It could be nothing more than stamping "New Patient" on any materials that the back office gets when they come out to get the patient.

The individual should say, "Oh, Mrs. Johnson, I see you're a new patient. Welcome to Eastside Cardiology." When they did that for me, I felt special. I felt as if they were making special arrangements for me, that somehow they were taking extra special care because I was a new patient. Heaven knows, that's when a patient is establishing a long-lasting impression.

On the other hand, what do you do when you have a late patient? Do you just automatically work them in? One practice in Long Beach said, "We'll check you in and see you when we can, but other people showed up on time, so we can't just automatically put you in. We'll see you when we can, but everybody else will come ahead of you."

Typically people say, "I see you're late. I don't know if we'll be able to see you. I'll have to ask the doctor. Do you want to reschedule?" That's the key. Do you want to reschedule?

Strategies – Rooming

Here are some other thoughts on rooming. We've talked already about some of these things, the nurse beckoning the patient instead of standing in the corner, going out to the patient and using that Post-it strategy to identify who it is.

The nurse should introduce herself. Many don't. Many simply say, "Hi. How are you today?" But they don't say, "My name is Nancy, and I'm Dr. Ford's nurse." There should be a social comment.

Towards the end of last summer, I was a mystery patient at a urology practice. The lady called me. I got to the doorway, and the first thing she said to me was, "What's your date of birth?" I thought, "Wait a minute. I'm out here in front of God and everybody, and I'm sensitive about my age." I thought, "Wow, why is she asking me this?" With a name like Meryl Luallin, it's not like there are three Jane Smiths coming up at the same time. So I thought that it was kind of awkward for her to ask me that instead of waiting until we get into the room.

Then, as we're walking down the hall, she turns to me and says, "Here, can you give me a sample?" before we're even in the room. I thought, "That's kind of embarrassing."

So again, what about just, "Hi. How are you today? Thanks for choosing our practice." Or if it's an established patient, "How was the traffic out there?" That's California. In the Midwest, it's, "How's the weather out there?" Something that says that you're connecting with me.

I was at a practice where the young woman called me by name, first name and last name, and then said to me, "Oh, I see you're a new patient." As we walked down to the room, she said, "Let me tell you about our services." She gave me chapter and verse on all of the services that were offered, and then when we got into the room, I sat down and she gave me the doctor's card. She said, "By the way, if you ever have any questions at all, please give me a call. I'm Laura F. There are two Laura's here. Here's my extension."

I thought that was really classy. When Dr. Hendrick came in, he said, "Oh, I see you've met Laura. She's a member of my care team. If you ever try to reach me and I'm not available, Laura will be returning the call." I thought to myself, "That's classy. That's really classy."

When you're rooming a patient, don't ever say to an individual, "The doctor will be in shortly." "Shortly" to a patient means five minutes. "Shortly" to a doctor means same day. So again, say, "The doctor will be in as soon as possible," or better yet, "The doctor has one patient ahead of you. He'll be here as soon as he can. Is there anything else I can do to make you comfortable?"

Chart rack timers are a little bit of a stretch, but if you've got a patient in the room, you should knock every 10 or 15 minutes saying, "Dr. Jones asked me to let you know we haven't forgotten you." That way the patient doesn't feel as if they've been abandoned.

Now let's talk about the doc. We talked about knocking ahead of time. Enter with a pleasant look. The last thing you want is to see your doctor coming in looking a little beleaguered like this or as if he's having a bad day. It's much better to have the doc come in looking like this.

Strategies – Provider

With regard to provider strategies, handshake, touch, and social comment. The thing to do for physicians of course is to have a way that they can write in either the social field on an electronic record or if you're still on paper charts something about what the patient's interests are or where they work so you can ask them.

A professional appearance with a white lab coat. Studies show that patients prefer to see their doctors wearing white.

Remember I said to you earlier the most important thing is for patients to believe you like them? How does that come across? How do you know when a patient likes you? Well, when they seem to share your pain.

If I come in and say, "Oh my gosh, I was up all last night. My baby was tugging his ear. I'm just exhausted." Instead of saying, "When did the baby start pulling his ear?" It's better to say, "I'm sorry to hear that. You must be exhausted."

If I say, "My shoulder hurts so much. I can't reach up to the third shelf," instead of saying, "Well, put the bowl on the lower shelf," say, "Oh, that's got to be frustrating."

Here are some phrases that let the patient know you really care. I'm not going to tell you, you have to go over the line. The next slide is a bit of a stretch. "I think you'll find I'm one of the most empathetic doctors around." I'll let you take a look at that.

You don't have to be that empathetic if you're a physician or an office manager, but at least sharing the patient's pain to some extent makes a difference.

How do you stay on time? As any patient can tell you, it's rare that you get in to see the doctor exactly at the time that the appointment is for. Most physicians are very frustrated when they will have a patient come in and they'll say, "How can I help?" and the patient says, "Well, I've had this pain in my elbow." The doctor then goes through the whole thing about what the pain in the elbow could be, and as the doctor is walking towards the door, the patient says, "Oh, by the way, I also have this horrible cough, and sometimes I even cough up blood." That is a real frustration to a doctor.

What some physicians have done, which I thought was very clever, was to have what they call a patient agenda. You can see one on the next page. It's a way of giving good instructions as well. The Cardiovascular Group in Georgia, when patients would arrive, they would ask the patient to jot down the two things that were most important in terms of time spent with the doc. What do they want to talk about? That helps the patient to focus on what they're going to use the time of the doctor for. I've seen a variety of things like that.

We talked very briefly about clear instructions. On the next page, this is one that was given out. Granted, these days most electronic records have a post-visit summary that you give to the patient. This is one that could be used and was used by a cardiologist, where you added the following meds and then stopped taking the following meds, and just wrote it down quickly for the patient. Then here are the tests to take for the next visit. All of this was used for the patient to have a good sense of what was expected.

Let's see if there's any other questions regarding the provider, and then we'll complete the end of the webinar.

Steve: As a reminder, if you'd like to ask a question, please press *6 on your phone at this time. We are in question mode. We invite your questions.

Regina, do we have some at info@healthcents?

Mental and Behavioral Health Surveys Question

Regina: I do, actually. I have one that says, "Do you use the same surveys with mental and behavioral health as with primary medical providers, and if not, how would you adjust it?"

Meryl: All of the questions that are on the survey are essentially the same. They ask about the ease of making the appointment, the consideration and care and courtesy of the staff, billing, the doctor's willingness to listen and all of that. So essentially we do, but it's typically a shorter survey. We don't ask quite as many questions.

Steve: Any other questions, please press *6 on your phone and ask your question at this time. We invite the audience to participate.

Meryl: While people are listening, I haven't been a mystery patient more than a couple of times in a behavioral health environment. It's interesting, behavioral health folks generally have never asked for mystery patient visits, but that may be changing given the changing value-based reimbursement and the measurement of PQRS, etc.

Improved Customer Service Correlation to Improved Revenue Question

Steve: Meryl, towards that end, we've talked quite a bit about the importance of really being tuned in to the patient's needs, and really respecting the patient largely is what we've talked about. One of the questions that I would have, and you've kind of connected the dots here, is as we've seen reimbursement move toward a value-based reimbursement, one of the areas that practices of all types are interested to know is if they improve their customer service, how does that equate to improving the revenue and profitability of their practice? Can you talk to that a little bit?

Meryl: Oh, absolutely. Whether anybody ever thinks that the Affordable Care Act is going to go away or not, the whole idea of improving outcomes is based on good communication from the provider, good communication and good transitions of care, which is also based on communication. If you want to improve patient outcomes, be certain the patient understands the treatment plan and is motivated by the doctor and others to follow and adhere. If you have good outcomes, that equates with better reimbursements, obviously.

Good communication is based on physicians connecting well with the patient and the patient wanting to please the doctor. If the patient follows the doctor's instructions and the instructions are clear and there's good follow-up and there's a good connection, then not only will there be better outcomes, but the cost to the government and to the insurance companies will be lower. Not that we're trying to save money for the insurance companies, but eventually, less utilization will mean the premiums will slow in their increases.

So the whole thing is based on patients understanding what's expected and how to accomplish what's expected. That's doctor communication and staff communication.

Steve: Thank you, Meryl. I would also reinforce that from working in the payer contracting field, today as much as 5% of the reimbursement of many payer contracts is associated with bonus pools that are being put in place both by Medicare as well as by commercial payers. These bonus pools typically do reward scores and outcomes on customer surveys, so without a doubt, there is that correlation. All the techniques that you're providing, all the guidance and the excellent advice that you're providing here to the practices, in fact can hit the pocketbook.

Physician Shadow Coaching

Meryl: Something else that we are being asked for a lot because we do it is physician shadow coaching. There are many physicians who think they're doing a great job, but their scores are very low. So we'll actually go around with the doctor, with permission from the patient, and observe and give the doctor feedback on the specific techniques they can use to enhance that patient interaction.

Let's go back to the last couple of slides here, Steve.

Steve: Okay.

Strategies - Provider Ending Visit

Meryl: The last strategy is how the doctor ends the visit. There are a whole lot of things that the doc does or should do to wind up the encounter, but certainly asking, "Did you get all of your questions answered?" is an easy way to do it. A better way is to say, "What other questions do you have for me?" That way, it sounds as if you're encouraging the patient.

Strategies - Provider Fee Ticket

Then with regard to the fee ticket, first of all, as a mystery patient, I always have to pay cash because I'm typically out of the area and therefore out of network, etc. The person who's registering me on the phone usually tells me that there is a fee that will be collected up front, and she usually – or should, anyway – tell me how much it's going to be.

So when I walk in and register, two different things happen. One, they'll either take my credit card and bill me up front for the deposit and then readjust it on the way out, or in one place, they actually just held my credit card. Two or three places held my credit card at the front desk until I departed, which is very clever because it makes certain that I actually do pay the bill.

The other thing is if you're not going to do it that way, if you don't collect up front, which I urge you to do – it's not uncommon, and it doesn't turn the patient off, or if it does, I wouldn't worry about it if the patient knows ahead of time that's what your expectation is – the other is a bright color on the fee ticket, something that you hand to the patient that tells the patient to check out, just don't walk out. And when that patient is walking by with the bright pink sheet attached to the fee ticket, then the check-out person can see that as she walks out. It also reminds the doctor to walk the patient out to the counter.

Complaints

Steve, I will leave you five minutes. I have one minute left to talk quickly about the complaints. Complaints are a result of one thing and one thing only — unmet expectations.

If a patient expects to be seen at 3:00 and the doctor doesn't show up until 3:05, she might complain because she'll expect the doc to be seen at 3:00. I know that sounds as if it's a bit of an exaggeration, but think about it. Anytime you don't get what you expect, you're set back and you could complain.

So how do you handle a complaint? Here is an acronym. This is part of the workshop that we typically use with staff members. It's HEART. The H stands for Hear them out. You let the patient vent and get the story said. The E is Empathize. Put yourself in the other person's place and think through what they expected. If they expected to have a parking place easy and convenient and it wasn't, if you expected that, you might complain as well. The A is Acknowledge. I can understand why you'd be upset, because truly, if you're empathetic, you do understand where they're coming from.

The R stands for Review. Review the details and offer alternatives. If they wanted to be seen at 3:00 and the doctor's running late, tell them, "Next time, maybe we could schedule you for the first appointment of the day. The doctor is more likely to be on time at that hour."

The T is to Take responsibility or tell them what you can do. Take responsibility for fixing it if it's fixable, or tell them what you can do if you have to offer an alternative.

Having said that, I just wanted to say thank you all very much for your attention. You see my email address. If some of you have questions and you didn't want to share out loud, please give me an email. Let me know what you thought of the webinar, or I'll be happy to answer questions.

Steve, it's your turn. Thank you so much for this great opportunity.

Steve: Yes, and thank you, Meryl, for all of the information and guidance that you've provided to our practices today. I think you have truly given them a road map for how to provide effective customer service. I think regardless of the scenario that a practice is currently in from a customer service perspective, there are points and practical tips that you've provided that they can put to use immediately.

So thank you again for sharing your expertise with the group today.

Also, a big thank you to the participants. Quill Healthcare is continuing to offer special discounts to those that participate in these webinars. In fact, right on this particular page, we list the discount where you get $15 off when you spend $75 or more on healthcare supplies, or $30 off when you spend $150 or more. Simply go to www.quill.com/medicalsupplies to redeem this offer.

As far as follow-up, at any time, you can contact our Quill Healthcare direct line at 1-800-789-1186. You can send an email to the same email ID that we encouraged questions. That's info@healthcents.com. You'll reach either myself or my partner, Susan, and we also will pass anything over to Meryl that's directly related to mystery patient or customer surveys. To reach Regina as well, please use that email ID.

If you would like a copy of the charts, at any time, please send an email to the email ID charts@healthcents.com and you'll be immediately returned information about how to immediately access a PDF copy of the charts.

Also, we would really appreciate it if you would take a moment and provide some quick feedback about this session and also any ideas that you might have or topics that you might have that you would derive value from in future sessions. All you need to do is go to healthcents.com/survey. We'd appreciate on your way out if you would do that this afternoon, that would be terrific. It always helps us to even further hone the value of these surveys. One of the key goals of Quill Healthcare is to lend expertise to practices of all types, and these kinds of quick surveys, which I promise you will only take two minutes or less, really help us to continue to hone the value of these kinds of sessions.

I want to thank Meryl once again for her participation as our distinguished guest speaker, and I want to thank all of the participants who are attending. This concludes our session about mystery patients. I wish all of you a happy new year and success in 2015. Thank you for attending. Bye.

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