Common challenges of manual patient referral management in 2019

  1. Documentation – During the referral process, referring physicians tend to miss out valuable patient information. Many times vital symptoms and findings from initial tests are often not sent with the referral order, leading to health complications that could have otherwise been avoided.
  2. Leadership disconnects – The leadership team should know which doctors are referring patients to specialists. Well-connected team structure enables educational conversation between leadership and care providers regarding overutilization, referrals to high-cost specialists, or the importance of sending all necessary documentation with every referral.
  3. Lack of coordination among caregivers – Did you know? Lack of coordination among caregivers are endemic and contribute to an estimated 44,000 to 98,000 deaths from medical errors each year.
  4. Follow-ups – Many primary care practices do not follow-up after they’ve referred a patient to a specialist. They vest the responsibility of scheduling a specialist visit with the patient. According to the Archives of Internal Medicine, this process does not happen in 50-60% of referrals that are made, putting patients at risk.
  5. Delays – The patient faces extended delays between the time the referral is sent and the time at which the actual appointment is made. As mentioned previously, delays and frustrations with the scheduling process can cause patients to avoid making an appointment, or they may ultimately cancel an existing appointment if the wait is too long.
  6. High-cost referrals – Primary care practices that refer patients to high-cost providers are harming their own practice and their patients. Exorbitant price tags affect reimbursement for PCPs and scare patients away from the idea of seeing a specialist, despite their medical conditions.

Challenges Specific to Patient Referral Workflow in Large Enterprise Hospitals

  1. Handling multiple EMR/EHRs – Large Enterprise Hospitals and Health Systems that are formed as part of mergers and/or acquisitions tend to handle multiple EMRs. EMR interoperability is their greatest challenge.
  2. Finding the right specialist – A Large Enterprise Hospital has a huge number of specialists. PCPs are not aware of specialists who were newly added or who came within their network as a result of mergers or acquisitions. So many times PCPs tend to refer their patients out of their network in spite of having the right provider within the network.
  3. Patient no-show rates – When patients miss/forget or do not show up for appointments, it results in revenue loss for the hospital. Patients miss appointments due to various reasons like no reminders, waiting time, a better specialist within the locality, reputation of the receiving provider, etc.
  4. Referral leakage – Did you know? Referral leakage for any health system can average anywhere from 55-65%! Patient leakage or referral leakage occurs more in an out-of-network referral than in an in-network referral. There could be many factors such as the reputation of a provider, lack of knowledge or insight and patient’s choice that lead to patient leakage.
  5. Patient dissatisfaction – Large enterprise hospitals should keep track of the number of patients moving out of their network. An alarming 25 to 50% of referring physicians do not know whether their patients see the specialist! Patients become dissatisfied with the treatment when specialists or PCPs do not follow-up with them regularly.
  6. Referral Analytics –  As a large number of referrals flow in and out of the network, it is difficult to track the exact number. It is also tedious to track the number of referrals in various status and to close referral loops.

Solutions for optimal patient referral management in 2019

  1. HealthViewX introduces a collaborative design that connects primary care providers with specialists on a single and uniform network.
  2. Electronically-connected specialists form a network of care collaboration, where both parties are responsible for the timely care of their mutual patients.
  3. Secure electronic notifications provide quick and reliable information between PCP and specialist.
  4. PCPs now have an enhanced ability to track referrals.
  5. Electronic Referral Management has decreased wait times for face-to-face specialty clinic visits.
  6. With Electronic Referral Management system, each step in the workflow prompts easy follow-ups and automatically closes the loop on all referrals
  7. End-to-End referral lifecycle management with bidirectional EMR/EHR Integration HealthViewX platform supports dynamic forms, workflows, task lists, reports, data visualization and has great integration capabilities. It can automatically pull referral orders from EMR/EHR in real-time. It also helps in configuring all other referral coordinator workflows and tasks with maximum automation.
  8. Multi-channel referral consolidation that brings all the referrals from multiple sources like email/phone/fax/notes into a single queue.
  9. Detailed referral information through which the Specialist receives all the necessary referral details.
  10. Automated Specialist / Patient Notification & Reminders with Customizable templates and configurable channels of communication
  11. Payer-specific prior authorization process automation – HealthViewX platform has a payer management module that maintains and manages
  • different payer details
  • their modes of prior authorization
  • direct authorization procedures
  • payer forms
  • online portal links

HealthViewX Patient Referral Management solution smooths the referral process and solves most of the inbound and outbound referral challenges for Large Enterprise Hospitals. Do you want to know more about HealthViewX HIPAA-compliant Patient Referral Management solution? Schedule a demo with us.