FAQS – Patient Referral Management

There has been a buzz around Patient Referral Management recently. Practices have considerable concern about how Patient Referral Management works and the related organizational components. This blog documents the Frequently Asked Questions by general practices in the U.S. and answers for the same.

FAQ – What is Patient Referral Management?

Answer – Patient Referral Management is the process of monitoring, directing and controlling patient referrals. It varies according to the nature of a practice and encompasses a range of different functions. Referral management centers may send referrals to specialty care or receive referrals from primary care. In addition to analyzing patient referral data, it also includes

  • Patient appointment scheduling
  • Communicating referral updates to the physicians
  • Referral process feedback
  • Referral loop closure

FAQ – How does a Patient Referral Management work?

Answer – It can vary depending on the nature of a practice. When patients need advanced treatment or additional diagnosis that cannot be given within the practice, they are referred to a specialist/imaging centre. The PCP identifies the need for a referral and places a request with the referral coordination team. The referral coordinator does the insurance pre-authorization and finds the right specialist for the referral. Then the referral coordinator sends the referral. Now the specialist validates the referral information and coordinates with the referring physician for missing information. The specialist then schedules appointments and takes care of the patient. The specialist must give timely updates to the referring physician. After the referral is over, the referring physician closes the referral loop.

FAQ – What are the medico-legal risks?

Answer – Some of the possible risks involved in a Patient Referral Management process include:

  • The referral letter getting lost in the process
  • Delays in the patient being seen by a specialist
  • The patient being seen by an inappropriate specialist (at the behest of the RMC)
  • The referral being returned to the practice when it is, in fact, needed
  • Whether referring through Patient Referral Management may breach patient confidentiality.

FAQ – Is patient confidentiality at risk?

Answer – In line with General Medical Council advice, practices should tell patients if their referral letter will be sent via a referral management centre.

Paragraphs 25-27 of the GMC’s Confidentiality (2009) state

  1. Most patients understand and accept that information must be shared within the healthcare team in order to provide their care. You should make sure information is readily available to patients explaining that, unless they object, personal information about them will be shared within the healthcare team, including administrative and other staff who support the provision of their care.
  2. This information can be provided in leaflets, posters, on websites, and face to face and should be tailored to patients’ identified needs as far as practicable. Posters might be of little assistance to patients with sight impairment or who do not read English, for example. In reviewing the information provided to patients, you should consider whether patients would be surprised to learn about how their information is being used and disclosed.
  3. You must respect the wishes of any patient who objects to particular information being shared within the healthcare team or with others
    providing care, unless disclosure would be justified in the public interest. If a patient objects to a disclosure that you consider essential to the
    provision of safe care, you should explain that you cannot refer them or otherwise arrange for their treatment without also disclosing that

If the patient objects to the involvement of the RMC, the practice should respect their wishes and make the referral direct to the consultant, if that is possible. The referring practice should, however, be able to rely on a duty of confidentiality at the RMC which is comparable to their own.

FAQ – Why go for a Patient Referral Management software?

Answer – Patient Referral Management process is currently too manual and requires a lot of time and effort. A Patient Referral Management software helps in automating the process. It eases the process of,

  • Insurance pre-authorization
  • Finding the right receiving provider
  • Patient coordination and communication
  • Referral updates to the referring physicians

FAQ – Whom does a Patient Referral Management Software benefit?

Answer – A Patient Referral Management Software helps in automating the manual process of managing patient referrals. It benefits all the stakeholders involved in a referral process. They are,

  • Referring physician – A referring physician identifies the need for a referral and initiates the same. A Patient Referral Management Software reduces the processing time of the referrals. It saves a lot of time and effort for referring physicians.
  • Referral coordinators – Referral coordinators do the insurance pre-authorization and also they also find the right specialist. They are made to handle many software at the same time. A single Patient Referral Management Software can help in easing the process for them.
  • Receiving providers – The specialists have tough time managing referrals from various channels and also fail to communicate effectively with the patient and the referring physicians. A Patient Referral Management Software can automate the process by channelizing the referrals into a single queue and also help in effective communication.
  • Patients – A software can help patients by reducing their efforts in communicating between the referring and receiving providers. It also enhances patient experience by reducing care fragmentation.

FAQ – Which organizations can use a Patient Referral Management software?

Answer – A Patient Referral Management software can help organization who send or receive referrals. Community Clinics and Federally Qualified Health Centres (FQHCs) send out referrals. They can use a Patient Referral Management software to track and manage their referrals. Specialist clinics and Imaging centres who receive referrals can use this software to manage their referrals and patient appointments efficiently. Large Enterprise Hospitals send and receive referrals. They can use a Patient Referral Management Software to track how many referrals are flowing in and out of their network.

FAQ – Does a Patient Referral Management software help both inbound and outbound referrals?

Answer – Inbound is when referrals are received in a practice and outbound is when referral are sent to a practice. As mentioned earlier, a Patient Referral Management can help in both sending and receiving referrals. Both inbound and outbound heavy practices can benefit from a Patient Referral Management software.

FAQ – How to implement a Patient Referral Management software?

Answer – A Referral Management software must identify the pain points in the current workflow and try to fit in by solving the challenges. For instance, before our HealthViewX Patient Management software is implemented, we do a few steps,

  • Understand the practice’s challenges and what they predominantly need to solve
  • Study the practice’s workflow completely
  • Propose a solution wherein it can fit in their existing workflow
  • Implement the solution without disrupting their existing system

Ideally, any Patient Referral Management software should follow the above for easy implementation.