Monthly Archives: January 2017

Problems With Medical Referrals in the US

During the last two decades, the number of medical referrals in the US has dramatically increased. The healthcare system has more specialists and specialties than before but unfortunately, no parallel growth can be cited for general health care quality or efficiency in patient management. The purpose of medical referrals is to ensure that the patients receive the right type of care from a specialist for a specific condition.

Here are the reasons why all those referrals are going down the drain, literally.

1. Inappropriate Referrals
2. Outdated Technology
3. Insufficient Data
4. Delayed care

Inappropriate Referrals:

It is estimated that nearly 20 million referrals are made in the US every year which are considered to be clinically inappropriate (according to an article that appeared in the HIT consultant blog -“19.7M Clinically Inappropriate Physician Referrals Occur Each Year”). Clinically inappropriate referrals are those referrals which are not made to the right Specialist. PCPs make inappropriate referrals due to the physician’s lack of information about the specialist, referring to offices about the lack of information on available specialists and personal relationships between the providers.

When an inappropriate referral is made the primary provider will have to re-refer the patient to a more appropriate provider or the patient will end up receiving care from an inappropriate provider; in either of the cases, the patient will get poor outcomes and increased cost.

Outdated Technology

Referrals made by a provider to a specialist sometimes could fall through the “cracks” in the referral process. This could vary from practice to practice; some due to faults in referral procedures or ambiguity of the processes.

One recurring problem with referral procedures is with the use of technology or lack thereof. HIPAA regulations have mandated certain standards for the use of technology to transfer patient data. For example, it is against the regulations to use providers’ personal email to send or receive patient data, HIPAA has also mandated against the use of fax which is vulnerable in the case of data theft.
On top of being insecure, these technologies are not capable of supporting modern healthcare requirements including instantaneous communication, secure chat and exchanging data.

Insufficient Data

Primary care and specialist care are poorly integrated into a single system, the lead cause of this is lack of data. There are no means to transfer data between specialist or primary provider. The specialist is always making the fresh diagnosis without knowing the care history of the patient while the primary provider is unaware what kind of care his/her patient has earlier received.

Delayed Care

Referrals are (traditionally) a slow and time-consuming process. The primary care provider with limited information about the available specialists finds it hard to shortlist an appropriate specialist. The provider has to go back and forth to choose one out of the various specialists. Between the primary provider’s preference and the specialist’s availability, the patients experience long waiting hours and would finally decide to meet another provider out of the network.

The wait to see a primary care provider, the wait to get referred and the wait till specialists appointment plus the possibility that this process may have to be repeated leads to long delays to even receive most basic care.

Primary and specialist care coordination is an important aspect of the healthcare continuum. Providers should create and evaluate a referral process which would ensure maximum security of the information shared, minimum resistance to sharing patient data and possibly reduce the time delay in the referral process.

HealthViewX Referral Management Solution is a web-based, multi-channel referral management platform. Providers can send and receive a referral, share patient related information and track referral progress through one window making the referral workflow seamless and effortless.

Challenges Faced By The Rural Hospitals In The USA

The rural healthcare infrastructure which serves 15 percent of the country’s population has been showing signs of ill-health lately. According to USA Today, since 2010 more than forty rural hospitals have shut their doors and the rest are under enormous pressure. For millions of Americans, especially Medicare patients such institutions are often the only source of healthcare.

Though it is said that all the hospitals have been affected by the changing regulations and are vulnerable to external factors, the rural hospitals take the hardest blow. Here are the major challenges faced by rural hospitals:

Financial Factor:

The rural population is in most cases poorer and may be living with the help of federal or state support. Minority communities in rural areas are more likely to be categorized as below poverty level. The rural population is also likely to be uninsured. This financial disposition also indirectly affects rural hospitals as the institutions are less flexible to change.

Workforce Shortage:

The US Department of Health and Human Services in its 2012 report states that patient-to-primary care physician ratio in rural areas is only 39.8 physicians per 100,000 people, compared to 53.3 physicians per 100,000 in urban areas. This uneven distribution of healthcare providers leaves rural population more vulnerable.

Change in Healthcare Reimbursement Rules and New Regulations:

Change in reimbursement methodology has led to an overall reduction in reimbursement. Though this affects all hospitals alike, rural hospitals are more affected by the loss of revenue. In the recent years, hospitals are also required to abide by some healthcare IT innovations such as EMR implementation which is often too costly to implement for a cash short rural hospital.

A rural hospital can do the following to help themselves stop the trend from the current state and how HealthViewX Referral Management Solution can help them in recovering.

Better Management – Hospitals need to be managed according to their current revenue and resource constraints. This may include restructuring the organization to make it smaller and agiler. HealthViewX Referral Management Solution gives valid insights into the referral practices of a hospital. This could help in better prioritizing the practice goals and actions to the common medical requirements of the community they serve.

Join Hands With Other Health Systems – Rural hospitals can join forces with a larger organization in their region which will give them access to a larger market and better resources. Having a referral solution in place will help the user identify and track the process-follow of each referral. This will allow the hospitals to understand where the referrals are actually going and identify the actual number of referrals that end up in the network and the number that ends up outside the network.

Embrace Innovation – The changing regulations which aim to boost the use of healthcare IT in hospitals is only going to intensify. Many such software and solutions are expensive for a rural hospital and it is a challenge to find the right solution within the allocated budget and exceed patient experience at the same time.

HealthViewX Referral Management Solution is a web-based, multi-channel referral management platform. Providers can send and receive a referral, share patient related information and track referral progress through one window making the workflow seamless and effortless.

Referral – What a PCP and Patient need to know!

Communication is a critical aspect of healthcare. Most healthcare providers across the country have some system, process, and procedures implemented to ensure smooth flow of communication, but such innovations are largely focused on improving in-facility communication. However, the communication between facilities for most parts remains crude.

The ability to send and receive information between facilities can not only improve the patient healthcare outcome but also enhance healthcare efficiency. A referral management software would simplify the procedures between primary care physicians and patients and helps PCPs to closely monitor the progress or the outcome of the patients who are referred to a specialist.

Problems With Conventional Referrals
1. Physician refer patients but cannot follow up
2. Lack of communication between primary physicians and patients
3. Patients not meeting the referred specialist
4. It is impossible to send follow-up information

Above listed are major issues of the referral. Complexity in the referral procedures starts at the physician’s practice because they are the ones who initiate a referral.

Here are some key points that PCPs are expected to validate before sending out a referral to a specialist.

Get to Know Your Patients More

Knowing a patient is as important as knowing about the problems they have. The patient outcome should be foreseen before a referral is made. A patient visits one PCP whom they trust to a great extent, so when the referral does not qualify their expectations the patients may just walk away.

In some cases, after getting suggestions from a specialist, patients get the second opinion from another physician which is usually a reverse process but this tends to happen often. This shows the importance of PCP in the referral cycle and it is the responsibility of the PCP to ensure patients’ smooth transition and get the required care.

Do Patients Really Need Specialists?

Once a patient selects their PCP they don’t want to see any other physician or specialist unless there is a need. Here PCPs are the generalists who take full responsibility for their patient. Before getting a patient to step into the specialist’s office they must identify a clear need for the specialist’s visit.

Also, general practitioners could solve many of the patient’s problems without the need for a specialist’s help. Only in some cases, physicians require additional visit (maybe twice or thrice) to identify the problem by giving alternative medicines. Even after multiple visits and when they cannot diagnose the problem they will send patients to a specialist at the time of need as they are primarily liable for their patient’s care.

Managing the Referral

To avoid any delay in patient diagnosis some physicians make referrals frequently. But referring more does not always mean it is the right approach.

Mostly referral happens within the network. Physicians send patients to specialists who are known to them and these specialists are easily accessible to them to follow up which helps in closing the referral loop. When this process does not go well as planned then the PCP will stop referring to that particular specialist as referral closure is very important to identify the patient health status.

Key points a patient must be aware of:

1. Referral is an important process in healthcare

2. Referral success partially depends on patient cooperation

3. The referral will require some patient-related data transfer and some methods of data transfer are safer than others.

How Not to Share Patient Information For Referral

The medical referral process is an important part of ambulatory care in the US. Medical referrals have a direct connection to patient health outcome and the provider’s revenue flow. Patient-specific information and the need to keep it safe is even more important.
To protect patient information from falling into the wrong hands, healthcare providers use various procedures and processes to ensure maximum security but when it comes to referral workflow there are no standard procedures nor any secure technology to ensure information safety.

Gigabytes of patient records are compromised each year because providers do not have processes, the required technology or is unaware of HIPAA regulations. Here is how not to share patient information during referral.

Email Is Not What You Think It Is:

Many providers rely on emails to send and receive patient information instantly. Emails are easy and a lot faster than faxes but the problem with emails is that the files sent through with emails are generally un-encrypted when transmitted or when saved leaving patient information sensitive to theft. Using emails to share patient-related data is against HIPAA compliant and according to HIPAA, the provider is held responsible for any breach.

Beware Of Faxes:

Faxes are the most common format to send and receive patient information between practices. Regular faxes are affected by the problem of encryption; since these files are not encrypted, this information could be accessed by an individual with access to phone lines and basic knowledge of the system. Faxes are slow and time-consuming and do not support all type of file formats. Received faxes are usually kept in the machine for some time exposing patient information to unauthorized people. Faxes leave a paper trail of patient information which will practically result in making EMR/EHR systems useless.

Triplicate Form:

Although triplicate forms sound straightforward, practically triplicate forms transfer the process of referring a patient from provider to patient or patient’s skin. The patient is left with the challenge of coordinating between physician offices – calling referral coordinators, faxing files to specialists’ office. Often a patient will have to request an appointment with multiple specialists which means sending sensitive patient information to specialists office who may not be taking care of the patient at all.

Sharing patient information is crucial in the medical referral process, but the systems that the healthcare providers use are incompetent to do a fast transfer of patient file and transfer it securely to authorized providers.
Hospitals need to establish clear-cut procedures in case of sharing patient information. Such a procedure should be able to track the flow of patient data and establish standard norms and practices to minimize the possibilities of compromising data.