2011 AFMC 24/7 Survey Results

2011 AFMC 24/7 Survey Results 2ND QUARTER, 2011 SURVEY PERIOD: MAY 2011

Table of Contents Executive Summary... 3 Survey Methodology... 5 Demographics of Survey Sample and Respondents... 7 Flow Diagram of Live Voice Calculation... 9 Providers Responses by Current Medicaid Caseload...11 Providers Responses by Geographic Region...15 Verification of Survey Responses...19 Recommendations...21 Appendix A: Survey Tool... 23 Appendix B: County-Level Map... 25 Appendix C: Frequency and Verification Tables...27 ARKANSAS FOUNDATION FOR MEDICAL CARE 2011 AFMC 24/7 SURVEY REPORT 1

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Executive Summary The Arkansas Foundation for Medical Care (AFMC) surveyed all Arkansas Medicaid primary-care physicians with a caseload of 100 or more Medicaid beneficiaries (N=801) to determine what happens when a patient calls their clinic after normal business hours. Please refer to Appendix A for the survey tool. After conducting a phone-only survey administration, AFMC received 456 completed surveys from providers in May 2011, resulting in a response rate of 66.09%. Two hundred thirty-four (33.9%) of the providers declined to answer the survey. This report provides a summary of the overall survey results and compares the survey results by current Medicaid caseload and geographic region. This comprehensive analysis will assist DMS to determine how often patients are able to speak with someone when they call a clinic after normal business hours. KEY FINDINGS n Overall, 55 percent of providers provide an after-hour call system where their patients are able to speak with a live person who include clinic personnel, the on-call physician, an answering service, a clinical triage system or the hospital staff. Please see Appendix B for this calculation of live responses and the county level map in Appendix C. n At least six in 10 providers have their office phone number listed on a website or the Internet. n Approximately half of providers include a call event in the patient s medical record. n Approximately half of providers provide an answering machine where patients leave messages for after-hour calls. When a patient reaches an answering machine, seven in 10 providers instruct patients to leave a message and go to the ER in case of an emergency, while almost three in 10 providers instruct patients to contact an answering service. n At least one in three providers uses an answering service. When a patient reaches an answering service, at least half of the providers page an on-call professional who responds within 20 minutes. n Less than 12 percent of providers use a clinical triage service like a nurse hotline to answer after-hour calls. When a patient reaches a clinical triage service, they are most likely to have a licensed professional review the clinical problem, offer treatment advice and contact office staff for serious problems. ARKANSAS FOUNDATION FOR MEDICAL CARE 2011 AFMC 24/7 SURVEY REPORT 3

n Less than 3 percent of providers provide direct contact with an on-call physician. n Out of the 93 phone calls that were made for verification, 69 (74.19%) providers after-hour system matched their survey responses. Twenty-four (25.81%) providers after-hour systems did not match their survey responses. n AFMC also called providers who did not complete the survey to determine if their after-hour calls system differed from providers who completed the survey. For the providers who answered the initial phone call but did not complete the survey, this group of providers had a significantly higher percent of answering machines compared to providers who completed the survey. They also had a significantly lower percent of answering services for after-hour calls compared to providers who completed the survey. All answering services from both verification groups stated that the practice responds within 20 minutes and they will send a log of all calls to the practice if requested. 4 ARKANSAS FOUNDATION FOR MEDICAL CARE 2011 AFMC 24/7 SURVEY REPORT

Survey Methodology This report summarizes results derived from the 24-7 Survey, which consists of 13 questions. Please refer to Appendix A for the survey tool. The survey contains four dichotomous questions scaled as Yes/No, two open-ended questions and two nominal questions to select only one response option. Additionally, there are five multiple-answer questions where the respondent should select all responses that apply to them. For the Yes/No and select only one response questions, results are presented as percents and sum to 100 percent. For the check all that apply questions, results are presented as utilization rates because the respondent could select multiple answers. AFMC pulled a list of primary-care providers that had a caseload of 100 or more Medicaid beneficiaries. Some providers share the same phone number. The assumption was made that the phone numbers dialed would have the same type of answering service for all providers with the same phone number. Therefore, the responses were multiplied by the number of providers at the clinic. The outreach team called each clinic asking them to participate in the survey, which would only take a few minutes of their time. Only the first eight questions were asked for these providers. Calls were made the week of May 16 through May 20. Phone calls where the phone number was disconnected, a wrong number or the office was closed were considered non-answered calls. Out of 801 phone calls, 690 clinics answered their phone and 456 clinics completed the survey. SURVEY 2011 Survey sample size 801 Total clinics answered phone 690 Phone answer rate 86.14% Total clinics complete survey 456 Completion rate 66.09% During the week of June 6, AFMC selected a random sample of 20 percent of the 456 clinics that completed surveys. AFMC staff called these clinics after normal business hours to verify whether their responses were accurate in the survey and to determine what happens when a patient calls the clinic after hours. Questions 9 through 13 on the survey tool were completed for the 20 percent randomly selected numbers. This verification analysis can be found on page 17. ARKANSAS FOUNDATION FOR MEDICAL CARE 2011 AFMC 24/7 SURVEY REPORT 5

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Demographics of Survey Sample and Respondents AFMC compared the survey sample to the providers that responded to the survey. The table below shows the percentage of respondents by demographic category: geographic region and current Medicaid caseload. DEMOGRAPHIC CATEGORY SAMPLE RESPONDENTS Region Central 20.60% 16.45% Northeast 21.60% 21.71% Northwest 34.46% 41.67% Southeast 11.74% 9.43% Southwest 9.99% 9.65% Out of State 1.62% 1.10% Current Caseload* Less than 200 25.09% 24.34% 200 to 349 24.09% 25.44% 350 to 649 24.47% 25.44% More than 650 26.34% 24.78% *Current Caseload as of April 14, 2011. The counties within Arkansas geographical regions are shown below. Northwest: Baxter, Benton, Boone, Carroll, Conway, Crawford, Franklin, Johnson, Logan, Madison, Marion, Newton, Pope, Scott, Searcy, Sebastian, Van Buren, Washington and Yell counties Northeast: Clay, Cleburne, Craighead, Crittenden, Cross, Fulton, Greene, Independence, Izard, Jackson, Lawrence, Mississippi, Poinsett, Randolph, Sharp, Stone, White and Woodruff counties Central: Faulkner, Garland, Grant, Lonoke, Perry, Pulaski and Saline counties Southwest: Calhoun, Clark, Columbia, Dallas, Hempstead, Hot Spring, Howard, Lafayette, Little River, Miller, Montgomery, Nevada, Ouachita, Pike, Polk, Sevier and Union counties Southeast: Arkansas, Ashley, Bradley, Chicot, Cleveland, Desha, Drew, Jefferson, Lee, Lincoln, Monroe, Phillips, Prairie and St. Francis counties ARKANSAS FOUNDATION FOR MEDICAL CARE 2011 AFMC 24/7 SURVEY REPORT 7

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Flow Diagram of Live Voice Calculation The following flow diagram illustrates the methods by which responses to calls were calculated based on the survey tool found in Appendix A. ALL RESPONDING PROVIDERS n=456 No Live Voice n=204 Live Voice n=252 Q4=Five or more than one response n=18 Q5 does not contain B n=149 Q6 does not contain B or C n=37 Q5 contains B n=62 Q6 contains B or C n=128 Q7 contains A-F n=52 Q8 contains A-D n=10 ARKANSAS FOUNDATION FOR MEDICAL CARE 2011 AFMC 24/7 SURVEY REPORT 9

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Providers Responses by Current* Medicaid Caseload Q2) Where is your office phone number listed? Check all that apply. Less than 200 n=111 200 to 349 n=116 350 to 649 n=116 650 and more n=113 All Respondents n=456 Phone book 99.10% 10 10 10 99.78% Website/Internet 65.77% 68.97% 68.97% 66.37% 67.54% Specific handouts with instructions for patients 72.07% 79.31% 87.07% 83.19% 80.48% Other 17.12% 23.28% 35.34% 28.32% 26.10% Almost all providers have their phone number listed in the phone book, at least six in 10 providers list their phone number on a website/internet, and at least seven in 10 providers give handouts to their patients with their phone number. Of the other areas where providers list their phone number, they also list their phone number on appointment cards, business cards, newspaper and any advertising materials. Q3) When a patient calls after hours, does the call event get included in the medical record? Less than 200 n=110 200 to 349 n=116 350 to 649 n=116 650 and more n=113 All Respondents n=453 Yes 44.55% 53.45% 43.97% 59.46% 50.33% No 55.45% 45.69% 53.45% 37.84% 48.12% Don t know 0.86% 2.59% 2.70% 1.55% Providers with less than 200 Medicaid beneficiaries on their caseload and providers with 350 to 649 Medicaid beneficiaries on their caseload are significantly less likely to place the call event in the patient s medical record compared to providers with 650 or more Medicaid beneficiaries on their caseload. *Current Caseload as of April 14, 2011. ARKANSAS FOUNDATION FOR MEDICAL CARE 2011 AFMC 24/7 SURVEY REPORT 11

Q4) What happens when patients call the office after hours? Answering machine where patients leave messages Less than 200 n=108 200 to 349 n=113 350 to 649 n=110 650 and more n=108 All Respondents n=439 55.56% 51.33% 41.82% 43.52% 48.06% Answering service 38.89% 38.05% 37.27% 36.11% 37.59% Clinical triage service (example: nurse hotline) Direct contact with on-call physician 2.78% 7.08% 2 17.59% 11.85% 2.78% 3.54% 2.78% 2.28% Other 0.91% 0.23% About half of providers provide an answering machine where patients leave messages for after-hour calls. At least one in three providers uses an answering service to answer calls after hours. Providers with 350 or more Medicaid beneficiaries on their caseload are more likely to use a clinical triage service compared to providers with less than 350 Medicaid beneficiaries on their caseload. Q5) What happens when a patient reaches the answering machine? Check all that apply. Leave message with office, instructed to go to ER if urgent Instructed to call another number to contact answering service Leave message to be monitored by clinic personnel every few hours Messages are reviewed in the morning. Less than 200 n=60 200 to 349 n=58 350 to 649 n=46 650 and more n=46 All Respondents n=210 9 68.97% 60.87% 71.74% 73.81% 25.00% 17.24% 36.96% 43.48% 29.52% 2.17% 0.48% 76.67% 77.59% 5 54.35% 66.19% Nine in 10 providers with less than 200 Medicaid beneficiaries on their caseload instruct patients to leave a message with the office answering machine or go to the ER if urgent. More than one-third of providers with at least 350 Medicaid beneficiaries on their caseload instruct patients to call another number to contact an answering service. Three in four providers with less than 350 Medicaid beneficiaries on their caseload review messages in the morning. 12 ARKANSAS FOUNDATION FOR MEDICAL CARE 2011 AFMC 24/7 SURVEY REPORT

Q6) What happens when a patient reaches an answering service? Check all that apply. Leaves messages with office in the morning, instructed to go to ER if urgent Page professional on call who responds within 20 minutes Less than 200 n=41 200 to 349 n=40 350 to 649 n=37 650 and more n=37 All Respondents n=155 26.83% 32.50% 21.62% 16.22% 24.52% 75.61% 52.50% 56.76% 56.76% 60.65% Other 21.95% 2 32.43% 37.84% 27.74% Three in four providers with less than 200 Medicaid beneficiaries on their caseload page a professional on call who responds within 20 minutes after a patient reaches an answering service. Q7) What happens when a patient reaches a triage service? Check all that apply. Licensed professional reviews clinical problem Licensed professional offers treatment advice Licensed professional prescribes medication Licensed professional contacts office staff for serious problem Licensed professional refers patients to ER without contacting office staff Less than 200 n=3 200 to 349 n=8 350 to 649 n=22 650 and more n=19 All Respondents n=52 66.67% 87.50% 10 89.47% 92.31% 66.67% 87.50% 10 73.68% 86.54% 9.09% 3.85% 66.67% 75.00% 90.91% 73.68% 80.77% 66.67% 37.50% 31.82% 10.53% 26.92% Other 33.33% 12.50% 4.55% 10.53% 9.62% Providers are most likely to have a licensed professional review the clinical problem, offer treatment advice and contact office staff for a serious problem and less likely to prescribe medication. ARKANSAS FOUNDATION FOR MEDICAL CARE 2011 AFMC 24/7 SURVEY REPORT 13

Q8) What happens if office staff answers after hour calls? Check all that apply. Each physician covers own patients every night/ weekend Practice personnel share calls Practice personnel share calls with other community practices Less than 200 n=3 200 to 349 n=4 350 to 649 n=0 650 and more n=3 All Respondents n=10 66.67% 2 33.33% 5 3 66.67% 25.00% 66.67% 5 Other 25.00% 33.33% 2 Due to small numbers, the results should be reviewed with caution. Only 10 providers responded that office staff answers after-hour calls. 14 ARKANSAS FOUNDATION FOR MEDICAL CARE 2011 AFMC 24/7 SURVEY REPORT

Providers Responses by Geographic Region Q2) Where is your office phone number listed? Check all that apply. Central n=75 Northeast n=99 Northwest n=190 Southeast n=43 Southwest n=44 All Respondents n=456 Phone book 10 10 99.47% 10 10 99.78% Website/Internet 81.33% 55.56% 72.63% 60.47% 52.27% 67.54% Specific handouts with instructions for patients 88.00% 75.76% 84.21% 69.77% 70.45% 80.48% Other 42.67% 26.26% 22.63% 16.28% 25.00% 26.10% Almost all providers list their office phone number in the phone book. Providers in the central and northwest regions are more likely to list their phone number on a website/internet. At least seven in 10 providers list their phone number in specific handouts with instructions for patients. Q3) When a patient calls after hours, does the call event get included in the medical record? Central n=73 Northeast n=99 Northwest n=189 Southeast n=43 Southwest n=44 All Respondents n=453 Yes 61.64% 45.45% 47.62% 41.86% 56.82% 50.33% No 31.51% 52.53% 52.38% 58.14% 43.18% 48.12% Don t know 6.85% 2.02% 1.55% More than half of the providers responding from the central and southwest regions indicate the call event gets included in the patient s medical record. ARKANSAS FOUNDATION FOR MEDICAL CARE 2011 AFMC 24/7 SURVEY REPORT 15

Q4) What happens when patients call the office after hours? Answering machine where patients leave messages Central n=70 Northeast n=96 Northwest n=183 Southeast n=42 Southwest n=43 All Respondents n=439 38.57% 5 48.63% 57.14% 53.49% 48.06% Answering service 24.29% 31.25% 44.26% 38.10% 37.21% 37.59% Clinical triage service (example: nurse hotline) Direct contact with on-call physician 37.14% 16.67% 4.92% 2.38% 11.85% 2.08% 1.64% 2.38% 9.30% 2.28% Other 0.55% 0.23% At least half of the providers in the northeast, southeast and southwest regions provide an answering machine where patients leave messages. Providers in the central region are more likely to use a clinical triage service when a patient calls the office after hours. Approximately 9 percent of clinics in the southwest region provide direct contact with an on-call physician when a patient calls the clinic after normal business hours. Q5) What happens when a patient reaches the answering machine? Leave message with office, instructed to go to ER if urgent Instructed to call another number to contact answering service Leave message to be monitored by clinic personnel every few hours Messages are reviewed in the morning Central n=27 Northeast n=48 Northwest n=89 Southeast n=23 Southwest n=23 All Respondents n=210 62.96% 87.50% 60.67% 86.96% 95.65% 73.81% 59.26% 16.67% 37.08% 13.04% 8.70% 29.52% 4.35% 0.48% 74.07% 70.83% 65.17% 60.87% 56.52% 66.19% Less than one in five providers in the northeast, southeast and southwest regions provide another number for patients to call when the patient reaches the answering machine compared to almost 60 percent of providers located in the central region. 16 ARKANSAS FOUNDATION FOR MEDICAL CARE 2011 AFMC 24/7 SURVEY REPORT

Q6) What happens when a patient reaches an answering service? Check all that apply. Leaves messages with office in the morning, instructed to go to ER if urgent Page professional on call who responds within 20 minutes Central n=16 Northeast n=29 Northwest n=80 Southeast n=16 Southwest n=9 All Respondents n=155 31.03% 32.50% 12.50% 11.11% 24.52% 75.00% 48.28% 53.75% 93.75% 55.56% 60.65% Other 31.25% 41.38% 28.75% 33.33% 27.74% At least three in four providers in the central and southeast regions page a professional on call who responds within 20 minutes when a patient reaches an answering service. Q7) What happens when a patient reaches a triage service? Check all that apply. Licensed professional reviews clinical problem Licensed professional offers treatment advice Licensed professional prescribes medication Licensed professional contacts office staff for serious problem Licensed professional refers patients to ER without contacting office staff Central n=26 Northeast n=16 Northwest n=9 Southeast n=1 Southwest n=0 All Respondents n=52 92.31% 93.75% 88.89% 10 92.31% 92.31% 75.00% 88.89% 10 86.54% 3.85% 6.25% 3.85% 88.46% 62.50% 88.89% 10 80.77% 30.77% 12.50% 33.33% 10 26.92% Other 7.69% 12.50% 11.11% 9.62% Providers in the southwest region do not use a triage service. Providers in the central, northeast, northwest and southeast regions are more likely to have a licensed professional review the clinical problem, offer treatment advice and contact office staff for serious problems when a patient reaches a triage service. ARKANSAS FOUNDATION FOR MEDICAL CARE 2011 AFMC 24/7 SURVEY REPORT 17

Q8) What happens if office staff answers after-hour calls? Check all that apply. Each physician covers own patients every night/ weekend Practice personnel share calls Practice personnel share calls with other community practices Central n=0 Northeast n=2 Northwest n=3 Southeast n=1 Southwest n=4 All Respondents n=10 10 2 10 3 10 75.00% 5 Other 10 25.00% 2 Only 10 providers responded that office staff answers after-hour calls. Due to small numbers, results should be reviewed with caution. 18 ARKANSAS FOUNDATION FOR MEDICAL CARE 2011 AFMC 24/7 SURVEY REPORT

Verification of Survey Responses During the week of June 6, 2011, AFMC randomly selected 20 percent of the providers that completed a survey to verify what happens when a client calls the clinic after normal business hours. Out of the 93 phone calls that were made for verification, 69 (74.19%) providers after-hour system matched their survey responses. Twenty-four (25.81%) providers after-hour system did not match their survey responses. When AFMC dialed the office phone number after normal business hours, 44 providers (47.31%) had an answering machine for the patient to leave a message or directed the patient to the ER or 911 in case of an emergency. Forty-six (49.46%) providers used an answering service to answer phone calls after normal business hours. Only one provider (1.08%) had a medical assistant or health professional answer the call, and two providers (2.15%) did not answer phone calls or provide an answering machine after normal business hours. For the 46 providers who provide an answering service to answer after-hour phone calls, each of the 46 answering services contacts the practice, and the practice responds within 20 minutes. If the answering service does not reach the practice, then 27 (6) answering services keep calling the practice. Two (4.44%) of these answering services are the practice themselves. Sixteen (35.56%) answering services will have a nurse call the patient to answer questions. Only five (10.87%) of the answering services provide a log of the calls to the practice. But of the 41 (89.13%) answering services that responded that they do not provide a log of calls to the practice, these services stated that they would send a log of all calls to the practice if requested. Because the number of surveys not answered was high (33.9%), additional verification was done. During the week of June 13, 2011, AFMC randomly selected 18 percent of the providers that did not complete the survey but did answer our initial phone call to see what happens when a client calls the clinic after normal business hours. Out of the 41 phone calls that were made, 30 (73.17%) providers had an answering machine for the patient to leave a message or directed the patient to the ER or 911 in case of an emergency. Eight (19.51%) providers have an answering service or an answering machine that directs the patient to dial another number. Three (7.32%) providers did not answer phone calls or provide an answering machine after normal business hours. ARKANSAS FOUNDATION FOR MEDICAL CARE 2011 AFMC 24/7 SURVEY REPORT 19

Verification: June 6 Verification: June 13 Q9) What happens when office phone number is dialed? n % n % Answering machine 44 47.31% 30 73.17% Answering service 46 49.46% 8 19.51% Medical assistant or health professional answers the call 1 1.08% 0 Keeps ringing/no answer 2 2.15% 3 7.32% For the eight providers who provide an answering service to answer after-hour phone calls, five providers services contact the practice and the practice responds within 20 minutes. If the answering service does not reach the practice, then all services keep calling the practice until someone is reached. None of the five answering services send a log of calls to the practice unless requested by the practice. The other three providers services hung up the phone when AFMC began asking survey questions. AMFC looked at the two groups of verification calls. For the providers who answered the initial phone call but did not complete the survey, this group of providers had a significantly higher percent of answering machines and a significantly lower percent of answering services for after-hour calls compared to providers who completed the survey. All answering services from both verification groups stated that the practice responds within 20 minutes and they will send a log of all calls to the practice if requested. 20 ARKANSAS FOUNDATION FOR MEDICAL CARE 2011 AFMC 24/7 SURVEY REPORT

Recommendations The results of this survey suggest that the majority of PCPs surveyed are fulfilling their obligations for providing after-hours communications with patients. As illustrated by the county-level map in Appendix C, there are opportunities to improve statewide, particularly in rural areas. If a priority for Medicaid, further emphasis and technical support might be provided through future new activities by Provider Relations to improve after-hours phone service. Additionally, Medicaid may wish to approach the Arkansas Medical Society to open discussions about how to improve after-hours phone services. ARKANSAS FOUNDATION FOR MEDICAL CARE 2011 AFMC 24/7 SURVEY REPORT 21

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APPENDIX A: Survey Tool 24/7 QUESTIONNAIRE 1) What is your office phone number for patients? 2) Where is your office phone number listed? (Check all that apply) A B C D Phone book Website/Internet Specific handouts with instructions for patients Other 3) When a patient calls after hours, does the call event get included in the medical record? 1 Yes 2 No 4) What happens when patients call the office after hours? 1 Answering machine where patients leave messages Go to Question 5 2 Answering service Go to Question 6 3 Clinical triage service (example: nurse hotline) Go to Question 7 4 Direct contact with on-call professional Go to Question 8 5 Other Go to Validation (Question 9) 5) What happens when a patient reaches the answering machine? (Check all that apply.) A B C D Leave message with office, instructed to go to ER if urgent Instructed to call another number to contact answering service Leave message to be monitored by clinic personnel every hour Messages are reviewed in the morning PROCEED TO VALIDATION (QUESTION 9) ARKANSAS FOUNDATION FOR MEDICAL CARE 2011 AFMC 24/7 SURVEY REPORT 23

6) What happens when a patient reaches an answering service? (Check all that apply.) A B C Leaves message with office in the morning, instructed to go to ER if urgent Page professional on call who responds within 20 minutes Other PROCEED TO VALIDATION (QUESTION 9) 7) What happens when a patient reaches a triage service? (Check all that apply.) A B C D E F Licensed professional reviews clinical problem Licensed professional offers treatment advice Licensed professional prescribes medication Licensed professional contacts office staff for serious problem Licensed professional refers patients to ER without contacting office staff Other PROCEED TO VALIDATION (QUESTION 9) VALIDATION OF AFTER-HOURS PHONE SYSTEMS. CALL OFFICE PHONE NUMBER. 9) What happens when office phone number is dialed? 1 Answering machine (do not leave message) 2 Answering service Go to Question 10 3 Medical assistant or health professional answers the call IF AN ANSWERING SERVICE RECEIVES YOUR CALL, EXPLAIN YOU ARE FROM AFMC AND ASK: 10) When patients contact the service, does the service contact the practice? 1 Yes 2 NO Go to Question 13 11) Does the practice respond within 20 minutes? 1 Yes 2 No 12) What does the service do if there is no response from the practice? 8) What happens if office staff answers afterhour calls? (Check all that apply.) A B C D Each physician covers own patients every night/weekend Practice personnel share calls Practice personnel share calls with other community practices Other: 13) Does the service send a log of the calls to Tthe practice? 1 Yes 2 No 24 ARKANSAS FOUNDATION FOR MEDICAL CARE 2011 AFMC 24/7 SURVEY REPORT

APPENDIX B: County-Level Map This county-level map shows the distribution of providers who responded they provide a live voice response when a patient calls their clinic after business hours. The percent represents the percent of providers in a county that provide a live response, and the n value is the number of providers within the county that responded to the survey. The counties shaded in tan have a percent less than the state percent. The counties shaded in blue have a percent greater than or equal to the state percent. of providers where a patient calls after hours and speaks with someone State percentage: 55% Below state percent Above state percent BENTON n=32, 46.88% WASHINGTON n=38 52.63% CRAWFORD n=16 81.25% SEBASTIAN n=26 76.92% POLK n=2 10 SEVIER n=5 FRANKLIN n=2 10 SCOTT LITTLE RIVER n=2, HOWARD n=1 MADISON n=1 10 LOGAN n=5, 6 CARROLL n=4 5 MONTGOMERY MILLER n=1 PIKE n=2 5 HEMPSTEAD n=2 5 JOHNSON n=10 YELL n=5 2 LAFAYETTE n=2 5 BOONE n=10 3 NEWTON n=1 GARLAND n=9 88.89% CLARK n=1 NEVADA n=1 COLUMBIA n=1 POPE n=13 30.77% CONWAY n=2 HOT SPRING n=2, 5 OUACHITA n=7 MARION n=3 10 SEARCY n=1 PERRY n=1, DALLAS n=3 CALHOUN BAXTER n=15 10 VAN BUREN n=6, 16.67% SALINE n=7 57.14% UNION n=12 66.67% FAULKNER n=7 71.43% GRANT n=1 10 STONE PULASKI n=46 82.61% CLEBURNE n=2 CLEVELAND BRADLEY FULTON n=2, 50/00% IZARD n=1 LONOKE n=4 5 JEFFERSON n=10 6 INDEPENDENCE n=4 25.00% JACKSON n=2 WHITE n=12 66.67% LINCOLN n=2 DREW n=4 75.00% ASHLEY n=8 5 SHARP n=1 PRAIRIE n=2 ARKANSAS DESHA n=3 LAWRENCE n=8, 12.50% WOODRUFF n=2 5 MONROE n=1 10 CHICOT RANDOLPH n=6 16.67% CLAY n=4, 25.00% CRAIGHEAD n=20, 95.00% CROSS n=1, LEE n=1, 10 PHILLIPS n=3, GREENE n=12 41.67% POINSETT n=2, ST. FRANCIS n=9, 55.56% CRITTENDEN n=7 85.71% MISSISSIPPI n=13 61.54% ARKANSAS FOUNDATION FOR MEDICAL CARE 2011 AFMC 24/7 SURVEY REPORT 25

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APPENDIX C: Frequency Tables Appendix D: Frequency Tables Q2) Where is your office phone number listed? Check all that apply. Frequency Utilization Rate Phone book 455 36.43 99.78 Website/Internet 308 24.66 67.54 Specific handouts with instructions for patients. 367 29.38 80.48 Other 119 9.53 26.1 Q2 Other Responses Frequency Frequency ADS IN LOCAL PAPER 1 1.33 1 1.33 APPT CARD 3 4.00 4 5.33 APPT CARD/BROCHURES 1 1.33 5 6.67 APPT CARDS 1 1.33 6 8.00 Advertising 21 28.00 27 36.00 BILLBOARD/NEWSPAPER/WORD OF MOUTH 1 1.33 28 37.33 BROCHURE/SIGN IN FRONT OF BLDG 2 2.67 30 40.00 BROCHURES/SIGN IN FRONT OF BLDG 1 1.33 31 41.33 BUSINESS CARD 3 4.00 34 45.33 BUSINESS CARD/APPT CARDS 1 1.33 35 46.67 BUSINESS CARD/BROCHURE 1 1.33 36 48.00 Baptist Health website 1 1.33 37 49.33 Beginning Readers 9 12.00 46 61.33 Business cards 1 1.33 47 62.67 DOCTOR REFERRAL LINE 1 1.33 48 64.00 Facebook 7 9.33 55 73.33 Insurance Manuals 12 16.00 67 89.33 PREVENTIVE HEALTH BROCHURE 1 1.33 68 90.67 RADIO/PAPER 1 1.33 69 92.00 SIGN OUT FRONT 1 1.33 70 93.33 appt cards 1 1.33 71 94.67 chamber comm. 1 1.33 72 96.00 newspaper 1 1.33 73 97.33 radio 1 1.33 74 98.67 TV, newspaper 1 1.33 75 100.00 ARKANSAS FOUNDATION FOR MEDICAL CARE 2011 AFMC 24/7 SURVEY REPORT 27 18

Q3) When a patient calls after hours, does the call event get included in the medical record? Q3 Frequency Frequency Yes 228 50.33 228 50.33 No 218 48.12 446 98.45 Don't know 7 1.55 453 100.00 Q4) What happens when patients call the office after hours? Q4 Frequency Frequency Answering machine where patients leave messages 211 48.06 211 48.06 Answering service 165 37.59 376 85.65 Clinical triage service (example: nurse hotline) 52 11.85 428 97.49 Direct contact with on-call professional 10 2.28 438 99.77 Other 1 0.23 439 100.00 Q4 Other Responses Frequency Frequency Directions on machine to go to ER for emergency 1 100.00 1 100.00 Q5) What happens when a patient reaches the answering machine? Check all that apply. Leave message with office, instructed to go to ER if urgent Instructed to call another number to contact answering service Leave message to be monitored by clinic personnel every hour Utilization Frequency Rate 155 43.42 73.81 62 17.37 29.52 1 0.28 0.48 Messages are reviewed in the morning 139 38.94 66.19 Q6) What happens when a patient reaches an answering service? Check all that apply. Leaves message with office in the morning, instructed to go to ER if urgent Page professional on call who responds within 20 minutes Utilization Frequency Rate 38 21.71 24.52 94 53.71 60.65 Other 43 24.57 27.74 19 28 ARKANSAS FOUNDATION FOR MEDICAL CARE 2011 AFMC 24/7 SURVEY REPORT

Q6 Other Responses Frequency INSTRUCTS TO ER IF URGENT, ALL OTHER CALLS ARE DIRECTED TO THE MD ON CALL AFTER HOURS MESSAGE GIVES PATIENT PROVIDER'S CELL PHONE. PROVIDERS ROTATE ON CALL DUTY Frequency 2 5.41 2 5.41 1 2.70 3 8.11 Answering service then pages clinic triage service 3 8.11 6 16.22 CAN ELECT TO SPEAK WITH ON-CALL NURSE 1 2.70 7 18.92 CLINICAL STAFF ANSWERS AND ADVISES PATIENT 1 2.70 8 21.62 CLINICAL STAFF ANSWERS TO ADVISE PATIENT 2 5.41 10 27.03 DEPENDS ON THE SITUATION. IF EMERGENT ON-CALL PROVIDER CALLED; OTHERWISE, INFORMATION FAXED THAT MORNING. DIRECTED TO CALL OFFICE BACK IN MORN OR GO TO ER IF EMERGENT EITHER DIRECTS PT TO CONTACT CLINIC IN THE MORN OR IF URGENT, PUTS CALL THRU TO ON-CALL MD INSTRUCTS TO ER IF URGENT, OR THEY PAGE MD ON CALL AND THE MD CALLS THE PATIENT & NO CERTAIN TIME LIMIT 1 2.70 11 29.73 2 5.41 13 35.14 2 5.41 15 40.54 2 5.41 17 45.95 Kids Care ACH receives calls with instructions 1 2.70 18 48.65 Nurse handles issue or pages physician on call 1 2.70 19 51.35 PAGE PROVIDER 1 2.70 20 54.05 Physician does respond; however, time frame couldn't be provided. 1 2.70 21 56.76 Professional answers call 1 2.70 22 59.46 The answering service is the hospital so they advise to contact clinic during business hours or go to Urgent care/er. No messages taken They do page the on-call professional; however, the response time is not known. 3 8.11 25 67.57 1 2.70 26 70.27 WILL DIRECT TO ER IF URGENT 1 2.70 27 72.97 pages MD on call 2 5.41 29 78.38 talk to someone 2 5.41 31 83.78 talks to Nurse 3 8.11 34 91.89 they forward call to Kids Care (Clinical Triage) 3 8.11 37 100.00 20 ARKANSAS FOUNDATION FOR MEDICAL CARE 2011 AFMC 24/7 SURVEY REPORT 29

Q7) What happens when a patient reaches a triage service? Check all that apply. Frequency Utilization Rate Licensed professional reviews clinical problem 48 30.77 92.31 Licensed professional offers treatment advice 45 28.85 86.54 Licensed professional prescribes medication 2 1.28 3.85 Licensed professional contacts office staff for serious problem Licensed professional refers patient to ER without contacting office staff 42 26.92 80.77 14 8.97 26.92 Other 5 3.21 9.62 Q7 Other Responses Frequency Frequency AT MINIMUM RN WILL BE ON CALL 1 20.00 1 20.00 Clinic forwards phones to local ER. Patients who call are told by ER staff to come to ER if Emergent and if not to contact physician next day during business hours 1 20.00 2 40.00 NURSE TRIAGE/ REFERS TO ER IF URGENT 2 40.00 4 80.00 call goes to on-call physician at hospital 1 20.00 5 100.00 Q8) What happens if office staff answers after-hour calls? Check all that apply. Each physician covers own patients every night/weekend Utilization Frequency Rate 2 16.67 20 Practice personnel share calls 3 25 30 Practice personnel share calls with other community 5 41.67 50 practices Other 2 16.67 20 Q8 Other Responses Frequency Frequency DOCTORS ROTATE ON-CALL DUTY 1 50.00 1 50.00 MEDICAL PROVIDERS ROTATE ON-CALL RESPONSIBILITY 1 50.00 2 100.00 30 ARKANSAS FOUNDATION FOR MEDICAL CARE 2011 AFMC 24/7 SURVEY REPORT 21

22 Verification Tables, Round 1 Verification Tables: Round 1 Q9) What happens when office phone number is dialed? Q9 Frequency Frequency Answering machine 44 47.31 44 47.31 Answering service 46 49.46 90 96.77 Medical assistant or health professional answers the call 1 1.08 91 97.85 Keeps ringing/no answer 2 2.15 93 100.00 Q10) When patients contact the service, does the service contact the practice? Q10 Frequency Frequency Yes 46 100.00 46 100.00 Q11) Does the practice respond within 20 minutes? Q11 Frequency Frequency Yes 46 100.00 46 100.00 Q12) What does the service do if there is no response from the practice? Q12 Frequency Frequency Keeps calling 24 53.33 24 53.33 Keeps calling or will call pt back 3 6.67 27 60.00 Nurse call pt to answer questions 16 35.56 43 95.56 Service is the practice 2 4.44 45 100.00 Q13) Does the service send a log of the calls to the practice? Q13 Frequency Frequency Yes 5 10.87 5 10.87 No 41 89.13 46 100.00 ARKANSAS FOUNDATION FOR MEDICAL CARE 2011 AFMC 24/7 SURVEY REPORT 31

32 ARKANSAS FOUNDATION FOR MEDICAL CARE 2011 AFMC 24/7 SURVEY REPORT

Verification Tables, Round 2 Verification Tables: Round 2 Q9) What happens when office phone number is dialed? Q9 Frequency Frequency Answering machine 30 73.17 30 73.17 Answering service 8 19.51 38 92.68 No answer/kept ringing 3 7.32 41 100.00 Q10) When patients contact the service, does the service contact the practice? Q10 Frequency Frequency Yes 5 100.00 5 100.00 Q11) Does the practice respond within 20 minutes? Q11 Frequency Frequency Yes 5 100.00 5 100.00 Q12) What does the service do if there is no response from the practice? Q12 Frequency Frequency Keeps calling 5 100.00 5 100.00 Q13) Does the service send a log of the calls to the practice? Q13 Frequency Frequency No 5 100.00 5 100.00 ARKANSAS FOUNDATION FOR MEDICAL CARE 2011 AFMC 24/7 SURVEY REPORT 33

PROMOTING EXCELLENCE in HEALTH CARE through EVALUATION and EDUCATION THIS MATERIAL WAS PREPARED BY THE ARKANSAS FOUNDATION FOR MEDICAL CARE INC. (AFMC) UNDER CONTRACT WITH THE ARKANSAS DEPARTMENT OF HUMAN SERVICES, DIVISION OF MEDICAL SERVICES. THE CONTENTS PRESENTED DO NOT NECESSARILY REFLECT ARKANSAS DHS POLICY. THE ARKANSAS DEPARTMENT OF HUMAN SERVICES IS IN COMPLIANCE WITH TITLES VI AND VII OF THE CIVIL RIGHTS ACT.