Community Healthcare Centers and what do they do

A Community Healthcare Center (CHC) is a non-profitable, consumer-directed healthcare organization. CHC serves the underserved, underinsured and uninsured people, and provides them with access to high quality and preventive medical health care. Since 1965 Community Health Systems have provided comprehensive health and wellness support services to more than 22 million Americans, who otherwise would not have had access to quality care.

Community Healthcare Network receives funds through federal and local grants and payments from patients and insurance companies. CHCs must compete once every three years for federal grant funding and use these federal grant dollars to help patients pay for their healthcare costs.  

Patient Referral Management in Community Clinics

Community Health Centers comprises of PCPs who offer primary health care services and related services to residents of a defined geographic area that is medically underserved. Many patients visit a PCP in a day. Community Health Centers do not have the facilities for giving specialized treatments or for taking advanced tests. So, when a patient requires any of these, the PCP refers him/her to the most suitable imaging center or specialty practice.

Community Health Systems mostly refer their patients out of the network. The referral workflow from the perspective of a referring provider is as follows.

• The PCP sends the referral through the EHR/EMR to the referral coordination team.
• The referral coördinator will study the patient demographics and understand the required diagnosis.
• The team coordinates for insurance preauthorization to cover the medical expenses for the required treatment/services.
• Based on these, the referral coordinator will find the right specialist or imaging center for further diagnosis.
• After finding the right specialist or imaging center, the patient details are sent out as a referral.
• Community Health Systems sends referrals through various sources like phone, fax, email, etc.
• The referral coordinator chooses the source depending on the receiving provider’s convenience.

The gap between the community healthcare and specialty care

A referral process may become inefficient and ineffective if the community health systems and the specialty clinics/imaging centers fail to communicate. When there is no proper communication from the specialty centers/imaging centers the community healthcare network finds it difficult to understand the progress of the referral. Let us see it from different perspectives to understand why there is a communication gap.      

• From a referring provider’s perspective, the referral coordinator receives and processes many referrals every day. After sending out a referral, it is very difficult to follow-up with it manually. There are no effective and secure means of communication between the referring and the receiving providers. If the receiving provider or the patient fails to update the progress of a referral to the referring provider, he/she will never get to know what happened with the referral. Closing the referral loop becomes nearly impossible in this case.

• From a receiving provider’s perspective, the referral he/she receives may contain incomplete information. Without vital details, processing the referral will be difficult. The source of referral are many but there is no single interface to manage it all. Missing out on referrals is common. There is no way of getting a consolidated data on the number of referrals missed and the number processed. Patient referral leakage becomes imminent if the referrals remain unprocessed for a long time.

• From a patient’s perspective, he/she is referred to take tests in an imaging center and then meet a specialist to continue with the treatment. If the patient has to communicate back and forth between the referring and the receiving providers for incomplete information, history of illness, etc, it annoys the patient. It is frustrating for the patient to communicate between the two ends.

Referrals become incomplete, inefficient and ineffective when the participants fail to communicate and share timely information.

Guidelines to bridge the gap between Community Health Systems and Specialist Clinics/ Imaging Centers

1. The referring provider must understand the reason for the referral. The referring provider should also make the patient understand why a referral is necessary and what the patient can expect from the referral visit. Give time for questions and encourage the patient to clarify their doubts during the referral appointment.
2. When the referral coordinator does the insurance pre-authorization, he/she must make sure that the receiving provider covers the insurance policy of the patient. This will keep the patient better informed of how much the service will cost.
3. It is better for the referral coordinator to contact the specialist directly. He/She can give information about the patient’s current situation, as well as other medical records, test results, and documents to avoid duplication of effort.
4. Both the sides have to agree on the urgency of the referral and discuss the duration of the process, frequency of referral updates and the mode of communication.
5. Any tool that can give prompt reminders on the appointments, follow-ups to both the patient and the receiving providers can help.
6. After the referral reports arrive, the provider must check the results and recommendations. If the referring provider cannot understand the specialist’s evaluation, he should contact the specialist to understand the diagnosis better.
7. Referral is an important part of patient care but the patients are not obligated to follow-up with the specialist. If the referral isn’t completed, the referring provider must talk to the patient during the next visit to find out why. Documenting this can help in directing future referrals to the right specialist or imaging center.

HealthViewX Patient Referral Management solution communicates effectively between the referring and the receiving ends. The timeline view and referral status help in tracking the referral. Prompt reminders will never let you miss an appointment or follow-up. To know our solution better, schedule a demo with us.