PERIODIC SURVEY OF FELLOWS
American Academy of Pediatrics
Division of Health Services Research
The telephone care questions for Periodic Survey of Fellows #79 were initiated by the AAP Section on Telehealth Care to examine the management of clinical patient telephone calls in pediatric practices. The questions addressed methods of telephone triage (staff, nurses, physicians) during and after office hours, as well as knowledge of billing practices for those services. Other questions on the PS#79 addressed the provision of medical home services, a summary of which has been provided separately.
The survey was an eight-page self-administered questionnaire sent to 1,618 nonretired U.S. post-residency members of the AAP, September 2011 to February 2012; response to the survey was 59%. Partial funding for this survey was provided by the National Center for Medical Home Implementation, Medical Home Capacity Building for CSHCN Cooperative Agreement, HRSA, MCHB, grant number U43M09134.
Analyses are based on 727 eligible respondents who provide patient care in an office- or clinic-based ambulatory care setting.
Management of clinical patient telephone calls:
During office hours:
• Six out of ten pediatricians (60.1%) report that during office hours their office staff takes messages for the pediatrician to return calls.
• Sixty-four percent of pediatricians (64.2%) say that registered nurses in their practice answer patient calls during office hours, with physician support as necessary.
• Four out of ten pediatricians (38.5%) say that office staff other than registered nurses answer patient calls during office hours, with physician support as necessary.• There is some variation in management of clinical patient calls during office hours by pediatricians’ practice characteristics (e.g., practice type and location, time spent in General Pediatrics and patient health insurance source). As example, pediatricians in solo/2-physician practice are more likely than those in group or hospital/clinic practice to report their office staff takes messages for physicians to return calls (75% v 59% v 56%, p<.01) and are less likely to say registered nurses answer patient calls during office hours (33% v 72% v 64%, p<.001). Both solo/2-physician and group practices are more likely than hospital/clinic practices to have office staff other than registered nurses answer patient calls during office hours (47% v 43% v 27%, <.001).
After office hours:
• More than one-half of pediatricians (56.0%) say their practice has an on-call physician who responds to all telephone calls after office hours.
• Twenty percent of pediatricians (20.4%) report their practice has registered nurses, with physician support as necessary, who respond to patient calls after hours.
• Thirty percent of pediatricians (29.6%) say after hours calls are outsourced to a third party call center staffed by registered nurses, with on-call physician support as necessary.
• There is some variation in management of telephone calls after hours by pediatricians’ practice characteristics. As example, compared to their counterparts, fewer pediatricians in group practice report their practice has on-call physicians to respond to after hours calls (43% group v. 77% solo/2-physician v. 72% hospital/clinic, p<001). Those in group practice are more likely than pediatricians in other settings to say they have practice-hired registered nurses to handle after hours calls (27% v. 10% v. 12%, p<.001). Pediatricians in hospital/clinic practice are least likely to report they outsource to a third party call center for after hours patient calls (14% hospital/clinic v. 25% solo/2-physician v. 39% group, p<.001).
Payment for clinical patient telephone calls:
• Nearly all pediatricians (92%) say their practice does not charge for clinical patient telephone calls, whether answered by physicians or registered nurses either during or after office hours; 6% of pediatricians say their practice does charge for these services and 2% are unsure.
• Pediatricians in solo/2-physician practice are more likely to report charging for clinical patient telephone calls (10% solo/2-physician v. 6% group v. 2% hospital/clinic, p<.01).
• Among those who know how their practice bills for clinical patient telephone calls (5% or 36 responding pediatricians), most say physician calls during office hours are billed using CPT codes submitted to patients’ insurance company and physician calls made after office hours are either billed using CPT codes submitted to patients’ insurance company or billed directly to the patient. Most also report after hours calls handled by registered nurses are usually billed directly to the patient.