Wednesday, January 7, 2009

Paying for Patient Telephone Calls

For years, BIDMC has required patients to pay for toll calls. Local calling was made free to them over a decade ago. Periodically, I receive complaints from patients about having to use telephone debit cards, credit cards or collect calling to reach parties in Massachusetts area codes. Today, we use a hospitality service to handle outgoing toll calls from patient rooms. When a patient calls a toll number (9-0-xxx-xxx-xxxx), the hospitality service handles the billing. Their charges for this service tend to be high, e.g. several dollars per toll call regardless of duration.

With the rates for in-State toll calls at only twice that of local calls, we have elected to pilot free calling to all Massachusetts area codes from a limited number of patient room phones. Once fully implemented, there are 360 patient room phones that could have free in-State calling.

It is difficult to estimate what may be the financial impact of this action. We asked the hospitality service how many calls were made to in-State area codes that involve toll charges. They show only 70 calls. The use of the service, however, is likely impacted by their high charges and the complexity of making an outgoing toll call. Also, many friends and relatives call patients which incur no charge since they originate outside the hospital. Similarly, many patients use cell phones for out-dialing.

To gauge what may be the calling activity for other MA areas, we looked at call activity occurring to the existing "local" calling area today from the patient room phones that would be impacted. Today, patients can call toll free to 617/857 and parts of 781/339. During the month of November, there were 12,593 calls totaling 35,672 minutes.

We estimate that 80 percent of non-critical care days are for patients residing in the current local calling area. The other areas in Massachusetts represent only 12 percent of non-critical care days. Although this represents residence zip codes of the patients and not zip codes of friends/relatives they would call in Massachusetts, I believe it provides some assurance the extended in-State calling will not be high volume or high cost. Many patients use personal cell phones and will likely continue to do so.

I'll report back on the cost of our pilot and the impact on patient satisfaction. I am curious - what are other hospitals doing? Feel free to post a comment with your hospital's approach to patient toll calls.


ukdataguy said...

We have seen that if you allow it, the majority of patients and visitors to a facility would rather use their cell phone than a land line to make calls, including all long distance calls. They clearly get a better rate than the "hospitality" services offer and, in most cases their cell phones are also their mobile telephone directory so it just easier to do.
I'm starting to think that the only reason to have in-room phones is for in bound calls and I would rather spend resources beefing up the quality of cell phone signals, using technologies such as femtocell, than to spend time and money managing a third party vendor that these days is offering in service that is decresing in popularity and usage.

Nick Dawson said...

I am curious if you have considered some implementation of VoIP? Even at the large-scale commercial level there are providers with packages that include free domestic long distance or at least per minute rates that are minuscule. If you had to move the cost to the patient account, I would think having a software based telephony system would make doing so easier. That said, I am sure there are administrative and capital costs associated ...
Like UKdataguy we are allowing patients who wish to do so to use their personal cell phone - not sure what the impact to our telephony system has been. We do not bill for in-room phones, although I am unclear how much of a financial impact (if any) that is.

Larry said...

While I'm sure you could get a rate for all domestic US calls for under a penny a minute to provide to patients, the VOIP upgrade requires new hardware and maybe a new network. Then benefits for patients are limited because they'll use cellphones, but for the staff are great. Several dollars per toll call seems almost extortionate, especially for patients.

There are even ways out of the Cisco tax by using less-expensive IP phones from Aastra or Polycom, and Asterisk or Freeswitch. There are almost as many distributions of Asterisk as there are Linux now. Even integrating billing by internal extension is possible, since all the data lives in MySQL.

Another option would be to hook up a virtual VOIP PRI to your existing phone switch to get the cheap rates without the new network or phones.

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