The staff will be doing the footwork of signing up patients, so they need to be as dedicated as you are.
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Editor’s note: This is the second installment of a two-part series showing how a busy office-based practice can incorporate patient advocacy into its standard workflow. In Part 1, we looked at the reasons for incorporating patient advocacy into your practice and offered an outline for implementing it. Part 2 amplifies the concepts explored in Part 1 and offers additional tips to improve your success.
Many patients feel they lack an effective mechanism for expressing their concerns and don’t feel they have a voice in the policy decisions that affect their health. That’s where patient advocacy can—and should—meet your rheumatology practice.
Start Small
Implementing a patient advocacy program doesn’t have to disrupt your office procedures—at least not much. Here are several tips for making the process run smoothly in your office:
- Do your homework—again. It’s important to check your particular state laws and regulations. We thought the Insurance Commissioner answered patient complaints, but in our state, the Attorney General is a better avenue. Your state may be different, so you need to know where patients should call when they have complaints. Resources for this information are your State Medical Society or Medical Board.
- Involve the staff as activists. Schedule time with your staff to explain the importance of patient advocacy. Validate the staff’s importance in the advocacy process as part of the patient care team. The staff will be doing the footwork of peddling the advocacy program and signing up patients, so they really need to be as dedicated as you are. We recommend you emphasize some or all of these important considerations:
- Your staff is part of the arthritis care team, with the new ability to help patients—even outside the clinic—by having the patients become advocates.
- Insurance and government policies affect your practice income and overhead and, therefore, directly affect your staff. It’s in their personal interest to mobilize patients to fight payment cuts and additional burdensome regulations that magnify overhead. Who knows? They could be working toward their end-of-year bonus.
- This process is not a big burden in time or resources; it takes only a few minutes per patient. Emphasize that small investments of time now may result in big benefits later, when patients are signed up and fight against the cuts slated for your services or the additional administrative burdens that threaten your practice.
- Navigate through the websites you will use, and show staff how to enter data quickly and efficiently. Suggest staff leave website registration pages open as tabs in their Web browser so they can quickly access them.
- Realize the importance of redundancy. We are all human, so mistakes are made. At the time of screening, have the staff ask if the patient got a copy of the letters. If a patient didn’t get papers at check-in, give them copies where they are worked up or in the exam room. Ensure they receive a paper before leaving. Be sure they are given the opportunity to sign up several times before leaving your office, but don’t be obnoxious or heavy-handed.
- Tag the patient’s chart for advocacy identification when they are signed up, or otherwise identify them as an advocate. This identifies players on your advocacy team and offers a chance for follow-up conversations. Your staff can ask patients who sign up if they have any specific items of interest that they have seen on advocacy websites. For patients who haven’t signed up, you can make a second offer to help. Again, it’s important to offer an opportunity and not to demand that patients get involved.
- Recognize that not all patients are “wired.” We practice in a mixed environment of technology and rural agriculture. I was surprised to find that 40% of my patients have no e-mail address. Providing a handout with postal addresses and phone numbers accomplishes two important goals: First, it offers a means for advocates who prefer to write letters rather than send e-mails. Second, it means that no patient feels left out, and everyone can have a sense of solidarity. I think this esprit de corps is important.
Go Big
Once you see how well the process can work, you may decide to expand your advocacy message into different parts of your practice.
Put advocacy links on your website in prominent places. As soon as we started enrolling patients, I got permission from the ACR Simple Tasks Campaign to post a link on my website. At least one of my rheumatology colleagues in Birmingham, Ala., has added advocacy links to that practice’s website, too. Make it easy for patients to find the resources they need. Also, consider posting a link to the Simple Tasks Twitter feed.
Run Simple Tasks videos in your waiting room. These videos are available on YouTube. One practice manager got a DVD from the ACR with all the Simple Task videos, and she had her waiting room TV vendor run these along with the vendor’s content. This sort of activist information helps generate conversations and questions that spur patients to become involved.
Use Simple Tasks pins. We ordered these lapel pins for everyone on staff to wear. The pins are somewhat pricey, but we also plan to give them as premiums to patients who can show us evidence of their advocacy (e.g., copy of a letter or e-mail) so they can have the equivalent of a medal for their valor in advocacy.
Identify patients who have connections, and put them to work. This didn’t really occur to me until I realized that one of my patients was once a political lobbyist and knows more mayors, state legislators and county commissioners than I could ever imagine. As one might imagine, this person has become one of our key players. Look in your practice for clergy, board members and other networked individuals who can extend advocacy for arthritis to areas beyond just your clinic patients. Be sure to specially identify these individuals, and take just an extra minute or two during their clinic visits to discuss advocacy.
Consider putting promotional messages on your phone answering device. Almost every practice I call today has some sort of promotional or instructional message that plays while the caller is on hold. Why not include advocacy messages here? It may take a little extra work to update the messages, but the subliminal impact of this technique is powerful.
Make a patient resource handout with contacts for many different advocacy groups and foundations (e.g., Lupus, Scleroderma, Sjögren’s Syndrome). You can also put links to these organizations on your website, but consider creating an advocacy page on your site if you plan to have more than just a few links; that avoids visual clutter on your website.
Place a sign next to your checkout area to reinforce your message. Include contacts and phone numbers for members of Congress, contacts for insurance disputes and important advocacy groups, such as the Arthritis Foundation and Simple Tasks Campaign. Consider posting an “Advocacy Issue of the Month” on the sign or board to focus on for patient efforts.
Place advocacy forms on your patient portal. Do you have downloadable patient history, insurance, HIPAA policy and other administrative forms available on your practice portal? Consider adding advocacy forms, drafts of letters for patients to send about important issues, etc. This will take extra time to keep current, but if you make it easy for patients to advocate (e.g., by copying your draft letter) then more patients will participate.
If you are really enthusiastic, consider creating a blog, electronic newsletter or e-mail alerts. Your information technology consultant can help set up relatively inexpensive programs that all but automate the process for doing this. The easiest way to do this is to tie it to your website or portal.
Keep the Ball Rolling
After you set the wheels in motion, step back and watch the advocacy machine roll, but only for a week or two. Grassroots advocacy requires continuous energy to be successful. We found that reinforcing the advocacy message at every staff meeting prevents the program from becoming mundane and infuses fresh enthusiasm into the staff.
When patients return for a visit after signing up to become advocates, ask what they feel is the most important current issue for them. This concurrently reinforces to them your opinion that their advocacy is important and valuable, and also gives you a feel for the issues that are important your patients.
Also, schedule time to periodically assess your process and efforts. Change messages on your phones or websites, post current issues on your advocacy sign, and revise your handouts; avoid giving patients a feeling that this advocacy stuff has gone stale. Avoid spending energy on portions of your program that seem to offer little in return.
Colleagues, we all intuitively understand the value and importance of advocacy. In these uncertain times, it’s more important than ever to generate a strong and united voice to keep bureaucracy from overwhelming our ability to help our patients. Enrolling patients and helping them advocate should be a critical part of our duty as rheumatologists. Don’t delay, begin today!
Christopher D. Adams is chief of rheumatology for the East Alabama Rheumatology Center in Auburn/Opelika. His experience includes military medical practice, health delivery logistics and planning for the military, clinical faculty at several medical schools, conducting clinical research and serving as a liaison for dialogues between the Alabama Society for the Rheumatic Diseases and managed care, as well as government entities.
Note: The opinions expressed are the author’s and don’t necessarily reflect the official views of the ACR.
