Patient recall is a crucial step in pediatric primary care, ensuring children and adolescents are up to date on vaccines, developing well, and most importantly, that they have vital in-person time with their pediatrician. We spoke to PCC’s Director of Pediatric Solutions Chip Hart for his take on how to set up a patient recall system that will help even out physicians’ workload, stabilize practice revenue, and set kids up for good health and successful academic years.
Maintaining a business over the course of the COVID-19 pandemic has been difficult for independent pediatricians. In January and February of 2021, many practices experienced a marked decrease in their patient volumes, leading to sloughs of revenue over the next billing cycle. Chip’s data finds that social distancing, remote schooling, and fears about the pandemic prior to a viable vaccine prevent families from coming into the practice.
The end of summer 2021 brought the opposite, and while some practices are still experiencing low volumes, many other practices are overwhelmed with patients arriving for vaccinations, COVID-19 checks, behavioral needs, and standard back-to-school well visits. Staffing troubles coincide with this increase in volume, leading to added stress and burnout for physicians and staff and longer wait times for patients.
According to Chip, patient recall is the key to evening out these periods of low and high patient volumes to enable pediatricians to practice on a more even keel throughout the year. “In August through September families have well visits, as this is a habit prior to school. Well -- if you target them and do recall to get the kids in who need to be seen, you can smooth out your annual schedule.”
To prevent overwhelming hikes in volume or long periods of few patients, Chip recommends a patient recall system that is based on patient engagement. “Patient engagement is always gigantic -- constant engagement even, not recalling,” Chip says. “Patient engagement is a big deal. Pediatricians should be the trusted source of medical information for parents with children.”
Patient engagement throughout the year maintains the relationships practices have with families, and the increased familiarity parents have with the office can even help make certain workflows in the practice easier, such as payment collection, COVID-19 testing, and appointment scheduling.
“We’ve had a total roller coaster of visit volume, and the only way to even out the rollercoaster is to fill out the valleys.” Chip Hart, PCC's Director of Pediatric Solutions
There are endless ways you can engage with patients and families, even during the slower months of the year. Online engagement is a convenient way to meet parents where they already spend much of their time, while in-person events such as flu clinics can be both fun and practical.
Especially because parents and kids spend a lot of time online, engaging images, videos, and helpful information can attract parents to the practice website and social media channels and help them stay abreast of the latest news and events at the office.
Online, patient engagement and practice marketing are similar, but distinct engagement strategies. Rather than trying to attract new patients, patient engagement should be communications directed towards your existing families, and include useful information and assistance to get patients in the door: educational items, office information such as hours and updates, and clinical events like flu clinics.
This kind of information also encourages patient activation, which is where a patient and their caregivers feel they are an active participant in the healthcare process, including directing the patient’s care, collaborating with physicians, making decisions, and participating in care plans. Therefore, any information that spurs families to take action and feel better about the process of arriving at their appointment is helpful -- whether it’s new office hours to better suit working parents, or new staff to reduce wait times. You can even engage with patient to prevent patients coming in, if this is a goal. For example, information about fever that prevents a new parent from making an appointment where it isn’t needed clears time for other patients.
For example, a practice could share updates in office hours, announce a new staff member, welcome families in for clinical events, and share helpful tips about common pediatric or parenting questions, such as when to bring a child with fever to the pediatrician or advice on remote schooling. Check out how Kids Plus Pediatrics in Pittsburgh, PA turned to Tiktok to share valuable information about vaccines and much more.
“It’s important to, even with all the opportunities you have had to see the kids over the summer, there are still hundreds of kids in the practice who haven’t been in front of a teacher or pediatrician in months,” Chip reminds pediatricians. “You’re missing opportunities to take care of these kids and provide them with some really important clinical services. It’s vital that you do this work.”
Recovery from the COVID-19 pandemic in communities created additional obstacles for families and pediatricians, which makes recall even more important than it was in prior years. Remote work and school, COVID-19 testing requirements, and the wait for a pediatric vaccine are topics on everyone’s minds, and in such a busy time it’s crucial to deliver the preventive care that will keep kids safe. However, a robust recall system will serve a practice well all year, every year.
A recall system that works all year will:
Chip recommends running reports that will help your practice discover the kids in need of preventive care or chronic disease management -- kids who haven’t had a visit in a while or who are missing vaccines and important screenings for depression, vision, hearing, and development, for example. Your practice could elect for a broad approach and send reminders via email, telephone, or mail to remind all patients to remain up to date on their vaccinations. Workflows can be set into place to examine siblings for preventative care checkpoints at sick visits. If your EHR allows it, you can also run reports to discover gaps in vaccinations or well visits -- PCC practices can do this via the Practice Vitals Dashboard.
While recall can help many practices recover from a sudden influx of patients, patient recall works at its best when used as a planning tool. In the coming months, pediatricians can expect to provide COVID-19 vaccinations for children as young as 5. The American Academy of Pediatrics supports vaccination for all eligible children, and pediatricians can reasonably expect the AAP’s endorsement of a pediatric vaccine once it is cleared for safety.
Chip cautions pediatricians to prepare early for vaccination efforts, not only for COVID-19 but for flu, too. “The fact is, we are probably going to be in a circumstance where practices will need to get the COVID vaccine in their communities. What have you done to prepare for that -- do you know the status of your kids? Can you do a COVID/flu clinic and you can give them on the same day? Do you even know the status of kids who need a flu shot? If you don’t, this is a problem.”
Flu shots are recommended for all eligible children and for pregnant parents by the AAP: “The flu vaccine is safe, effective, and can be given alongside other routine immunizations and the COVID-19 vaccine,” said Flor Munoz, MD, FAAP, lead author of the policy statement and technical report, developed by the AAP Committee on Infectious Diseases in October 2021.
Recall is all about preparation -- to prepare kids for healthy school years without sick days, to prepare staff and physicians to care for the typical and the unexpected, and to prepare to reach out to the families who might otherwise fall through the cracks. To prepare for recall and vaccination efforts in the coming months, your practice has a few tasks to consider.
For a successful recall effort, you’ll need data, materials, and a plan, of course. First, think ahead 6 or 9 or 12 months and identify the times of year when the office is slow, or at least minimally busy. This is the ideal time for patient recall efforts, and these efforts will need to begin far enough ahead of time to get kids on the schedule and last throughout the slow period, which for many practices is typically winter or summer.
Next, collect your data. Good data from your EHR or another data analytics source will be the key to focusing your recall efforts, because it will show the gaps in care your recall aims to fill. Perhaps this year you’ll want to focus on catching up on vaccines, while next year you want to focus on updating care plans for behavioral health patients.
Especially if your recall efforts are focused around a typical kind of visit, such as for vaccines, you’ll need to plan ahead to have the relevant materials. For practices offering the COVID-19 vaccine, this extends to vaccines, vaccine storage, PPE, and more. Stay in touch with your state’s Department of Health to receive vaccines -- while you may be put on a list to receive doses, having a positive relationship with your DoH doesn’t hurt. In many states, the DoH websites provide tools to educate providers on ordering vaccines, such as in this video from the Alabama DoH:
Your plan could also include events that encourage families to make that appointment -- whether for flu, vaccines, well visits, or even car seat checks, events can get families in the door and ready to start asking questions about their next appointment. Check out our previous post on drive-thru clinics to learn how to get started with your next clinical event.
Training is also important for practice physicians and staff. You might set up training on counseling for vaccine-hesitant families, or to review vaccine cold chain procedures. During the COVID-19 pandemic, your practice should also be trained and ready to respond and report any COVID-19 occurrences, according to the OSHA’s Emergency Temporary Standards.
COVID-19 requires its own similar recall preparation. Chip recommends that practices prepare to see every child between the ages of 5 to 11 years old in the coming months -- for some practices, this will mean recall efforts that are spaced out for several months, including multiple options for families to attend vaccination events like drive-thru vaccinations. The effort, he says, is well worth it:
“Practices who do drive thru immunizations clinics swear by them. When you can vaccinate 600-1000 kids on a weekend, it does amazing things for your position in the community, and you’re saving lives. Every kid who you see is very likely a kid who isn’t going to get the flu and won’t call to ask for a COVID test or COVID protocol, because flu and COVID protocol are the same. You’ll also keep kids in school when there’s a chance they would have been sent home.”
Chip encourages practices to put in the work of preparing for vaccinations so that kids can be seen by the pediatricians who are best familiar with their care and can perform perhaps their most important work in healthcare. “Every time pediatricians give away a vaccination opportunity to the pharmacies, they erode the most powerful thing that pediatricians do, which is give vaccines. It also weakens the patient centered medical home concept.”
Recall can help deliver the best in preventative care, exactly when patients need it. Learn more about how to prepare for a drive-thru clinic in our previous post. A focus on preventative care includes mental health too -- learn more about how your practice can integrate behavioral healthcare with any budget with our ebook.