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What's with all the preappointment phone calls from the doctor's office?

The first call came five days before the doctor’s visit. On Christmas Eve, a human voice kindly offered to preregister me for my December 29 appointment at Given Health Care in Essex. She had some questions: Date of birth? Emergency contacts? Employer? Insurance? Co-pay? Is she just going to take my word for it? I wondered. Isn’t all this info in my fancy new electronic health care record?

The day after Christmas, a Saturday, there was a voicemail from Colorado: A robot had called to remind “Paula” about the same December 29 appointment. Three days later, I showed up at the doc’s only to find the “check-in” and “check-out” procedures were still in place. If anything, there were more people in the office, not fewer, and they all seemed to want to know when I was born and whether I had a co-pay.

A few days after the appointment, another robo call came: “According to our records, it’s time for ‘Paula’ to schedule an appointment with ‘Dr. Levine,’” the automated voice said, mispronouncing my physician’s name. “If you have already scheduled this appointment, please disregard this reminder.”

I did, happily, but not without pondering: What’s with all the phone calls? Aren’t we supposed to be cutting health care costs? Is it really necessary to remind a patient multiple times about a hard-to-get appointment he or she is not likely to forget?

The flurry of phone calls is reducing costs, according to Lisa Goodrich, vice president of faculty practice operations at Fletcher Allen Health Care in Burlington. Every no-show is a “lost revenue opportunity,” she notes. And since the automated “Televox” message system was implemented in the summer of 2005, the number of patients who blow off their appointments has dropped 10 percent, to 6.5 percent.

There have been “staff savings,” too. “Three full-time equivalents,” Goodrich explains, or roughly $150,000 a year. Appointment-reminder postcards, and their associated mailing costs, have been largely eliminated.

The hospital has had some complaints, Goodrich admits. “The most commonplace is: ‘I got two phone calls for the same visit. Why?’ The answer is pretty straightforward: There is no way to predict if we are going to call you for preregistration, or get ahold of you. Making sure you are aware of the visit is what the Televox call is for.”

Except where an automated message might compromise a patient’s privacy — when it comes from infectious diseases, oncology or psychiatric departments, to name a few — the system has been adopted by every one of Fletcher Allen’s 45 clinical sites as well as the hospital’s 100 outreach locations throughout Vermont and New York.

In fact, Fletcher Allen’s entire notification process, including the preregistration part, has been shaped by concerns about “patient confidentiality.” Hospital officials determined some time ago that the old check-in system was too public. Sharing sensitive personal information in close proximity to other people could have adverse effects, from simple embarrassment to identity theft.

So, when the hospital expanded in 2005, “we moved everything to the phone,” says Shannon Lonergan, director of registration. She oversees 40 employees working two shifts in a call center located in South Burlington’s Tech Park.

Currently, about 25 percent of FAHC’s 70,000 monthly patients seeking physician appointments receive a preregistration call prior to an appointment.

The other 75 percent are repeat customers. “Your data is effective for 90 days,” Lonergan explains. “We don’t have to reverify demographic information every time the patient has an appointment.”

Unless, that is, he or she is on Medicare — in which case the federal government requires the hospital to ask nine standard questions every time the patient receives any form of care.

Confused yet? Fletcher Allen may soon expand its preregistration “threshold” from 90 days to 120, meaning you’d only get that call if more than four months had passed since your last appointment. Lonergan says it would be “a major step toward reducing administrative costs.”

But folks who rarely visit the doctor, like me, can still expect to hear from Fletcher Allen every time. It’s best to call back the preregistration people before you show up. A few years ago, I made the mistake of thinking I could take care of it at the doctor’s office. When I got there, someone handed me a portable phone, led me into a private exam room and gave me a number to call. No one would touch me until I got through to the call center.

The digital conversion of health records isn’t likely to change this process — not for a while, anyway. For those who choose online registration, when it becomes available, the info they supply won’t necessarily save steps or eliminate the phone call. Call-center workers will load the DIY data from the new system into the old system and contact the patient only “if there are issues,” says FAHC spokesman Michael Carrese.

And if the “issue” happens to be an aversion to automated phone calls, well, there’s not much the medical establishment can do. Looks like it’s going to be a while before our health care system comes up with a prescription for real and lasting efficiency.

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