Patient Referral Program in Federally Qualified Health Centers
FQHCs are high outbound referral setups, meaning they send out numerous referrals. A patient visits the clinic when he/she is suffering from an illness. Depending on the need for specialist examination or additional diagnosis, the PCP might refer the patient to an imaging center for further diagnosis or a specialist practice for advanced treatments.
Most of the FQHCs have a team of referral coordinators or RN’s, LPA’s, MA’s operating across various locations handling the referrals today. This team sends out referrals and ensures effective referral coordination. With the help of the patient demographics and diagnosis details available from the referral order, the referral coordinator does the insurance preauthorization and finds the right imaging center or specialty practice for the patient. Following that, the coordinator creates a referral that includes the details of patient demographics and the required diagnosis. Then the referral is sent to the relevant imaging center or specialty practice.
What factors plague the traditional referral process?
The traditional patient referral process in FQHCs are riddled with flaws. The primary shortcomings of the process are improper communication and the far-reaching consequences of follow-ups. Let us consider the following stats,
- According to the Archives of Internal Medicine, only half of the referrals result in a completed appointment.
- An Archives of Internal Medicine study shows that PCPs do not receive consult reports from the receiving providers about 40% of the time.
- The Journal of General Internal Medicine found that 68% of specialists receive no information from the PCP prior to referral visits.
- The Journal of General Internal Medicine found that 63% of PCPs and 35% of specialists were dissatisfied with the current referral process
- An MGMA study found that 53% of Appointments with more than three weeks of lead time resulted in a no-show
Given these statistics, it is fair to conclude that PCPs are not satisfied with the existing referral program in Federally Qualified Health Centers.
Challenges in the existing referral workflow
The following are the most common problems faced by Federally Qualified Health Centers. Let us consider the challenges with a typical referral scenario to understand it better.
- Finding the right specialist/imaging center – Due to the increasing amount of imaging centers and specialists, it takes a lot of time and effort for the referral coordinator to narrow down the referral coordinator’s search and find the right one. It is also less likely for an FQHC to have the updated list of imaging centers and specialty practices.
- Insurance pre-authorization – The referral coordinator must check the pre-authorization requirements, health plans, etc. They must retrieve patient-specific data like the history of medications, medical diagnosis and insurance coverage. They must then send it to the insurance company to validate these records. This exhaustive process increases the burden for the referral coordination team.
- Time Spent – As referrals are handled manually, a referring coordinator spends approximately half-an-hour to one-hour for creating a referral and even more time in following up.
- Tracking the referral – Specialists are usually busy and do not have the time to inform physicians about the progress of referrals. This causes physicians to lose track of referrals. They get no information about appointments, referral loop closure, or feedback from specialists or patients.
Improve Patient Referral Workflow with HealthViewX Patient Referral Management
As per the report from the Journal of General Internal Medicine, referrals managed electronically are twice as likely to result in better referral adherence. This proves that web-based referral management optimizes patient satisfaction and care. HealthViewX has thoroughly analyzed the workflow of FQHCs. We have implemented the following features for many of our FQHC clients thus positively impacting their workflow.
- EMR/EHR integration – Our System integrates directly with electronic health records (EHRs). This enables healthcare professionals to easily obtain prior authorizations in real-time at the point of care. It also eliminates time-consuming paper forms, faxes, and phone calls.
- Insurance pre-authorization automation – There are two ways in which HealthViewX solution automates the insurance pre-authorization process. The first one is the API-based method. Through this, we retrieve information regarding the forms and communicate information back and forth between the FQHC and the insurance company. The second one is the Form Automation method. Through this, we get all payer-specific forms, fill in the necessary information and send it to the insurance company via e-fax.
- Intelligent Provider Match – The system has a smart search feature that enables PCPs to filter receiving providers according to their preferences. The list is always up to date with the newly added specialty and imaging centers which makes it easy for the PCP.
- To and fro Communication – The PCP and the center can communicate with the help of the inbuilt secure messaging and voice call applications at any time of the referral process. This allows physicians to get referral updates easily.
- Referral Analytics – Customizable dashboards and reports provide information about the number of referrals sent, referrals in various statuses, referrals that were missed, processed and pending. It gives a clear picture for the FQHC and helps them in making informed decisions.
Web-Based Referrals Encourage Patients to Engage With Your FQHC
Patients can use electronic resources within HealthViewX Patient Referral Management System to contact providers regarding questions or concerns. This feature
- minimizes unnecessary visits and re-referrals
- improves provider availability for other patients who need an in-person appointment.
Electronic referrals also enable PCPs to spend less time on administrative tasks, giving them more time to engage with their patients. Web-based referral management improves accountability and patient satisfaction while reducing costs, allowing providers to effectively close gaps in healthcare.
Automating referrals and related processes enables practices to eliminate 70% of tedious administrative duties so they can focus on improving care delivery. Patients are more likely to schedule and keep appointments when physicians are consistently available and receive accurate patient information to provide optimal care.