By Nicole Klutz, Au.D.
In our third installment of our blog series about Managed Care, we take a look at what Third-Party Referral Networks (TPRNs) look for in their preferred providers as well as the key metrics to ensure you are successful with TPRNs.
I found the right TPRN(s) for my business – now what?
So, you’ve taken the time you need to find the best fit of a TPRN(s) for you and your business. Perhaps you’re still waiting on your credentialing to be completed, or you’re all set and ready to go – but you’re not sure what steps are next. You’ve already taken the first step to understanding Managed Care, what it is and how it fits within your business, as well as thoroughly researching the TPRN that you identify with and whose services and offerings align with that of your business.
Now comes the exciting part: integrating Managed Care into your patient care delivery model and business model.
Now comes the exciting part: integrating Managed Care into your patient care delivery model and business model. The great news is that even if Managed Care is new to you, and you’ve never worked with a TPRN before, these organizations are ready to help you incorporate best practices based on years of data, experience and expertise. Don’t forget – they want you to succeed, and they want the patients referred to you to experience the best service, so it is in their best interest to support you as much as possible.
As we discussed in our first blog on Managed Care, “Managed Care – Threat or Opportunity,” a multitude of factors influence profitability in the clinic, and although conventional wisdom says that fitting a set of hearing instruments through a TPRN will not provide profit greater than that of fitting a set via private pay retail sales in the first year, it is much closer than you may have thought. It is important to remain knowledgeable about your clinic’s performance metrics and data to further support and drive your decision to accept patients from one, or many, TPRNs.
It is important to remain knowledgeable about your clinic’s performance metrics and data to further support and drive your decision to accept patients from one, or many, TPRNs.
We all know that there are key metrics we observe and report on as business owners and clinicians that help to identify the health of the practice – such as average selling price, cost of goods, closing rate, return rate, etc. The importance of tracking and maintaining healthy key performance indicators is also applicable to TPRNs.
Therefore, we’d like to take the time to review 3 key performance indicators that you should be aware of, know how to track for your patients in TPRNs vs private pay, and the implications of each metric.
Key Performance Indicators with TPRNs
- Average closing rate: Of the total number of patients seen in your clinic annually, what percentage buy hearing aids?This may sound familiar to many HCPs as conversion rate but is also referred to as closing rate. It is important that you track your average closure rate for patients referred through TPRN separate from that of private pay patients seen in your clinic. Find out the closure rate the TPRN expects you to deliver, and consider the factors that might impact this KPI in your practice. Does the TPRN include on plan formularies products you feel confident in recommending to patients? How informed are patients about their benefits by the time they reach your clinic? How far along are patients in their decision to purchase hearing aids? Be sure to work with TPRNs that align with your practice values and whose business processes complement your patient care delivery model.
- Patient Satisfaction
Patient satisfaction is a very important KPI for TPRNs, as it measures a patient’s perception of the quality of care they received and their overall experience with accessing their plan benefits. TPRNs measure patient satisfaction by reaching out to every patient at some point in their journey with either a phone call, email or mailed questionnaire, asking them to rate their experience with the provider, product and overall process. Network providers are an extension of the TPRN, so it’s critical that they deliver an experience that drives patient satisfaction.
- Appointment availability
How many times have we all experienced calling up a new medical professional and when it comes time to schedule an appointment, they offer you the “first available” which is weeks away. So, what do you do? For a fleeting 30-60 seconds, you quickly question whether or not you should say “OK – I’ll take it.” If you do, perhaps the first thing you think of when you hang up the phone is – can I go somewhere else and be seen earlier?The length of time a patient has to wait directly impacts their commitment to follow through and show up, and may even impact their decision to continue to pursue hearing solutions. Therefore, the time from referral to appointment is a key metric that many TPRNs review to ensure providers are getting referred patients in within an acceptable timeframe. For some providers, it may be a byproduct of their scheduling system or block system they are using. It is important to leverage your relationship with your TPRN and professional support team to encourage a review of scheduling and how to balance and optimize your current scheduling processes with your intended goal of bringing TPRNs on board.
- Average return rate: Of the total number of hearing aids sold annually, what percentage are returned?Perhaps this may be one of the most reported upon key performance indicator in hearing healthcare practice as we all strive to keep our treatment rates high and our return rates low. It is inevitable that a percentage of your patients will return or exchange their hearing aids. It does not mean that you didn’t listen to them, or recommend the best possible solution –it just happens sometimes.While we all look at this metric in our own professional practices, it is important to know that TPRNs also look at this KPI and monitor it with their preferred providers over the course of time to ensure everyone is experiencing the best outcomes. Find out what return rate is acceptable to the TPRN and aim to meet or beat it. As with closure rate, return rate should be tracked separately for patients referred through TPRN vs private pay patients.
Getting started on the right foot
Now that you have identified the right TPRN for your practice, understand the key measures of a successful relationship with the TPRN and have become credentialed, it is essential to take the next step of familiarizing yourself with the systems, tools and resources you have available to you.
the TPRNs also know how important it is that you are both comfortable and knowledgeable with the systems and the processes – and that’s what they are there for!
From everyday services, to ordering new devices, checking status, or asking questions – it is essential that you leverage the time you have right now to make sure you are ready to go. Don’t worry – the TPRNs also know how important it is that you are both comfortable and knowledgeable with the systems and the processes – and that’s what they are there for!
- Review the provider portal: Make sure you know how to access the provider portal, that your credentials to login work appropriately, and that you’re comfortable moving around the portal.
- Submitting a new order: Do you know how to submit a new order for a patient referred into the office?
- Order status: Placed a new order recently? Make sure you and your office staff know where and how to check the status of the order.
- Exchanges or returns: Do you need to exchange the product you ordered, or has the patient decided to return their devices? What is the length of the trial period allowed? Are you entitled to a portion of professional fees even if the product is returned? Make sure you are comfortable knowing the policies and where to go to initiate the appropriate services.
- Getting paid: Know what forms/signatures are required to approve your professional fee payment to avoid delays.
- Questions & Support: Know your resources, who to call, or if Live Chat is available for any questions you have as you start to become more familiar with the entire process.
Success comes in many different ways
We all know that hearing healthcare field is evolving and constantly changing – and these unprecedented times have caused those timelines to accelerate even as new dynamics appear. Don’t forget why you chose to become a provider and work with a TPRN in the first place: the overwhelming opportunity to effectively reach many of the adults in the U.S. with untreated hearing loss.
Managed Care and TPRNs provide you with a solution that maintains the quality of the care and service provided while reducing out of pocket costs, allowing you to successfully evolve and grow your practice with access to a patient subset that you may not have had before.
Have a question?
At Phonak, we strive to be your valued partner, and the resource you trust when you have questions about Managed Care and TPRNs. During these unprecedented times it has never been so important for us to provide you the support and guidance you need. As you are navigating these uncharted waters, our experts and specialists are here to support you. Send us your questions at firstname.lastname@example.org, and we’ll do our best to earn your trust!
Nicole Klutz, Au.D., is Manager of Audiology at the Phonak Audiology Research Center (PARC) in Warrenville, IL. In her role, she provides audiological support and professional training to employees and hearing care professionals around the country.