Tag Archives: medical referrals

Referral Management Software For Referral Inbound-Heavy Practices

In a year, practices receive 15 billion fax referrals in the USA. Practices receive referrals through fax, online forms, direct messaging, email, virtual print, direct walk-ins, and other channels. An imaging center or specialty practice or a dental center is a high inbound referral setup. Thousands of referrals flow in every day. So they need an effective referral management solution to manage the increasing inbound referral rates.

Traditional referral process in a dental center

In a dental center, a referral coordinator has to receive, accept and process the referral requests. The referral coordinator has to manually key in and create a referral, include all the patient information into the EMR/EHR/RIS. The referral coordinator takes around half an hour to process a referral request. The rate of processing is very slow. The referral coordinator finds it difficult to process even 20 referral faxes in a day. It results in piling up requests that are not yet processed. The referral coordinator is at loss trying to contact the referring provider for missing information. Patient referral leakage also becomes imminent.

Consequences of a slow referral network

The dental center loses its revenue they do not process referrals on time.
Providers stop referring the center thereby harming its reputation.
Patients may have severe illness and may need immediate attention. The waiting time may affect their health.

Problems faced

Handling many referrals manually in a short period.
Varied sources of referral make it difficult to get a comprehensive data about the referrals flowing in.
Limited referral information makes it difficult for the referral coordinator to proceed with the diagnosis.
It takes a lot of time for the dental center to contact the referring provider for clarifications.

HealthViewX Patient Referral Management solution at your aid

Patient Referral Management is complicated not only by the different sources but also by trying to manage all the referrals manually. The current referral management is no way close to the increasing demands of the referral process. Its inability to communicate between the referring and the receiving ends makes it slow and non-feasible. Relying on EHR/EMR/RIS for managing referrals makes it a costly affair and does not fulfill the current requirements.

Electronic Referral Management has been creating buzz for some time. Many applications are looking to solve the referral process issues. Before choosing one, a practice must consider the following aspects.

Simplify data sources – Capable of handling numerous referrals from various sources and bringing it to a platform from where it can be processed.
Data security – Sensitive patient data must be secured and protected.
Data Analytics – Complete analytics of the referrals flowing in, processed, missed etc.
Timeline View – To know the history of the referral and to what status it is attached to.
Integration with scheduler – To schedule appointments for the patients.
HIPAA Compliant – Secure data exchange of patient sensitive documents.

Any dental center receives a number of referral requests in a day. The referrals usually have an attachment in pdf form which will be not editable. They will have a form that has to be filled out with the details given in the referral. HealthViewX Patient 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 for further action. 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 them.

Problems Addressed

Single Referral Workflow Queue Consolidation – It collects Fax, Phone, Email, Website form referrals and manages them in a single interface. This helps in managing the referrals better.
Timeline View – Both the center and the PCP can view the timeline data of the patient in which the referral history is present. The referring and receiving providers can attach documents and notes at any time for one another’s reference.
To and fro Communication – At any time of the referral process, the PCP and the center can communicate with the help of the inbuilt secure messaging and voice call applications.
Referral Data Consolidation – It has options for printing the consolidated data about the referrals and the referral history of any patient as a hard copy at any time in pdf/excel.
Secure Data Management – HealthViewX Patient Referral Management is HIPAA compliant. It manages all patient-related documents securely.
Referral Analytics – Helps in tracking the number of referrals and gives complete information about the referrals processed, missed, scheduled etc with the help of a Referral Data-centric Dashboard.

HealthViewX Patient Referral Management solution helps dental centers in managing their referral network and increasing their revenue. Are you a dental center looking to track your inbound referrals very effectively? To know about HealthViewX Patient Referral Management System in detail schedule a demo with our team.

Improving Patient Referral Management Workflow Between Federally Qualified Health Centers & Specialists Clinics/Imaging Centers

Federally Qualified Health Centers and what do they do

A Federally Qualified Health Center (FQHC) is a community-based organization that provides comprehensive primary care and preventive care, including health, oral, and mental health/substance abuse services to persons of all ages, regardless of their ability to pay or health insurance status. Thus, they are a critical component of the health care safety net. FQHCs are called Community/Migrant Health Centers (C/MHC), Community Health Centers (CHC), and 330 Funded Clinics. FQHCs are automatically designated as health professional shortage facilities. a non-profitable, consumer-directed healthcare organization. FQHC serves the underserved, underinsured and uninsured people, and provides them with access to high quality and preventive medical health care. FQHCs were originally meant to provide comprehensive health services to the medically underserved to reduce the patient load on hospital emergency rooms.

FQHCs include community health centers, migrant health centers, health care for the homeless health centers, public housing primary care centers, and health center program “look-alikes.” They also include outpatient health programs or facilities operated by a tribe or tribal organization or by an urban Indian organization. FQHCs are paid based on the FQHC Prospective Payment System (PPS) for medically-necessary primary health services and qualified preventive health services furnished by an FQHC practitioner.

Their mission has changed since their founding. Their mission now is to enhance primary care services in underserved urban and rural communities

Patient Referral Management in Federally Qualified Health Centers

Federally Qualified 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. Federally Qualified Health Centers do not have the facilities for giving specialized treatments or for taking advanced tests. So, when a patient requires any specialist medical attention, the PCP refers him/her to the most suitable imaging center or specialty practice.

Federally Qualified Health Centers 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 Federally Qualified Health Center and specialty care

A referral process may become inefficient and ineffective if the Federally Qualified Health Centers 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, the physician refers him/her 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 Federally Qualified Health Centers and Specialist Clinics/ Imaging Centers

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.
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.
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.
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.
Any tool that can give prompt reminders on the appointments, follow-ups to both the patient and the receiving providers can help.
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.
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.

Why Is Documenting A Medical Referral Not Easy For A Federally Qualified Health Center?

How does referral works in a Federally Qualified Health Center?

Federally Qualified Health Centers (FQHCs) are private, non-profit organizations that directly or indirectly (through contracts and cooperative agreements) provide primary health services and related services to residents of a defined geographic area that is medically underserved. Federally Qualified Health Centers are high referral outbound centers, who send out a number of referrals in a day. A Federally Qualified Health Center has many PCPs who attend to numerous patients with different health problems. The PCP initiates referrals when the patient needs an additional diagnosis from an imaging center or a specialist practice. The following are the steps through which a referral flows,

Referral Initiation – The referring provider gives the details of the patient and diagnosis to the central referral coordinating team. A referral coordinator will study the demographics of the patient and the diagnosis required.
Insurance Pre-authorization – If the patient has an insurance coverage, the referral coordinator will validate the same. This step helps in finding out which imaging center or specialist practice will cover the medical expenses.
Finding the right provider – Depending on the treatment required, insurance coverage, patient’s convenience, the referral coordinator will narrow down the search and find the right receiving provider for the referral.
Sending out the referral – After finding the right provider, patient information and the diagnosis details are shared while referring. The physicians can share the information via phone, fax, email, etc depending on the source that suits the receiving provider.

Medical referral history documentation in Federally Qualified Health Centers

Referral history gives details of what has happened with the referral till date. The referral history is equally important to both the referring and receiving providers. Unfortunately, the receiving provider maintains this history through paper-based forms or EHR and it is not easily accessible to the referring provider. Documenting a medical referral is quite a challenge for the provider who initiates the referral. So what factors make it so tedious and challenging?

Physicians get busy – After the referral is initiated, the referring provider gets busy with other appointments and forgets about the referral until the receiving provider gives updates. Not to forget the receiving provider is also a specialist or from an imaging center who will also be busy. The receiving provider or the patient fails to communicate with the referring provider regarding the progress of the referral which makes it difficult to document the referral.
Lack of effective modes of communication – There is no effective platform to share patient’s sensitive data or communicate with the referring or receiving provider. The physicians are not available over calls or messages which makes the situation worse. There is a need for a standard HIPAA compliant application that the referring and receiving providers can use to share information which helps in referral documentation.
Manual effort making the referral process tedious – The referral process has manual intervention at every stage. This frustrates the providers and the referral coordinating team. Giving timely updates to the referring provider regarding a referral is too much of effort for the receiving provider. Documenting the referral manually becomes a challenge.

Why document a medical referral?

Patient’s need – The patient may come to the clinic at any time looking for the medical history of the referral. At that point, the clinic should be able to give the patient the medical referral history. So documenting a referral becomes a necessary process.
Clinic’s records for future reference – It is important for a Federally Qualified Health Center to maintain a history of its patient’s demographics and referral records. If the patient comes back to the clinic with an illness, these records will help in understanding the patient better and giving the best treatment the patient needs.
Direct future referrals – A history of medical referral records will help the physician in figuring out who responds quickly and who does not. The next time the physician sends out a referral, he/she will choose the most responsive and the most suitable receiving provider for the referral.

Information Technology to aid Federally Qualified Health Centers

Information Technology is transforming healthcare to a great extent. Documenting a medical referral is easy for a healthcare based software application like HealthViewX. HealthViewX Patient Referral Management solution simplifies the referral process by the following steps,

Referral Initiation – The patient demographics and diagnosis required are already in the application. The referral coordinator can create the referral through a simple three step form which includes insurance pre-authorization, finding the appropriate receiving provider with the help of “smart search”, etc. The receiving provider is notified of the referral.
Referral status and timeline view – With the status, a referral is tagged to, the referring provider can get to know in what stage the referral is. A timeline view shows a history of stages through which the referral has progressed.
Referral and timeline view reports – The timeline view and the referral analytics data can be generated as a report in any form chosen.
Referral closure and feedback – If the referral is completed, the status can be changed to closed. A feedback form is generated for the patient and the receiving provider. This can help the referring provider in making the referral process better next time.

HealthViewX Patient Referral Management solution smoothes out the referral process and reduces the burden of the referring and the receiving ends of Federally Qualified Health Centers. Do you want to know more about HealthViewX Patient Referral Management solution? Schedule a demo with us.

How can Federally Qualified Health Centers Ensure The Progress Of Patient Referrals?

Federally Qualified Health Centers are community-based health care providers that receive funds from the HRSA Health Center Program to provide primary care services in underserved areas. They must meet a stringent set of requirements, including providing care on a sliding fee scale based on ability to pay and operating under a governing board that includes patients.

The scope of services of a Federally Qualified Health Center

Basic Health Services
- Health services related to family medicine, internal medicine, pediatrics, obstetrics, or gynecology that are furnished by physicians and where appropriate, physician assistants, nurse practitioners, and nurse midwives;
- Diagnostic laboratory and radiologic services;
- Preventive health services
- Emergency medical services
- Pharmaceutical services as may be appropriate for particular centers
Referrals to providers of medical services and other health-related services;
Patient case management services (including counseling, referral, and follow-up services) and other services designed to assist health center patients in establishing eligibility for and gaining access to Federal, State, and local programs that provide or financially support the provision of medical, social, educational, or other related services;
Services that enable individuals to use the services of the health center (including outreach and transportation services and, if a substantial number of the individuals in the population served by a center are of limited English-speaking ability, the services of appropriate personnel fluent in the language spoken by a predominant number of such individuals);
Education of patients and the general population served by the health center regarding the availability and proper use of health services
Telehealth/Remote long-distance health services
- The CARES Act that has been established in response to the COVID-19 pandemic authorizes FQHCs to provide telehealth services
- This act removes the previously existing barriers that restricted the scale of services that physicians and practitioners could exchange to patients remotely
- Price has been set at $92 for claims with the code G2025

Patient Referral Program in a Federally Qualified Health Center

Federally Qualified Health Centers constitute Primary Care Providers (PCP) who serve the underserved population. FQHCs are high outbound referral setups i.e they send out numerous referrals. A patient visits the clinic when he/she is suffering from an illness. Depending on the severity, the physician might refer the patient to an imaging center for further diagnosis or a specialist practice for advanced treatments.

An FQHC is recommended to have a dedicated referral coordination team to send out referrals and ensure effective referral coordination. With the help of the patient demographics and diagnosis details, the referral coordinator reviews the insurance prior authorization 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. Finally, the referral is sent to the relevant imaging center or specialty practice.

Challenges faced

The referral creation involves tedious manual work due to the following reasons.

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.
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.
No Updates – After a referral is sent, both the referring and the receiving providers may not be updated on the referral progress. In other words, the specialist/imaging center and the patient fail to update the clinic on the progress of the referral resulting in open referral loops.

Why are referral updates important to a Federally Qualified Health Center?

The patient’s well being – The primary role of a physician is to check on his/her patients’ health. Therefore, it is essential for a provider to know the status of the referral, the appointment, the patient’s condition, or illness.
Referral loop closure– Open referrals are a result of the referring provider not being updated on the referral’s progress. The ultimate aim of a referral process is to give the patient better treatment. Closing a referral loop is very important because it indicates that the patient was taken care of.
Data Analytics – PCPs require concrete data of how many referrals were converted to an appointment by a specialty care or an imaging center. It will help in analyzing who responds quickly and to whom the PCP can direct future referrals.
Referring to the right person – Depending on the progress of the referral and the patient’s feedback, the physician can get to know how good or bad the referral process has been. This will help the physician in knowing what step to take next.
Schedule follow-up appointments – After the referral is done, the physician has to schedule an appointment for the patient. For eg: If the physician is referring his patient to an imaging for X-ray, the physician must be notified once the test is done so that he can schedule an appointment and give treatment to his patient depending on the results. Structured appointments scheduled in a well-managed referral system is a constant source of new patient revenue.

Monitor your referral pipeline better with the HealthViewX solution

The major problem with an FQHC not getting updates is that everything is manual. A software solution can solve this problem quite easily. HealthViewX Patient Referral Management solution enables a referral in three simple steps thus providing a successful referral program. After the referral is created, it can be tracked with the help of the status. Both the referring and receiving providers will be notified of the appointments, test results, treatment recommendations, etc. HealthViewX can integrate with EMR/EHR and can also coordinate between the referring and the receiving sides. Any referral has a timeline view which is common to both the receiving and the referring providers. In the timeline view, history of the referral can be seen for eg: notes related to the patient’s health, previous status of the referral, etc. Documents attachment and status change can also be done at any time of the referral process. HealthViewX Patient Referral Management solution can allow providers to be updated on the progress of the referral. This helps providers simplify the referral process and close the referral loop.

HealthViewX Patient Referral Management solution helps the referring provider to track the referral progress. Schedule a demo with us and our patient referral management experts will guide you through our HIPAA compliant solution.

Reference

(source:http://ldh.la.gov/index.cfm/page/797)

Ten Advantages A Referral Management Software Should Provide

Referral Management Process in healthcare

Patient Referral Management in healthcare plays a vital role in treating patients. The physician identifies the need for a referral and sends it to the most relevant imaging center or specialty practice. A patient referral goes through the following steps,

Referral Initiation – The referring physician identifies the need for a referral and initiates medical referrals.
Insurance Pre-authorization – If the patient has an insurance coverage, the referring physician has to validate the same. The physician must do this to find the imaging center/specialist care practice comes under the patient’s insurance coverage.
Finding the right provider – Depending on the treatment required, insurance coverage and patient’s convenience, the physician will narrow down the search and find the right receiving provider for the referral. Dr.Miller is a primary care physician. A patient visits his clinic complaining of chest pain. After the initial diagnosis, the physician refers him to a specialist for better treatment. The referring physician looks for the best cardiologist in the city. Considering the patient’s and specialist’s comfort, the referring physician initiates the referral.
Sending out the referral – After finding the right provider, the referring physician shares the patient information and the diagnosis details with the receiving provider. The referral is sent via phone, fax, email, etc depending on the source, the receiving provider is comfortable in getting the referrals from.
Following up with the referral – After the receiving provider receives the referral, the specialist may communicate with the referring physician for missing information. The physician should get things sorted and continue with the referral. The provider should schedule appointments with the patient and follow-up with the same. The specialist should give the referring physician timely updates on its progress.

The referral process is quite demanding for the physicians. Communicating and giving timely updates is not easy with the current workflow. Considering the complexity of referral networks, an effective Referral Management Software is the need of the hour.

Ten Advantages a Referral Management Software should Offer

The current process of referral is very time-consuming and tedious. It has no tracking system or cannot give periodic updates to the referring physician, patient, and the receiving provider. An updated electronic referral management system is required to streamline the referrals. It would enhance the overall experience of the PCP and patients, curb referral leakage and patient no-show rate. A Referral Management Software reduces manual intervention and makes the process simpler. It should offer benefits that will improve the physician-specialist equation, improve hospitals’ operational efficiency and increased revenue. The hospital must consider the following benefits before choosing a Referral Tracking Software,

Multichannel Referral Consolidation – The receiving provider gets multi-channel referrals through sources like FAX, online forms, direct messaging, email, virtual print, direct walk-ins, etc. An Inbound Referral setup must have a Referral Management software that consolidates all referrals into a single queue. After the first step of multi-channel referral consolidation, it is easier to process the referrals.
Reduced Referral Leakage – Referral Leakage is the single huge problem faced by high referral inbound setups. Referral leakage for any health system is between an average 55% to 65%. This, in turn, leads to high revenue loss. A Referral Management Software should ease the processing of several referrals on time. The Referral Tracking Software must help in finding the right specialist and also make sure that no tests are repeated. The Referral Management Software must make the patient documents available to both the referring and receiving physicians. Scheduling patient appointments and following up to see if the patient completed a referral visit will reduce the referral leakage.
Increased Operational Efficiency – It is the efficiency of hospital staff to manage referrals and check the progress of the treatment. A Referral Tracking Software must make the process simple by reducing the time spent on referral initiation. The software must make referral information available to both the referring and receiving physicians. Multi-channel referral consolidation, specialist smart search and increased referral tracking will improve operational efficiency.
Automated Scheduling – The Referral Management Software must support an inbuilt scheduler. It schedules automated appointments with the patients and gives prompt reminders to the patient and the physician. This will never let a patient or physician miss their appointments thus reducing patient no-show rates. It helps the physician manage all their appointments on time. It thus leads to reduced patient referral leakage.
Improved Referral Tracking – Manual referral tracking is a tedious job for hospitals. The referring physicians are least informed about the progress of the referral. This affects referral completion and referral loop closure. The Referral Management Software must always keep the referring physicians informed about the referral’s progress.
Referral Completion – 25 to 50% of referring physicians do not know if their patients actually visit the specialist. Referral loop closure is very important for the referring physicians. Referral completion cannot happen when the referring physician is not informed about the progress of the referral. The Referral Management Software must aid in referral completion by providing a secure platform for the receiving and referring physicians to communicate. Referral tracking and feedback for the referral from the receiving physician aid referral loop closure.
Streamline the Flow of Referral – A Referral Management Software must streamline the flow of referral. It should consume less time for each step with minimal efforts of the patient, receiving and referring physicians.
Enhanced communication between PCPs and specialists – The primary care physicians and the specialist find it difficult to communicate about referrals. The physicians may need to communicate for missing referral information, referral tracking or referral completion. The referral tracking software must have inbuilt messaging, audio and video calling features to enhance the communication between the primary care physicians and specialists.
Improved Patient Satisfaction – The patient faces difficulties in acting as a bridge between the referring and the receiving medical care physicians. This leads to patient dissatisfaction and patient referral leakage. Timely response to referrals, minimal diagnosis, and full insurance coverage improve patient’s experience with the referral. A Referral Tracking Software must cut down patient waiting time, improve the relationship between PCPs and specialists and the overall patient satisfaction. Improved patient experience directly results in increased revenue.
Complete Referral Analytics – The Referral Management software should give complete data of the referrals flowing in and out of the network. Visualized data in the form of graphs, tables, charts, etc help in tracking the referrals in the pipeline. It helps in scheduling patient appointments with available documents. It gives a comprehensive data of the number of patients with various referral status and follow-up reminders for a day. The physician can customize the dashboard to show the preferred receiving physicians, the average revenue generated per patient referral, etc.

HealthViewX Patient Referral Management solution features

HealthViewX Patient Referral Management solution has features that best suit a hospitals’ Referral Management System.

Seamless communication – HealthViewX solution has an inbuilt audio calling and messaging application which is secure and enables faster communication
HIPAA compliant data security – The solution is HIPAA-compliant and offers secure data exchange. It supports almost all formats of files and keeps the patient documents safe.
Referral history – The timeline view provides the history and current status of the referral. A status helps in knowing the referral progress.
Data Analytics – A comprehensive dashboard helps to track the number of referrals in the queue and shows the number of referrals in different statuses. This helps in knowing how fast the referrals are getting closed.
Report Consolidation – The data regarding the referrals and timeline view can be printed as a report anytime in pdf/excel form.

With HealthViewX Patient Referral Management solution in hand managing a referral life cycle is very easy. A 30-minute demo with our team will help you know how effective our solution can track and manage the referral life cycle. To know more schedule a demo with us.

Reference

https://www.mass.gov/files/documents/2016/08/uy/2011-hcctd-full.pdf

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3160594

How To Control Patient Referral Leakage In Your Referral Network?

Health providers in a health system need patients to run their practice profitably. Be it a hospital, health network or private practice, healthcare providers rely on incoming referrals from other health providers and entities. Referrals generate revenue and improve patient retention rate. Providers tend to refer patients to specialists within the same hospital or health network. This is to retain them in the same hospital. A provider should consider factors such as personal relationships, quality outcomes, proximity, insurance coverage and patient preference before referring a patient. When a provider fails to consider these, patient referral leakage is bound to happen.

Patient Referral Leakage

Patient Referral Leakage happens when healthcare providers refer patients out-of-network. Accordingly, patient leakage is sometimes known as network leakage or referral leakage. The following definitions will help in better understanding of patient leakage,

In-Network – In-network refers to medical care within a network of doctors, hospitals, and other health providers who have a contract with a health insurance company. Inside the network, patients seek medical care only from those providers who are under the terms of the health insurance. In-network care is cheaper due to discounted rates that a health insurance company has negotiated ahead of time with the various health networks.
Out-of-Network – Out-of-network refers to patients looking to get medical care outside their current health network. This means that the patients seek care from out-of-network providers who cover their health insurance. Health providers refer patients seeking advanced treatment out-of-network. This is the main reason for patient leakage.

Why does patient referral leakage happen?

Sometimes patient referral leakage is unavoidable. When patients need medical care that is unavailable in their network, the health provider must understand the patient’s needs. The health provider must refer the patient to a specialist or an imaging center depending on the need.

However, there are occasions where in-network providers may refer patients to out-of-network providers on purpose.

Provider’s Repute – Sometimes, a health provider may refer their patients out-of-network to another provider who is more reputable in that specialty. This could be because the current health network has not employed a reputable specialist. The provider must make sure that a patient gets the best treatment possible.
Unaware of Providers in their network – Health providers who have just joined a health network or are a part joint ventures, acquisitions do not know all their specialists. This causes confusion and the health providers refer the patient out-of-network. When a health system fails to make it easy for health providers to refer within the network, patient leakage is inevitable.
Patient’s Choice – When certain treatment or care is not available within a network then it is up to the provider to refer the patient out-of-network. The health provider may recommend a next best course of treatment and the provider to consult for advanced treatment. Patients do tend to take the provider’s advice but it is up to the patient. This is why certain amounts of patient leakage will always exist. If the patient decides to move out of the practice due to unavoidable reasons then referral leakage becomes inevitable.

Why should it be curbed?

Patient’s Benefit – The patient may need immediate care and attention. So processing and closing it at the earliest will be the best for the patient. Patient leakage leads to open patient referral loop which will affect the patient’s health.
Patient’s Experience – A patient moves out-of-network due to many reasons. Primarily it is because the patient is not satisfied with the medical care provided in the current health system. Patient’s bad experience has a direct effect on hospital’s revenue, the number of incoming referrals, patient crowd, etc. In order to give efficient care to the patients, a health system must prevent patient leakage.
Missed Revenue and Reimbursement opportunities – The main problem with patient leakage is the missed revenue opportunities for health systems. These organizations miss out on reimbursement for medical services that they had provided earlier when patient leakage occurs. This applies to healthcare systems that adopt value-based care or payment models such as accountable care organizations (ACOs).
Failed relationships with healthcare providers and patients – Patient leakage results in failed relationships with healthcare providers and patients. Many health systems have spent resources on building clinical alignment with their referral network. Unfortunately, when patients go out of the system providers lose their trusted receiving providers.

How to tackle Patient Referral Leakage?

Employing right providers – Organizations can cut down patient leakage by employing respected, experienced, and well-regarded providers that they. This will cut down the number of patients who voluntarily go out-of-network. This is because they will find the right provider in their network.
Clear communication between physicians and patients – Clear communication between providers and patients is key to creating a positive patient experience and engagement. A health system can decide to give patients control of their own health by implementing an e-consult software. It should allow patients to schedule their own appointments, talk to providers online, order prescriptions, etc.
Being transparent in all aspects – The health system must be transparent about prices and pricing structure with the patients. Healthcare providers should give upfront estimates of costs and detailed end-of-care financial statements. Quality metrics is the other part that health networks must make readily available to the patients. It includes patient outcomes, patient satisfaction scores, physician reviews, etc. Ease of use and timely access to best care are crucial aspects of the patient experience. In a health system, it is important for a patient to receive medical care easily and in a timely manner.

How can HealthViewX Referral Management solution help?

Information Technology is transforming healthcare to a great extent. Patient referral leakage never happens with the help of a software application like HealthViewX. HealthViewX Patient Referral Management solution simplifies the referral process by the following steps,

Referral Initiation – The patient demographics and diagnosis required are already in the application. The referral coordinator can create the referral through a simple three-step form which includes health insurance pre-authorization, finding the right receiving provider with the help of “smart search”, etc. After finding the receiving provider, the referral coordinator refers the patient. When the receiving provider receives the referral, the provider will get notified of the referral.
Referral status and timeline view – With the help of a referral status, the referring provider can get to know what stage the referral is. A timeline view shows a history of stages through which the referral has progressed.
Referral and timeline view reports – The health provider can generate the timeline view and referral analytics data as a report in any form.
Referral closure and feedback – The referring provider can close the referral when it gets completed. The receiving provider and the patient can give a feedback on the referral process to the referring provider. Thus the referring provider can make it easy for the other the next time.

HealthViewX Patient Referral Management solution smooths the referral process and reduces the burden of the referring and the receiving ends. Referral Management software cuts down patient referral leakage to a considerable number. Do you want to know more about HealthViewX Patient Referral Management solution? Schedule a demo with us.