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6 Reasons FQHCs and CHCs Benefit from Patient Referral Management Software

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. FQHC is 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.

FQHCs and CHCs provide critical primary care services to tens of millions of people each year in this country. Their role in the front-line of healthcare makes them important entry points for patients entering the broader healthcare system. Let us see how these organizations use patient referral management systems to leverage their role as an important source of patient referrals and improve the care they can provide for their populations.

  1. Minimized out-of-pocket expenses for patients

For the longest time, organizations managed outbound referrals based largely on each referring PCP’s preference for individual specialists. This worked better in the open, PPO networks that were more common in the past. Now, however, narrow networks and varied plan participation by specialists can lead to high out-of-pocket costs and irate patients if they are referred to the wrong specialist. Referral management software solves this problem.

  1. Creating a more integrated provider network

Today, many organizations recognize their referral stream is a valuable point of leverage when advocating for patient populations. FQHCs and CHCs want better customer service, quicker appointment times and better care coordination with specialists. It is high time they recognize a referral management system which will allow them to organize, quantify, and eventually shape their referral stream. Many primary care organizations have found that pleas for better coordination with specialists go unheard until a change in referral patterns was included. When a referral management system is implemented, the network is more integrated and easy to handle.

  1. Increased patient advocacy and access to care

Patients being referred from FQHCs and CHCs often have limited health insurance or no insurance coverage at all. It is a tremendous challenge for referral coordinators to find specialists who accept patients’ insurance plans (if they have insurance) and are willing to accept uninsured patients or underinsured because providers report they have much higher no-show rates, which means a loss of income for the specialist. Simply telling a patient they need to see a specialist and perhaps giving them a name and phone number isn’t enough to make a referral visit happen; it’s just the first step.

A referral management solution allows the clinic to curate and maintains a set of specialist resources that referring providers know both accept patient insurance plans and provide excellent care. This is a very essential step as it improves patient experience of the referral and increases their access to quality care.

  1. Chronic care management revenue optimization

Many FQHCs and CHCs participate in programs such as Chronic Care Management (CPT Code G0511 or 99490) or 340B. Through the clinic’s ability to track and coordinate referrals, it leads to increased revenue for the clinic, which helps them continue to care for uninsured and underinsured patient populations.

  1. Better referral workflows

Many primary care settings lack a centralized or coordinated method for managing referrals. It is common to learn that existing referral management involves the use of spreadsheets and is entirely manual. Referrals are send based on individual provider’s preferences. It is because referring providers don’t know who is in the network, nearby, available, and takes the patient’s insurance plan – but they do know who practices good medicine. This can lead to inconsistent patient experiences, more expensive healthcare overall, and deprives the clinic of taking full advantage of the referral volume they are sending into the medical community. With referral management software in place, it is easy to identify providers within the network who perfectly match the referral requirements.

  1. Improved care coordination

On average, one out of five patient appointments at an FQHC or CHC results in a referral. By definition, when a patient receives a referral it means there has been a change in diagnosis and it requires the advice of a specialist. A well-implemented referral management system helps ensure patients get the best possible access to care. It also makes the patient journey from primary care to the specialist as seamless as possible, even when providers are employed by different organizations or independent. Communication and sharing of data between different EMRs are highly impossible. This is where EMRs/EHRs tend to miss the mark.

Top 6 Reasons Why You Need A Referral Management System Even Though You Have An EMR/EHR

When an organization considers purchasing a patient Referral Management System (RMS), one of the first points management considers is whether or not its existing EMR/EHR can provide the missing functionality with an add-on, or perhaps already does but is not being used.

In general, use cases that are exclusive to employed healthcare providers working within the provider system will favor using an EMR alone. However, once an organization wants to do complex tiering of its networks and/or work with provider resources outside its organization, a Referral Management System becomes critical. 

Below, we provide the top 6 reasons a Referral Management System is a necessary tool for a healthcare system in addition to an EHR/EMR.

6. Referral Management Systems Enable Healthy Provider Network Utilization

A healthy referral network should be able to distribute referrals evenly among comparable resources in a given geography. It is essential to maintain active participation among all the providers in the network. Often a favored specialist at the top of the list keeps getting more and more referrals at the expense of others who might be just as qualified. An effective Referral Management System can provide load-balancing algorithms so that referrals are distributed evenly among comparable providers.

5. Referral Management Systems Provide End-to-End Patient Referral Tracking

Part of the clinical opportunity for referral management stems from the fact that referrals typically occur when there is a change of diagnosis or an escalation in care. As such, a referral is often the first indication that a patient will likely trigger significant downstream consumption. A well-implemented patient referral solution enables an organization to track patients in real-time and better guide patients towards high-quality low-cost care settings. Further, the system needs to encourage specialist staff to report appointment attendance or noncompliance, as well as return clinical notes to primary care offices for better patient care and better patient outcomes.

4. Referral Management Systems Facilitate Real-Time Referral Reporting

The ability to report highly granular referral analytics that illustrates referral patterns is essential for any Referral Management System. Organizations taking on risk as well as organizations optimizing referral patterns need to stay vigilant about network performance and network adequacy. Referral analytics should help organizations identify particular areas of concern as well as provide reporting that impacts referral patterns and facilitates change. Furthermore, robust Referral management software should be able to provide this data within the application itself as well as have the ability to export this data in any suitable format. 

3. Referral Management Systems Create Dynamic Referral List Based on Location

Many organizations must be able to manage referrals across large geographic areas. Indeed, the Service Level Agreements (SLAs) that many provider organizations enter into with payers as part of risk-sharing arrangements have network requirements that dictate how far away a specialist referral can be for a patient. A patient referral management solution can store the SLAs from the different payers, and then generate a geo-specific list of referral resources that can be based on the primary care provider’s location or the patient’s home.

2. Referral Management Systems Create Dynamic Referral Lists Based on Payer Selection or Plan Design

Referral networks tend to have networks within the network, where different payers or insurance plans have preferences or rules where patients can go for care. A referral management solution can generate a referral list for each patient based on the plan each patient carries.

1. Referral Management Systems Connect Healthcare Clinics Across Different EMRs

Once an organization wants to manage referrals across networks (e.g. among affiliates), chances are high that many offices will be using different EMRs. An effective referral management solution will be able to provide workflow and integration solutions that can work across multiple different EMR/EHR vendors and networks. 

How has HealthViewX added value to referring physicians’ patient referral problems?

1) Automating the insurance pre-authorization process 

HealthViewX platform has a payer management module that maintains and manages 

  • Different payer details
  • Modes of prior authorization
  • Direct authorization procedures
  • Payer forms 
  • Online portal links
  • With this information already present, it provides the referral coordinator with the capability to automate 
  • Prior authorization submission
  • Status checks coupled 
  • Fax integration

It simplifies the process of insurance pre-authorization. The referral coordinator need not waste time on the process anymore.

2) Intelligent Provider Match 

Our “Smart Search” feature makes it easy for the referring provider in finding the right provider. It has smart filters and search options that help in narrowing down the specialist based on the requirements.

3) Establishing best practices

After using our HealthViewX Patient Referral Management System, physicians were automatically alerted to

  • Appointments
  • Referral status
  • Patient diagnostic reports
  • Referral completion 

As a result, we can cut down on miscommunications and bridge the gaps between the specialist and the physician community. The system also assembles a patient encounter record from the EMR/EHR and pushes it directly to the physician.

4) Forming a close-knit of trusted referral receiving centers

Our system helps in strengthening ties with the medical community. From a history referral experiences the PCPs can from a close-knit of referral receiving providers. Physicians can now refer patients to hospitals they can rely on. 

HealthViewX Patient Referral Management solution helps the referring physicians in handling and managing their referrals. Are you an inbound referral heavy practice looking for an end-to-end referral management solution? Schedule a demo with us. Our patient referral management experts will guide you through our HIPAA compliant solution.

Why Should Federally Qualified Health Centers Give Virtual Communication Services To Their Patients?

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. FQHC is 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.

These 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. CHCs/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

Virtual communication services in FQHCs

With effect from January 1, 2019, CMS has released a new reimbursement plan for FQHCs. It says,

FQHCs can now receive payment for virtual communication services when at least 5 minutes of communication technology-based or remote evaluation services are furnished by an FQHC practitioner to a patient

The patient must have had an FQHC billable visit within the previous year, and both of the following requirements are met:

  • The medical discussion or remote evaluation is for a condition not related to an FQHC service provided within the previous 7 days
  • The medical discussion or remote evaluation does not lead to an FQHC visit within the next 24 hours or at the soonest available appointment

How can FQHCs receive payment for virtual communication services?

To receive payment for Virtual Communication services, FQHCs must submit an FQHC claim with HCPCS code G0071 (Virtual Communication Services) either alone or with other payable services. Payment for G0071 is set at the average of the national non-facility PFS payment rates for HCPCS code G2012 (communication technology-based services) and HCPCS code G2010 (remote evaluation services) and is updated annually based on the PFS national non-facility payment rate for these codes.

What is the payment rate for G0071 and G2012?

HCPCS code G0071 is set at the average of the national non-facility PFS payment rates for HCPCS code G2012 (communication technology-based services). HCPCS code G2010 (remote evaluation services) and is updated annually based on the PFS national non-facility payment rate for these codes. For 2019, the payment amount for code G0071 will be $13.69 (average of HCPCS codes G2012 and G2010).

What types of practitioners in FQHCs can furnish virtual communication services?

Technology-based communication and remote evaluation services are billable by FQHCs, only when the discussion requires the skill level of an FQHC practitioner. FQHC practitioners are physicians, nurse practitioners, physician assistants, certified nurse midwives, clinical psychologists, and clinical social workers. If the discussion could be conducted by a nurse, health educator, or other clinical personnel, it would not be billable as a virtual communication service.

What types of communication technology can be used?

Virtual communication services should be initiated by the patient contacting the FQHC by

  • Telephone call
  • Integrated audio/video system or
  • Store-and-forward method

Store and forward method include sending a picture or video to the FQHC practitioner for evaluation and follow up within 24 hours. The FQHC practitioner may respond to the patient’s concern by telephone, audio/video, secure text messaging, email, or use of a patient portal.

How can HealthViewX help FQHCs in giving virtual communication services to their patients?

HealthViewX has the following features that will enable FQHCs in giving communication services to their patients,

  1. Buy Hemp Oil Singapore Inbuilt audio and video calling apps – HealthViewX supports audio and video calling options that help practitioners in contacting their patients easily.
  2. http://turningpointacupuncture.com/?gj6=8vm7m2hkhyi Secure messaging – HealthViewX has an asynchronous messaging option that enables providers to chat with patients and discuss their health plan.
  3. https://wildworldofanimals.org/bhibiookg33 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.

With HealthViewX Patient Referral Management solution in hand FQHCs can stay in touch with their patients easily. A 30-minute demo with our team will help you know how effectively our solution can give virtual communication services to your patients. To know more schedule a demo with us.

Pros and Cons of Patient Referral Management Software: All you need to know

Advantages of HealthViewX patient referral management software

  1. Inbound and Outbound Patient Referrals – HealthViewX Referral Management Solution can integrate with both the receiving and referring end. For inbound referrals, it helps in channelizing various sources into one single queue. In the case of outbound referrals, it facilitates integration with the existing system to read the patient data and send out referrals.
  2. Referral Timeline – Any referral has a timeline, to capture and notify the progress of the referral to all the stakeholders. A referral will be mapped to a status which helps in tracking it better. With this, the providers can always be aware of how the referral is progressing.
  3. https://www.davesarcade.com/2019/09/13/7wt02lx1yed Workflow and Task Management – A workflow can be defined on how the referral flow must be(business rules – who sends it, to whom, what data must be included). Tasks can be created to manage referrals by assigning it to the respective person.
  4. http://www.himalayanecolodges.com/u0dzdumc6 Improved communication – HealthViewX Referral Management Solution supports messaging and calling features for the referring and the receiving providers to stay connected.
  5. Data Management – HealthViewX is HIPAA compliant and enables secure data exchange of all patient-related documents.
  6. https://www.hackshed.co.uk/l1nx09w Seamless Integration – Minimal disruption in the existing referral flow by integrating with any EMR/EHR/RIS or Third Party application.
  7. https://www.jollysailorsbrancaster.co.uk/ee9v57g Referral History Consolidation – The consolidated data regarding the referrals and the referral history of any patient can be printed as a hard copy at any time in pdf/excel.
  8. Smart Search – HealthViewX Referral Management solution has a smart search facility that helps in finding the right provider for the treatment required.
  9. Referral Data Analytics – Referral data-centric dashboard gives a complete view of incoming and outgoing referral pipeline, referral volume, referral status, patient follow-ups, etc.
  10. Buy Indica Hemp Oil Insurance Pre-authorization – HealthViewX supports automated insurance pre-authorization that reduces the manual work of the referral coordinators and saves 10 minutes of manual work per patient.
  11. Buy Cbd Flower Online Intelligent Provider Match – The solution supports an “Intelligent Provider Match” Feature that helps in finding the right specialist/imaging center easily based on the diagnosis, relevance, location, distance, patient preference.
  12. http://www.anrc-uk.com/r9j54r5bj8 Seamless communication – HealthViewX solution has an inbuilt audio calling and messaging application which is secure and enables faster communication
  13. HIPAA compliant data security – HealthViewX is HIPAA compliant and offers secure data exchange. It supports almost all formats of files and keeps the patient documents safe.
  14. Referral loop closure – Referral updates are hard to miss making it easier for timely referral loop closure.

Disadvantages of patient referral management software and the hindrance to its usage

  1. https://www.jollysailorsbrancaster.co.uk/p4d18qo Capital investment: Depending on the number of referrals processed and the size of the referral network, healthcare organizations are billed quarterly or annually. This is an additional recurring expense.
  2. Buy Cbd Isolate Paypal Misunderstanding that ‘EMRs are enough’. With EMR implementation being widespread across the USA, its acceptability is increasing. Most health care organizations that have gone through the process of evaluating, comparing different EMR/EHR management systems, choosing, implementing and training their staff on its usage are wary of repeating the process. They definitely see benefits from using EHR systems and feel the satisfaction of process improvement more than the urge to improve further.
  3. http://champspublichealth.com/ia3qgxcck2 Mindset – Psychologically organizations are more open to EMR EHR implementation than patient referral software and often compare the two rather than evaluate wholesome benefits.

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.

 

Three Best Practices For Large Hospitals To Improve Patient Experience Through Optimal Referral Management

It is crucial for large hospitals to build a high performing referral network as they serve a huge community by providing them services in primary care and a variety of specializations. Large organizations spend months or even years building a referral management solution for their network which appears to have the right components on paper, but the patient referral volume continues to decline.

Usually, the problem with such Large Hospitals is that they overlook small but impact operational issues that are necessary to retain patients within their network. Making just a few changes to the existing referral strategy can have a huge impact on

  • Retaining more number of patients within the network
  • The quality of care given to their patients

Here are the 3 best practice solutions that can create a high impact in improving the existing referral management process in Large Hospitals.

1. Putting the patient first to build loyalty

The primary step to retain patients within the network is to accommodate their preferences. It is important for the health system to consider patient’s preferences before initiating a referral. Most patients prefer to choose the receiving provider based on a number of convenience factors like insurance, language, availability and distance. When a patient is paired with the receiving provider who best matches his/her preferences, it is more likely for the patient to visit the provider. Also, when the patient’s experience with the referral is good, it is more likely for the patient to stay within the network.

HealthViewX Patient Referral Management Software takes care of updating your provider database with details of specialists newly added to the network. The “Intelligent Provider Match” feature allows physicians to filter and search providers based on patient’s convenience factors like operating hours, location, language, insurance, distance etc.

2. Supporting EMR/EHR Interoperability to improve care coordination

A patient may need to see a specialist in a different facility within the same hospital. In most cases, the EMRs will be different. EMR Interoperability will allow facilities to share the patient’s records in real time without compromising patient security or privacy. Providers, patients and insurers all benefit from increased access to the patient’s medical information.

Also, interoperability is an essential part of the Government’s Meaningful Use Stage 2 requirements. Meaningful Use Stage 2 will affect Medicare payouts for health care providers in stages, eventually leading to reduced payouts to all providers that take Medicare and do not follow the guidelines.

Seamless functioning between EMRs like Epic, Cerner, Athena Health, Greenway Health, Allscripts, Nextgen, etc is important. HealthViewX Patient Referral Management Software acts as a bridge and enables seamless communication of data between the referring and receiving ends.

3. Tracking referral data to know where to make changes in the referral network

Tracking referral data is often the most underestimated and impactful component of a high-performing network. By having real-time visibility of the complete referral ecosystem, health systems can gain actionable insights on how to take meaningful decisions on referral process, provider relationships, etc. Large Hospitals should be able to track referrals in various status, referral loop closures, percentage of referrals flowing in and out of network, referrals sent to different specialities, insurance provider, etc.

HealthViewX Patient Referral Management has a customizable referral-centric dashboard that helps in tracking the number of referrals and gives complete information about the referrals processed, missed, scheduled etc. It can also be customized for different locations based on the priority of the large hospital.

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

HealthViewX Blogs rated in Top 100 Healthcare Blogs

How Can Large Enterprise Hospitals Tackle Operational Problems Effectively?

Did you know? There are about 8000+ large enterprise hospitals in U.S. How is a hospital classified as a large enterprise hospital?

Hospitals which have typically 500 or more beds are categorized as Large Enterprise Hospitals. They are capable of serving the whole population in the community by offering them wide range of services related to primary care and specialties. Some larger hospitals offer a combination of acute and long-term care services while also providing research opportunities in some cases and accommodating a variety of specializations.

Operational challenges faced by  Large Enterprise Hospitals

Considering the huge number of patients in such hospitals, the patient referral volume is also high. In order to improve patient satisfaction and retain patients within their network, a large enterprise hospital must have a seamless referral process. Below are the most common operational challenges that affect the patient referral workflow in large enterprise hospitals.

  1. Buy Cheap Cbd Oil 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. They  spend millions of dollars having to migrate from one EMR/EHR to another. It is also possible that if one EHR faces a down time, the entire patient referral workflow is affected. Data security in communication between multiple platforms is crucial to protect patient interests. In a merger or acquisition, patient experience must never be compromised despite the backend operational challenges that may occur. Seamless functioning between EMRs like Cerner, Athena Health, Greenway Health, Allscripts, Nextgen, etc is important.
  2. Training their staff – Staff in each division in the hospital might be comfortable with using a different EMR system. The user interface and familiarity affects speed of operations. The health system has to train and migrate all staff to a single EMR which costs millions of dollars and time to get the staff up-to-speed.
  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, better specialist within the locality, reputation of the receiving provider, etc.
  4. https://www.sdepa.fr/non-classe/jkkpczgcg Referral leakage – Did you know? Referral leakage for large 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. Enterprise hospitals use different systems to track out-of-network and in-network referrals. There could be many factors like reputation of provider, lack of knowledge or insight and patient’s choice that lead to patient leakage.
  5. Patient dissatisfaction – Large enterprise hospitals should keep in 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. https://www.environmentalhealthproject.org/5i6nkit 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, referral loop closures, percentage of referrals flowing in and out of network, referrals sent to different specialities, insurance provider, etc.

HealthViewX Patient Referral Management Features for Large Enterprise Hospitals

In order to solve the operational challenges faced by large enterprise hospital, the process has to be improvised. This can be done with web-based referral management which will optimize patient satisfaction and care.

HealthViewX has completely analyzed the workflow of large enterprise hospitals. We have implemented the following features for many of our enterprise hospital clients thus improving their operational efficiency

  • Multi-channel referral consolidation – The HealthViewX solution can capture fax, phone, email, online form referrals or any other referrals in a single interface. It makes it easy to monitor and manage all channels of referrals in a single queue.
  • https://wildworldofanimals.org/0smuzgm Insurance pre-authorization process HealthViewX automates the insurance pre-authorization process. The provider need not coordinate with the insurance company for prior authorization. The HealthViewX solution will do it for them. This reduces the manual effort of the referral coordinators.
  • http://www.himalayanecolodges.com/ugkqwr7s Patient coordination framework – 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. Even the patient will be notified of the referral. The receiving provider can schedule appointments based on the patient’s comfort. This will cut down patient no-show rates.
  • https://www.mansmith.com/y17rws6c0 Timeline View to track referralsWith 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. The chances of a referring provider missing out on referral updates are very less.
  • Buy Cbd Oil Tennessee 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.
  • Buy Hemp Oil Singapore 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. It can also be customized for different locations based on the priority of the enterprise hospital.

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

 

Reference

https://www.beckershospitalreview.com/lists/50-largest-hospitals-in-america.html

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

https://www.beckershospitalreview.com/lists/52-great-health-systems-to-know-2018.html