Cleveland Clinic Indian River has turned out to be a “long-hauler” in its case of phone flu.
It’s been more than eight months since the hospital’s physician practices were suddenly stricken with phone problems. At first, they were thought tied to the implementation of new electronic health records software, which placed additional demands on staff already stretched thin by the COVID-19 pandemic.
Now, the pandemic has eased. More people want check-ups again. They are fighting cancer, or afraid of a heart attack, and calling for a doctor’s appointment. But many still can’t get through.
Last week, more than 150 frustrated patients responded to a post on social media asking if people were continuing to have problems reaching their Cleveland Clinic doctors.
The question, posed by Vero Beach 32963 on a local Facebook group, repeated the claim of the hospital’s top executive, Dr. Greg Rosencrance, that call center metrics show the situation is improving.
The fact that there were only 150 complaints in the span of one day may back Rosencrance up: There were 250 comments to a similar post in April.
Either way, there clearly is an ongoing issue, with many of the posts referring to problems last month, last week, and even one from “yesterday.”
The metrics showing improvement that Rosencrance provided appeared to include only physician practices in the hospital’s Wellness Center.
In December, when appointment calls for those doctors began being routed to a call center in Weston, Florida, some 70 percent of calls were answered, and 21 percent were “abandoned” – people hanging up when they got sick of waiting. By May, the “answered” rate was up to 84 percent, and 11 percent of calls were abandoned.
Rosencrance said June numbers showed even more improvement, with abandoned calls down to 5 percent.
But those numbers apparently did not include primary care physicians’ practices acquired in January when Primary Care of the Treasure Coast merged with Cleveland Clinic. The metrics also didn’t include Vero Radiology, now owned by Cleveland Clinic.
Vero Radiology, which has its own schedulers and still uses its own electronic health record software, was mentioned frequently in the Facebook posts as having intolerably long hold times.
The metrics also didn’t account for the significant number of patients complaining of not having voicemails returned, including for prescription refills. Their messages would have been left with physicians’ offices, not the call center.
And the numbers couldn’t include patients who since last fall have been driving to their doctors’ offices, so frustrated are they with the ongoing phone issues.
One woman who ended up driving over – twice – said she called Vero Radiology multiple times over the course of three days, including once when she put the phone on speaker and stayed on the line two hours, and could not get anyone to answer.
“Calling Vero Radiology is a NIGHTMARE,” she wrote in her Facebook post. Even after she went in person, she had to wait 30 minutes to talk to someone, she said.
Just last week, a patient needing a mammogram after lumps were found in her breast waited a half-hour on hold before finally hanging up.
“I can’t BELIEVE how neglectful that is!” she wrote on Facebook. Eventually the patient called a different department and left a message there. Someone got in touch with the other department and that person finally called the patient back.
As with many of the commenters, this patient found the real-life people she dealt with to be “very kind and accommodating.” But she wondered why Vero Radiology doesn’t have the kind of phone system where you opt to get a call-back rather than wait in the hold queue. The concept is hardly new.
“I didn’t want to interrupt the wrong person’s workflow, but I felt I had no choice,” said the patient. She is now looking for another imaging center. “Especially if I need more follow-up for these lumps. This is frightening enough without these roadblocks!”
Even doctors can’t sidestep the phone snags.
One physician whose specialty practice regularly requests records from Vero Radiology said hold times typically last 30 minutes, far longer than normal.
Still another patient spent more than six hours on the phone over the course of two days trying to schedule a PET scan for her husband that was needed as soon as possible.
Finally, she gave up on phones and emailed “every person in a management position at Vero Radiology,” she said. “That finally got a response, and we got an appointment. It never used to be like this before Cleveland Clinic took over.”
A former employee of Vero Radiology who retains close ties to management there said the number of schedulers is down while patient visits are way up. Last Saturday, schedulers worked at overtime pay – a rare budget authorization, the source said – “just to try to regain traction and get their heads above water.”
“What is happening to patients and families at CC is a travesty and an embarrassment to the Vero Beach community,” said Nick Liguori, a retired GM employee from Ohio. “I have lived here 15 years and the last 12 months has been a complete nightmare dealing with CC.”
Liguori finally switched to a non-Cleveland Clinic urologist last month after what he called a “nightmare” communicating with his Cleveland Clinic-employed urologist. That included trying to ask some questions about care after two procedures in March. He called it “an experience never to be forgotten.”
Another patient is similarly at the brink of changing doctors. She wrote about her effort a month ago to book an appointment with a Cleveland Clinic dermatologist. “I ask for my dermatologist, get put in a loop for the appointment department instead, and no one answers that line either. If I didn’t love my doctor, I would leave in a heartbeat.”
One patient who was having trouble getting responses to messages sent via MyChart, the Epic patient portal, called the hospital operator a week ago and asked to speak to the patient experience ombudsman. The line went to voicemail, and she left a message. So far, she has not been called back, she said.
Had such problems occurred under the management of Indian River Medical Center, the elected board of the Indian River County Hospital District might have intervened. The district, on behalf of county residents, retained ownership of the hospital in the transaction that named Cleveland Clinic Florida tenants of the hospital and all its facilities in January 2019.
But since the problems began last October, the subject has not come up in the monthly, publicly televised, open-to-the-public Hospital District meetings, held in County Commission chambers on the third Thursday of every month.
Those meetings always include a time for public comment. To date, no one from the public has spoken up about the phone issues, a fact that baffles District Board Chairwoman Marybeth Cunningham.
As to why the trustees themselves haven’t brought up the problems, Cunningham says the new lease is a “more hands-off agreement” with the district than the old Indian River Medical Center had.
And it may be too painful to admit that such a simple-sounding problem can’t be solved by Cleveland Clinic. “We want them to succeed so badly,” she said. “We really don’t want to talk negatively about them in a public meeting. That’s probably the honest truth.”
Cunningham, an ex-officio member of the hospital board, said she and the hospital’s chairman of the board, Wayne Hockmeyer, who sold his home here last summer, have been holding joint telephone calls with Rosencrance every three weeks since March specifically to discuss the phone issues.
“I have reached the level of, ‘Guys, this is crazy.’ That’s how I feel,” Cunningham said.
Cunningham herself has fielded dozens of complaints about Cleveland Clinic phones from residents she runs into in her social life. “I also continue to get comments from people who are actually in the hospital and it’s nothing but praise [for Cleveland Clinic].
“They’ve been treated well and gotten great care. But what I hear is that it’s just impossible to get hold of somebody. I have one person who told me she’s been waiting for a callback from a doctor for four months. She ended up going to a non-Cleveland Clinic doctor.”
Among the torrent of negative Facebook posts was a possible solution. A poster had gotten a call-back from Cleveland Clinic explaining what could be at the root of some of the problems.
When you call a doctor’s office, the first option on the recorded message asks if you’re calling in regard to an appointment. Only in the second option are you asked if you want to speak “directly” with someone at your doctor’s office.
The message says to “please listen carefully before making your selection.” But it does not say to listen to all the options first.
Furthermore, the Cleveland Clinic Indian River website still has numbers that are not active – including the hotline established to help people unable to get through to their doctors.
Another number on the Indian River website, reached after hours, directs you to call another number in Broward County.
The phone problems seemed to start last fall when hospital administrators decided to go forward with a planned installation of new electronic health records software on the out-patient, or ambulatory, side of the hospital system.
The $15 million system that would allow the hospital to integrate with the entire Cleveland Clinic system included the practices of all the doctors employed by Cleveland Clinic who had offices outside of the hospital itself. Hospital-owned urgent care clinics and satellite offices were also included.
Along with $2.1 million in IT upgrades, the launch of the EHR software, called Epic, required intensive training that left fewer staff members available to answer phones. When the system went live on Sept. 15 the situation got worse.
With people trying to catch up on appointments and others still concerned about COVID-19 flooding the phone lines, patients found themselves dangling on endless holds. Calls would suddenly drop. Messages weren’t returned.
One nurse in the Wellness Center who has since left Cleveland Clinic said calls for appointments were being routed to nurses and medical assistants who normally work with charts and patients in the exam room area, not anywhere near the front office staff where calls used to be handled.
People who had barely left their homes since lockdown began driving in person to the offices to make their appointments.
In mid-December, a new wrinkle appeared in the problems: The first COVID-19 vaccine became available. With cases beginning to spike for the third time, even more calls poured into the hospital’s phone lines, adding to the chaos.
By March, with vaccine scheduling mostly in the hands of the Health Department and Treasure Coast Community Health, call volumes dropped, the hospital said in a statement Monday.
But phone problems were still occurring. In late March, Rosencrance decided to double down on the call center concept, adding 20 people to answer the phones. And there may have been more added since then.
“We have increased our call center staffing by 38 percent between March and June,” the hospital said in its statement. “We have also engaged a third-party vendor to assist as necessary on days with high call volumes.”
“Optimizing our call center is a process and we have made progress,” read a quote attributed to Rosencrance in the same statement.
“At the same time, we know that there has been dissatisfaction with patients who have had challenges connecting with us. We recognize that and have teams working every day to make connecting with our call center and physician offices more efficient and user friendly.
Improving this process is one of our highest priorities at Indian River Hospital.”
At the same time, several doctors leaving the hospital to retire or set up private practices cited the hospital’s phone foul-ups for adding to their stress and infuriating patients, even though the problems were beyond the physicians’ control.
Last weekend, management authorized overtime pay for schedulers at Vero Radiology to try to catch up with a backlog of calls, an attempt to “regain traction” lost over the past few months, said one former longtime employee who maintains close ties to management there.
Those efforts may not always be well received.
One patient was floored to get a call from a scheduler last week for a test ordered in March by a Cleveland Clinic doctor. “Ridiculous!!” the patient exclaimed.
