Referral Network & Its’ Complexity Decoded

Why generate referrals?

When a patient suffers from any illness he seeks the advice of his Primary Care Provider(PCP). If the illness lies within the PCP’s specialty he can initiate and complete the treatment – a need for the referral arises when additional tests, diagnosis, and therapy are beyond the scope of the PCP. There is also an additional need where a specialist intervention may be required for more advanced specialized treatments.

A care provider prefers to refer his patient to the practice because it increases the chances of the patient being referred back to him after additional treatment. It also helps the PCP generate more revenue by retaining the patient in his reach, thereby minimizing patient leakage. This way the PCP, imaging centers and specialists generate referrals for each other and the patient is retained in their ecosystem. There are two categorizations of medical referrals between physicians and PCPs. In-network, when a patient is referred to the practice and Out-of-network when he is referred out of the practice.

Sources of Referral

A hospital or imaging center can get referrals through multiple channels such as direct messaging, email, fax, virtual print, phone, patient walk-in etc. In a day an imaging center or hospital can have numerous referrals in hard copy or faxed option sent through emails and/or EMR.

What complicates a referral network?

There are many factors that can cause the failure of a referral. Let us take the following instances to understand why tracking a referral becomes tedious:

Dr. Anderson a Cardiologist attends to many patients in a day. He is treating a patient with cardiac arrest who fell down and suffered a fracture, he would need the assistance of an orthopedic to treat the fracture. Dr.Anderson would need to refer the patient to an orthopedic based on both their availability. The patient’s progress will have to be tracked after the referral has been made. If the patient fails to update Dr. Anderson, how would he know the status of the diagnosis?

Dr. Matthews gets a referral for asthma. He does not get the case history or the previous reports of the patient. He tries to contact the referring provider but to no avail. So he makes the patient repeat the tests to diagnose his condition and to continue with the treatment. This is a waste of time for both the patient and the provider.

Mr. Andrews is referred to a specialist from a famous hospital. As the hospital does not accept diagnostic reports from other clinics, Mr.Andrews is forced to spend money on the same tests again. He is made to wait for a long time which forces him to look for another specialist. This leads to an unclosed referral loop and patient referral leakage.

To summarize the key points,

  • Tracking a referral manually is tedious for both the referrer and receiver.
  • It is difficult for the patient to coordinate between the PCP and the specialist or imaging center

Why does referral leakage happen?

Patient leakage or referral leakage occurs more in an out-of-network referral than in an in-network referral. There could be many factors leading to patient leakage.

  1. A reputation of the Provider – Sometimes, a provider will refer their patients out-of-network in order to have them see another provider who is more reputable in a certain field, specialty, or procedure.
  2. Lack of Knowledge or Insight – Sometimes the providers are not aware of the specialists in their practice and tend to refer out of their network.
  3. Patient’s Choice – If the patient decides to move out of the practice due to unavoidable reasons then referral leakage becomes inevitable.

Why should it be curbed?

  • It is important to process and close a referral as soon as possible because the patients may be in need of immediate attention.
  • Patient referral leakage ultimately leads to unclosed referral loops.

How can HealthViewX Referral Management solution help?

The patient referral is contributing factor for patient volume in the case of imaging centers and hospitals. The current process of referral is very time consuming and tedious with no tracking and periodic updates to the referrer, patient, and the receiver. An updated system that will help make the process streamlined and seamless would enhance the overall experience of the PCP and patients and also curb the referral leakage and patient no-show rate.

How great would it be if referrals from all possible channels and forms can be brought into a single queue? That is how exactly HealthViewX works.

HealthViewX Referral management helps to implement a multi-channel referral consolidation system. Let us take an imaging center that receives referral requests. The referrals usually have an attachment in pdf form which will be non-editable. Any imaging center will have a form that has to be filled out with the details given in the referral. HealthViewX referral Management comes to play here. Using Optical Character Recognition(OCR) the information from the referral will be read and the form is prefilled with the required details. Now the referral coordinator can just validate the details and create a referral and assign it to the person concerned. The referral information can also be channelized based on the request of the user for eg: Two referrals forms can be filled in if it concerns people in different locations. The solution can be integrated with EMR/EHR/RIS and can write the updated information back the system used by the imaging center.

Impacts

  • Multi-channel referral consolidation –  Fax, Phone, Email, Online form referrals are captured, managed and monitored in a single interface
  • No change in current process – PCP’s continues to send the referrals without any change in the current process(Fax/Phone/Email/Online form)
  • OCR – Optical Character Recognition (Helps avoid manual errors and reduces the referral processing time for referrals through eFax)
  • Patient Appointment Scheduling and notification – Increase the conversion of referral to patient appointment by automated reminders and notifications for pre-requisites (through SMS and/or email)
  • Referral Analytics – Helps in making informed decisions with regards to the future investments, GTM strategy, and workforce increase
  • PCP, Patient, and Imaging Centre Communication – Streamlined and secure communication

Are you looking for a solution to solve your referral complexity? A 30-minute demo with our HealthViewX team will help. Our experts will walk you through the HIPPA compliant solution that makes the referral workflow simple but significant. Schedule a demo with us to know more about HealthViewX – Referral Management Solution

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Referral Network & Its' Complexity Decoded
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Referral Network & Its' Complexity Decoded
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There are two categorizations of medical referrals between physicians and PCPs. In-network, when a patient is referred to the practice and Out-of-network when he is referred out of the practice. Sources of Referral A hospital or imaging center can get referrals through multiple channels such as direct messaging, email, fax, virtual print, phone, patient walk-in etc. In a day an imaging center or hospital can have numerous referrals in hard copy or faxed option sent through emails and/or EMR.
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HealthViewX
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