Dr. X’s review went something like this:

1 STAR Rating: “If I could leave a negative star review, I would. Avoid Dr X. My mom was on vacation when she fell.  Unfortunately, she was “cared” for by Dr. X.  Dr. X said, ‘unless my mom wanted to play professional sports, she did not need surgery’. My mom was in a lot of pain and when she returned home, she saw another doctor that said my mom needed surgery right away or she would lose mobility!  The HELPFUL doctor couldn’t believe that Dr. X didn’t even change the bandages…. Dr. X, bring light and good health to the world by retiring.”

Like anyone who receives a review like this, the doctor was upset and completely disagreed with the reviewer’s account of the visit. He immediately instructed the staff to post a response with the “facts”, and then began to pressure his team to have Google delete the reviewer’s comment. As you can imagine, even if the reviewer isn’t responding, the outcome is not positive for the practice or the doctor; and if the reviewer is responding, the outcome likely only gets worse.

So, we know that bad reviews happen, even to the very best of providers.  How should we handle them, and how can we manage the conversations within the clinic and with the providers?

Step One: Consider your options.

The first rule of Review Club: work the plan. It’s easy to allow any review, especially a not-so-great-one, to feel very personal.  The key to success is the consistent, long game. Just like managing any situation that isn’t going perfectly within the business, the goal should be to consider your options and work the plan. This is the very reason there is a Customer Review Strategy in place to begin with; it is the clinic’s time to shine.  An emotional response, particularly a direct response including any details around the patient visit, may not only validate the patient’s identity and easily be a HIPAA/privacy violation, but it often fuels the fire. Consider the options and work the plan; but what is the plan?

Step Two: Remove.

Does the review qualify as inappropriate in Google’s eyes? Getting rid of a Google review is not necessarily simple, but it isn’t impossible either.  Google only removes reviews if the reviewer breaks one of Google’s user policies. 

Google Review Policies:

1. Spam and fake content that is posted to manipulate ratings. This includes posting multiple times, including from different accounts.
2. Off-topic posts that are general in nature, such as political commentary or personal rants.
3. Promoting actions be taken or items purchased that fail to comply with local legal regulations. Such restricted content includes promoting alcohol, gambling, guns, pharmaceuticals, adult services, and more. 
4. Illegal or depict illegal activity, such as copyrighted content, endangered animal products, graphic violence, human trafficking, etc.
5. Terrorist in nature.
6. Sexually explicit or in any way sexually exploits children.
7. Offensive, obscene, or profane.
8. Dangerous, considered harassment or intimidating, or that incite hatred.
9. Impersonating others or having false representation.
10. Dishonest or biased. This includes posting reviews of your own business (or having a current or former employee do it for you) and trying to manipulate a competitor’s ratings.

So, does this review qualify for deletion under any of these policies? In this instance, our review does not qualify for removal.  If you believe, after reviewing the policies, your business can prove the reviewer broke one of Google’s policies, you have a chance to present your case. I’ve included an abbreviated overview of how to contact Google support below.

To contact Google’s support for small businesses:

1. Go to Small Business Support
2. Scroll down and select “contact us”
3. Select “customer reviews and photos,” and then “manage customer reviews”
4. Choose to receive help via phone, web chat, or email

Using any of these methods, one can expect help within 24 hours. If the practice chooses to contact Google via email or chat, it is helpful to have a screenshot of the review in question ready to go.

When the Google support team reaches out, it is up to the practice to explain why the review should be removed. Be ready to explain why the review is in violation of policy and defend your request to get it removed.

CLICK THIS LINK to request to delete a review from Google.

Step Three: Respond

If having Google remove the review isn’t going to work for the practice, the easiest way to have a review removed is having the patient remove it themself.  Typically, this is accomplished by contacting the patient offline with hopes to better understand what happened and find a way to resolve the issue.  Where this approach can become risky is when a well-meaning practice representative accidentally validates a patient’s claim during the casual phone conversation, for instance, by apologizing for the incident or mishap.  Apologizing opens the door, if only a crack, to admission in a malpractice action and trying to have the patient see it “your way” may inflame the patient instead of inspiring them to remove a post. 

Additionally, engaging with the reviewer may prompt more online discussion.  There is nothing stopping a patient from replicating their comments on multiple online platforms.  Businesses that have the most success responding to poor reviews utilize only their most experienced, skilled and disciplined staff, and those team members stay within a very defined framework.  Additionally, having some sort of fix readymade that directly addresses the patient concern is imperative.  The caller must have a plan to resolve the issue going into the conversation.

Step Four: Move On.

Sometimes time is the best healer. When a practice has an active reputation program in place, one bad review won’t be disruptive in the bigger picture; and confronting the reviewer is most often, not worth the risk.  If the practice has an active program to solicit reviews, in a few weeks this review will be buried by an overwhelming number of other reviews that for the most part, should be very good.  If this is a one-off, the manager or clinical supervisor can make note and move on.  If there seems to be a trend within the practice, this time is a great opportunity to meet with the provider or team to realign, fix a process or define a new approach. 

Overall, having an active reputation program in place, understanding your Customer Review Strategy and working your plan to consider, remove, respond or move on will improve the online reputation of your practice and the providers that work within it.

As we think back to the first days of the pandemic lock down, it brings back vivid memories of uncertainty; fear for ourselves and our patients and wondering how we could continue to serve our patients who were already predisposed for isolation by the pure nature of hearing loss.  Never in our lifetime had we been asked, or in some cases told, to shelter-in-place due to a medical threat. The healthcare world was managing difficult questions of how we keep people safe while still being able to serve their medical needs.  The discussions were swirling in the media, in phone conversations with colleagues and within practices on what is considered “essential healthcare services” when a community is faced with a global pandemic?  Some classified “essential” as anything required to save a patient’s life; others considered anything that negatively impacts a patient’s quality of life as “essential care”.  As a medical provider that witnesses the impact on the overall health and wellness that even an untreated mild hearing loss can bring, knows that for most, untreated hearing loss has substantial consequences when the world is managing normal circumstances. Now to be isolated at home, without support systems like family and friends, created an environment where a patient’s only contact with the world is through a video or phone call, television, radio, and social media.  We argued that hearing care services were even more essential in everyday life, now more than ever, hearing was a person’s primary lifeline.

At that point, we started asking ourselves, how can our physicians and providers meet patients where they are: in the community, at their homes, and on their connected devices. Although some of these changes will reverse as the world feels safer and more comfortable, we believe that there has been a fundamental shift in the delivery care.  We already had digitally enabled care in some ways, through apps and our patient portal, we needed to expand our care delivery and inform our patients.  We ultimately learned to connect to our patients in new ways, through: telemedicine appointments, remote-programming schedules, drop-off services and curbside care; and we are not looking back. 

To make patients feel as safe as possible and meet the social distancing guidelines, medical professions were able to start providing telehealth visits to meet their healthcare needs in a time that being in an exam room with a patient was not “safe”.  In audiology, we can provide a vast number of services via telehealth, however, we must have our patients positioned to move to this type of care.  What do I mean by this?  Remote programming has been available in hearing instruments for quite some time, but not widely adopted due to licensing concerns as it relates to telemedicine and audiology.  But once again, COVID 19 created a window where prior telehealth regulations by insurers were loosened so patients could be provided healthcare as it was needed, and providers could receive payment.

In hearing care, we had the answer – remote programming.  Thankfully, the hearing instrument manufacturers had been incorporating remote programming capabilities for quite some time. That said, many of us did not wholly appreciate the effort until COVID hit unexpectedly. And even then, many of us were not fully prepared to deliver it to the bulk of our patients. Our practice had written hearing aid delivery guidelines that include activating any remote programming capabilities in the hearing instrument. So, in theory, as part of our clinical protocol, all instruments are to be set up for remote care services.  Guess what happened when the pandemic started?  We quickly discovered that for whatever reason, many providers had not initiated the remote capability.   As I investigated the reasons why it had not been done, the first reason was time, they didn’t have enough of it during the delivery of the technology to add another feature and counsel on it.  However, the biggest reason was they didn’t think the patient would use it.  And for the most part, at that time, they weren’t wrong.  Most of our patients set in-person appointments for their follow-up and on-going hearing care.  When we look back now, we just weren’t planning for a pandemic-like environment.  We had been delivering care one way, for a very long time; and only for extreme cases, like illness or distance, did we ever really use any type of phone consult, telemedicine visit or remote programming capability as a practice.  Wow.  We were wrong about adaptation when there are extenuating circumstances and other available care channels to receive help. 

This is where the Curbside Care Channel journey began for ENT and Allergy Associates of Florida.  To service our patient’s hearing instrument needs, we first had to have all hearing aids prepared for remote programming, which for most patients meant we needed their instruments in the clinic. However, at this time during the pandemic, we couldn’t have the patients physically in the hearing aid clinic, and thus, Curbside Care was born.  While servicing the patient this way, we could wear proper personal protective equipment, do the proper patient attestation, take temperatures, and mostly stay at the required social distance. Best of all, we could take the patients hearing instruments from them and prepare them for remote programming while they sat in the safety of their own car.

The next hurdle was figuring out how to inform our patients about the new way to visit the office. We wanted them to know that we were here for them.  The fastest way to engage with them was on our social media of course.  We went “Live on Facebook” on ENTAAF’s Hearing Clinic social channel and talked about the new way to visit the office, how the Curbside Care would allow us to assist them safely, what remote programming meant and communicated that they did not have to be our patient to get help. 

As providers, we focused on how we could manage the situation within the government guidelines and still find solutions that would meet the needs of our patients while protecting the staff.  Even though what we came up with may even seem outside-of-the-box, we simply focused on how to meet the needs of the patient by managing them “where they were”; and in this case, they were in their car. After all, some practices still utilize the care channel of ‘at-home’ care, and take care of patients where they live, we surely could be creative enough to manage care if they would drive to us.

Considerations when adding or maintaining this modern delivery channel:

1. Put a clinical guideline in place that requires that if remote programming features are available, they are activated at time of fitting.  Next, add this feature to your chart review process to monitor provider compliance.
2. Assess the parking spaces around the practice to determine best parking spots to assign as Curbside Services.
3. Assure you have adequate signage designated for the curbside area and that you have communicated to the patient how to notify the office when they arrive.
4. Familiarize and train support staff on services that can be provided curbside and how to triage patients between face-to-face care, drop-off service, remote programming appointment and curbside care.
5. Become familiar with all manufacturers remote capabilities allowing your team to manage patients that may have purchased from other locations. Understanding what is available also allows the practice to determine if there are other products that may meet the needs of current patients.  
6. Develop manufacturer specific checklists listing the required steps the provider must execute to enable remote programming capabilities in products.
7. Regroup with your providers and staff to discuss benchmarks around different care channels, talk about how they are doing, and what they are seeing with patient outcomes.  Remember, there is always a way to improve the experience for both your patients and the team that is providing the care.

Hopefully, we are turning the corner on this pandemic.  With that, many patients are still not comfortable being in the office, and for many, having to come into the office is a burden. We believe that Curbside Care and Remote Programming Appointments are here to stay in the world of hearing care.  Moving forward, we will continue to deliver hearing care in these newer channels.

Second of three articles.   Following the implementation of a successful virtual patient management pilot, QM2 moved forward with lessons learned and developed patient engagement strategies focusing on the right patient, the right intervention, at the right time, through the RIGHT channel.

“When something really great happens, what do you do?  You share it,”  said James Benson, President and Founder of QM2 Solutions as he reviewed the results of its early virtual visit programs.  “In the spring of 2020, we had virtual visit pilot programs at ENT Hearing Associates of Florida, Colorado ENT and Allergy of Colorado Springs, and South Carolina ENT in Columbia South Carolina.  Each group had different needs and patient types, but the volume and value of the patient engagement was clear.  How could QM2 easily adapt and share the successful programs with others in the hearing industry?

First, the basics.  QM2’s approach to virtual care focuses on asynchronous ‘e-visit’ and ‘check-in’ technology for patients to complete virtual visits, then driving other patient engagement through in person visits, telemedicine, remote programing and testing.  QM2’s technology includes patient outreach using text or email providing notifications and encrypted links for patients to connect to their clinicians.  The ability for patients to simply connect with their provider when they have an issue, and the ability for the professional clinician to triage responses based on the patient’s relative need, satisfied two seeming incongruent objectives: 1) Increase the number of quality patient engagements; and 2) Save time through a focus on triage and automatic connections.

Next, QM2 created targeted hearing outreach programs around three patient types, 1) Acute- Connecting to hearing aid patients with current technology or care needs; 2) Chronic follow-up: Directing on-going engagements to diagnosed, but untreated hearing loss, and on-going conditions like dizziness and imbalance issues with fall risk; And 3) patients who are seeking answers or help with non-diagnosis hearing issues or concerns.

In the start of the fourth quarter of 2020 QM2 launched the hearing aid virtual patient management program at groups in Alabama, California, Florida, Texas, and Wisconsin.  The results of these implementations drove significant patient interactions and ongoing care.

On average, 50% of hearing aid patients open and read virtual visit messages from the practices (emails or texts announcing the program and providing a link into the SEngage portal), while 20% of patients completed hearing aid virtual visits when provided the connection.  That means, for every 2000 SEngage patient engagements, over 400 patients completed virtual visits.

The data is instructive.  43% of hearing aid patients completing virtual visits report a change (or suspected change) in their hearing and a declining ability to communicate.  50% of hearing aid patients have identified features and functions they wish worked better (or were included in their hearing aids.)

As QM2 began to help clinicians prioritize responses, we found that “somewhat happy” patients report a 49% change in hearing, and that 76% of “somewhat unhappy” patients report changes in their ability to hear and communicate.  Working with clinicians we found that “somewhat” patients often not been seen for years, not attending clean and fit appointments, been re-tested or attended product “events”.  Yet, re-engaging these patients through virtual channels, making it easy for them to communicate their needs, drives impact.  These two-way engagements pointed to additional testing, adjustments, and sometimes, new technology or treatments.  Audiologists are surprised when they note the number of patients re-engaging the patient and the impact, they are having by re-connecting to these patients.

To determine the impact of this type of care on the business of audiology, QM2 looked at its customers’ ratio of experienced hearing aid patients beyond three years of use to the number of units sold to experienced users.  What have they discovered?  Most selling hearing aids to less than 5% of the eligible patients in their database per year and that implementing a virtual patient management program can increase the number of units sold by 30% year over year.

The final article in this series will speak to clinician techniques, what is next for virtual patient management to drive better care and increased business.

Don’t want to wait for the final article? Learn more today!

Part 1 of 2 .

By Patricia Ramos, AuD

How many times have you seen a patient in the office for a follow-up visit only to find that the information that you really need to serve the patient is not there?  This can happen when you are the only provider in a practice but, especially if there are multiple providers involved in the care of the patient.  Let’s be honest, when you work in a multispecialty, medical environment there are many variables that can lead to missing documentation, both diagnostic and rehabilitative components of documentation can be extensive based on the number of subspecialties that are provided within your practice. 

Let’s review two scenarios that you might discover in a chart audit.

Patient calls in and needs a tubing change or a possible receiver replacement. In reviewing the chart, you realize that you did not document the tubing size or the receiver strength.

• As a solo practitioner in a medical practice providing audiology care, we often get to know our patients very well and there is a lot of information often obtained from the patient in each visit.  This leads us to have the challenge of covering all needed areas with the patient, but also documenting it for further future reference. When I first started seeing patients clinically as a solo provider, and yes, of course I was younger, I could remember the patients by their names, their stories, their needs or patterns, (never changed a wax guard, would put the batteries in the HA’s without removing the paper).  It is not uncommon for us rely on our interactions and memories of patients concerns as opposed to assuring that we have a documentation plan that is consistent and also allows for us to document quickly and accurately.
• Because of the lack of documentation of tubing size or receiver strength, the only way to address the patient’s needs is to have them come back into the office before care can be initiated versus being able to assure the patient that we can address their problem in an office visit. A great example of this would be making sure one has proper wax guards or receivers in stock before the patient even arrives to the office.

A patient is seen with a complicated asymmetric hearing loss where a masking dilemma could occur. Upon review of the audiogram presented from previous testing, you are unable to assure that the thresholds depicted are accurate because there are no recorded effective masking levels recorded.

• As an audiologist, we must make sure that we are confident in the test results that they have led to an accurate initial diagnosis. Medical and surgical decisions surrounding a patient many times are solely based on the audiometric results. If previous testing performed does provide all needed information, the only option is to “retest”.
• If you proceed with making recommendations based on results that you did not obtain personally and you cannot with certainty know that the thresholds are valid due to lack of recorded masking levels, you could be sending a patient to surgery on improper results and surgery is not indicated.

As you can see from the simple scenarios given above, with only one piece of information missing in the documentation of each example, proper patient care was delayed because the missing information did not allow us to provide care with confidence, therefore requiring additional time on the patient and the provider.

Whether you are using some form of electronic health records program, handwritten notes, or dictating, the key to documentation is having a plan/outline that will allow you to document quickly but thoroughly without missing vital information.   One way to do that is to have appointment specific chart note templates that outline the components of each visit type so that as a provider you have all required components of the visit identified, i.e., diagnostics: case history questions listed and only need to  input the answers given by the patient;  Hearing Aid Fitting Note Template where all information needed for the devices and the fitting i.e. conformity examination performed, reviewed all components and their care/maintenance are also outlined.

Once you have established the components of the chart review process, the next most important step is to determine what to do with the information obtained.

1. Determine and prioritize the potential areas of improvement
2. Create a clinical documentation plan that is specific to the provider that you are reviewing
3. Commit to ongoing clinical chart review to document improvement, self- review and peer review

Documentation is key to patient care and being able to defend yourself in a chart audit, either from an insurance company or a medical malpractice claim.

Let’s start with the basics:

• Is there a medical order in the chart for diagnostic testing performed?  This is required in audiology for billing purposes, and you can only bill what is “ordered”.
• Is the patient’s name, medical record number (MRN) and date of service (DOS) included on every page of documentation for the patient?
• Is there documented medical necessity in the chart, i.e., reason for appointment? must always be medically based to be able to retain the monies paid upon audit.
• Do the services that were rendered match the patient complaint and documented history?
• Does the audiogram and other testing results have the information as required by your state?  Calibration date, Name of equipment and credentials of who is performing the testing to name a few.
• Do you have appropriate time stamped or written signatures of the provider that is billing for the services?
• Are physical exam findings documented, complete, accurate and appropriate for the patient reported symptoms and test ordered?
• Is all documentation accurate and legible?
• Is there clear documentation of the assessment, clinical impression or diagnosis for all testing performed, and plan of care for the patient?

Need a place to start? Look for the Chart Audit Form in May!

What started as an approach helping an audiology practice stay in business last spring, has become a beacon for expanded patient engagement and growing sales.

It happened to almost everyone.   Patients stopped calling, aware that ‘non-essential’ services were shut down.  And, while patients were still suffering, practices were furloughing staff and struggling to get ahold of patients.

“We developed our application, SEngage, to engage patients on behalf of their healthcare providers,” said James Benson, President and Founder of QM2 Solutions. “Before COVID we were using our system to deliver patient experience surveys and build online reputation.  Then COVID hit and we needed to do more for our customers.”

QM2 Solutions reached out to Dr. Patricia Ramos to talk about how they could help. Patricia Ramos is the Director of Audiology and Rehabilitative Services at ENT and Allergy Associates of Florida and oversees their audiology division, ENT Hearing Associates of Florida.

ENTAAF and their ENTHAF Audiology division is a large ENT and audiology practice with greater than 25 offices throughout Florida.  They were seeing decreasing volumes and were managing locations with decreased in office staffing and providers.

“We came together with QM2 through online meetings on evenings and weekends and laid out a plan for engaging our audiology patients,” Dr. Ramos said.

It was important for ENTHAF to test how virtual visits would work with hearing aid patients.  “Would our older demographic respond?  I needed to review clinical approaches and measure results.  It was all new to our providers and patients,” She said.

ENTHAF launched with a small group of patients.  Within the first week, 146 patients-initiated HIPAA compliant asynchronous visits with the practice.

The patient responses were prioritized and fit into the following categories: (1) I’m fine, thanks for giving me a way to connect, (2) I need supplies or batteries, (3) My hearing aids seem broken, (4) I would like to buy new hearing aids, and (5) I have an illness/condition requiring a physician evaluation.

Within three weeks, the practice collected $18,000 through the newly created remote service delivery channels.  The provider team scheduled 256 additional follow-up visits between the audiologists and physicians at a direct value of $25,000.  Medium term follow-up revenue from the limited program generated $32,000.  Overall, ENT Hearing Associates of Florida E-visit program initiated $75,000.  And it was just the beginning.

“The results of E-visits were real. We proved that we could improve hearing aid patients’ lives while generating revenue through virtual delivery channels,” Ramos said.

“In that first six weeks we showed that by focusing on the right patient, at the right time, through the right communication channel, our customers would serve more patients and generate significant revenue,” Benson said.

The next two articles will focus on the growth of the program, lessons learned, and the impact of new, approaches to engaging patients.

During the Florida Combined Otolaryngology Meeting in November 2020, I presented an overview on trends in audiology virtual visits.  Check it out on the MedAudPro YouTube Channel HERE!

Love this article? Check out Virtual Visits by the same author.

Why new Virtual Visit channels are important?

• A well-planned virtual visit program eliminates visit barriers. No-show research and studies on patient visit patterns highlight that patients often do not call when they have a need.   Phone trees, visit anxiety, long wait times, hurried providers, uncertainty about the reasons for their visit, limit patient driven engagement.  Lack of action by patients who need it delay key treatments that impact health and the cost of care.
• COVID fears, rules, and corresponding changes in consumer choice are reducing patients calling or coming into the office.  While in-clinic volumes are increasing, they will not return to pre-covid rates for some time. Virtual visits give providers a simple and secure way to begin or continue care.
• New clinical channels for delivery with more effective methods for patient triage, allow practitioners to make the best use of clinic time and space.
• Virtual visits create connection for both billable and non-billable e-visits and check-ins increase patient access to your practice.

What are the key ingredients to a virtual visit program?

• Build virtual channels by evaluating visit types and technology, then mapping patient type and services to each channel(s).
• Create a wide virtual funnel by reaching out to many patients.
• Utilize emails and/or texts to create virtual connections.  Secure patient messaging educates patients about virtual visit options and open the door to direct interaction.
• Develop diagnosis, visit-type content to streamline a patient’s virtual visit.  By helping patients efficiently communicate their needs, symptoms, and concerns, providers identify specific care opportunities.
• Cultivate virtual visit, clinical pathways around specific diagnoses.   Focus on chronic conditions and develop internal clinical guidelines to make sure you are quickly addressing patient needs.

Now Act!

Virtual visit programs are dependent on a clinic’s most valuable resource, the clinician, and their professional judgement, expertise, and clinic management.  New virtual approaches that open the door to thousands of patients highlight a clinic’s workflow and ability to respond to patient needs.   Asynchronous visit technology, not requiring real time response, allows for greater reach, but underscores the need to act fast on a patient’s needs.  The good news is that technology, supplemented with internal expertise, allows for more efficient triage.  These approaches, along with consideration to use the most efficient delivery channel, magnify a clinic’s capacity.

What a virtual visit program is NOT.

A Virtual visit program is not telemedicine software.  It is not emailing or texting patients. It is not having a portal. 

It is a comprehensive approach that focuses on the right patient, at the right time, with the right care, through the right channel.

Groups who have implemented virtual approaches create an impressive magnitude of “other” service opportunities realized through virtual visits.  Increased clinic site visits, surgeries, increased curbside services, and home-based services.  In the hearing aid industry, there is a significant increase in remote programming of hearing aids, and hearing aid purchases as a direct result of patient requests.

Maybe the most important way to describe the impact of virtual visits program is to talk about real life examples and the real-life results.   Today we highlight the journey of an hearing aid practice, ENT Hearing Associates of Florida.  On April 6, 2020 they identified the desire to develop a virtual visit program with established hearing aid patients.  The group started small, identifying care pathways.  They contracted with QM2 Solutions to implement an asynchronous portal and messaging system.

The group then began announcing the program and connecting remotely to patients.  As patients responded, they were brought to a customized, patient virtual visit where they answered four questions about their hearing needs.   Patients completed their visit on their smartphone, their computer screen, iPad, or tablet.  

It didn’t take long for ENT Hearing Associates of Florida to realize an impact. Within a week a hundred and forty-six different patients completed audiology E-visits. The patient response ranged from everything from, “thanks for giving me a way to connect,” to, “my hearing aids are broken.” Some stated they would like to purchase supplies and others requested to buy new hearing aids!

While engagement of a hundred and forty-six different patients is impressive, the 256 additional patient engagements within three weeks of the initial virtual visit are maybe more important to share.  Additional engagements included: curbside pickups, telephone calls, and more than 90 face-to-face audiology appointments.  The practice then focused on using telemed software to assist in both hearing aid sales and hearing aid adjustments.   Finally, triaging audiology virtual visits led to face-to-face ENT and Telemed visits.  The impact to the number of visits was real.

ENT Hearing Associates of Florida expanded their clinical reach and deepened patient engagement.  They took time to develop a well-organized virtual visit program and found it deepened connection with patients.  As the program matures and outcomes are measured, they are seeing better outcomes and greater patient satisfaction.  Ultimately, this approach had a significant revenue impact for the practice and has been expanded to address the needs of other patient groups.

Find out if a virtual patient management program is right for your practice. Click here for a Free Strategic Virtual Patient Management Assessment.

About James Benson

QM2 Solutions, CEO & Founder

James Benson is the President and Founder of QM2 Solution. QM2 Solutions, with headquarters in Elkhart Lake, Wisconsin, provides solutions that generate practice growth and clinical improvement through patient feedback.

Before QM2 solutions, James worked as a practice administrator and management consultant to surgical subspecialty groups including 12 years working with Otolaryngologists. James served executive leadership roles within the Association of Otolaryngology Administrators (currently known as ASCENT), as consultant to the AAO-HNS Board of Governors and is a co-founder of the Large Group Executive Forum for Otolaryngology Practices.

James speaks nationally on areas of healthcare quality, outcomes, experience, benchmarking, and business development. James has a BS from the University of Wisconsin-Madison (1994) and a Master of Science from the University of Wisconsin-Green Bay (Quality and Systems Design (2000).

Connect with Jamie on LinkedIn

In January 2021, we passed the one-year mark since the first reported case of COVID-19 in the US.  There is still much unknown about how the virus impacts the health of multiple systems within the human body. Initially with COVID, the presentation of sudden onset hearing loss, tinnitus and dizziness were not associated as the acute, primary symptoms.  Since then, there has been documentation that not only have patients who have presented with these symptoms tested positive for COVID-19, these were their only presenting symptoms.   Ongoing retrospective and post-mortem studies promise to shed light on the systemic damage and the possible long-term impact to the hearing and balance mechanism. Additionally, there have been reports of sudden onset hearing loss, recorded outer hair cell damage, and self-reports of hearing loss and tinnitus post hospitalization.  To further complicate these cases, some of the medications utilized to treat the more severe presentations are known to have an ototoxic effects. 

One thing we noticed initially was how imperative it became to include COVID-19 exposure, length of infection, treatments and any on-going symptoms in our patient case history.  As the year progressed, we made a number of adjustments and even added completely new processes to the clinical and operational protocols within our practice. 

These are some of the more significant adjustments we have made in our clinics:

• Patient attestation of health status and questions about personal travel both domestic and internationally at the time of making the appointment
• Patient attestation of health status and temperature checks prior to checking into the office waiting room.
• Curbside check-in for those patients that are more comfortable waiting in the car until the time of the appointment or until notified by the office staff that the provider is ready to see the patient.
• Limited seating for patients inside waiting room for social distancing
• Switched patient chairs in waiting room that can hold up under the continued disinfecting process between every patient.
• Providing proper and complete PPE to protect our clinical staff based on interaction with the patient, i.e., sneeze guards on the check-in desk, KN95 masks, face guards, safety goggles, and consistent glove use for all patient contacts.
• Enhanced and created new care delivery channels to accommodate patients that were not comfortable with in-person appointments.  These delivery channels allowed all patients to access care with in both the ENT and Audiology Departments while remaining aligned with state or personal social distancing guidelines.  New patient care delivery channels included telemedicine, e-visits, remote programming, curbside care and phone consults.
• Digital outreach to hearing aid users for accessory offerings to assist in better communication for: (1) those who felt isolated at home and needed to more easily communicate with family, friends and medical providers and (2) patients who were in a work from home scenario and found they needed additional assistance.
• Implemented e-visit program for established audiology patients that allowed them to connect to our practice through a secure web interface to communicate the status of their medical condition to our providers.  This new care channel continues to allow us to serve patients quickly and in a number of cases, without the need for an in-person appointment.  
• Case history expansion and audiological monitoring plan for those with reported COVID-19 exposure and history.
• Developed clinical process to track patients for monitoring of long-term impact on auditory system post-COVID.

COVID-19 has heightened our need to have candid conversations about any weakness in the patient journey throughout our practice.  It will continue to drive efforts for consistent quality improvement, the formalization of processes and to avidly work on communication gaps between providers, physicians and all staff members within a multi-specialty practice. It’s a good reminder that even the worst of experiences can often be the catalysts of innovation, improvement and betterment – and we see it every day within our teams and in our patient outcomes.

During the Florida Combined Otolaryngology Meeting in November 2020, I presented a short literature review that covered some of the COVID-19 research related hearing loss and tinnitus.  You can find that video on the MedAudPro YouTube Channel HERE!

Since then, there have been additional studies published by Science Daily & Ear, Nose & Throat Journal, along with many others. These studies continue to reference acute symptoms of hearing loss and tinnitus.  There have been a number of compilation articles published that provide excellent at-a-glance reviews for clinicians that need a broad understanding of what to look for but don’t have time and resources to do the research.  Here is a good overview in Healthy Hearing published in December 2020.

Let us know how your clinic is managing new COVID clinical and operational practices!  Join the conversation www.facebook.com/groups/medaudpro