Tag Archives: patient

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,

  1. 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.
  2. 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.

  1. 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.
  2. 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.
  3. Patient’s ChoiceWhen 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,

  1. 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.
  2. 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.
  3. Referral and timeline view reports – The health provider can generate the timeline view and referral analytics data as a report in any form.
  4. 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.


Why Should A Physician Share A Good Relationship With The Patient?

 A physician attends to many patients in a day. But for a patient, the major concerns are about the severity of the illness, the quality of the treatment, etc. Patients expect the physician to diagnose the problem accurately and wants the best care possible. The ultimate goal is to get relieved of the illness as soon as possible. The physician must be interactive with the patient and it is important for the patient to cooperate with the physician to recover soon. So the relationship a physician shares with his patients is very important.

Factors affecting the physician-patient interaction

A patient wants to be taken care of and be able to frequently communicate with the physician. The physician also likes to engage with his patient and make the treatment easier but it is not easy always. So what are the factors that affect the interaction between the patient and the physician?

  • Physicians get busyPhysicians are always busy. Remembering the diagnosis of every single patient is close to impossible. He might forget what the patient is suffering from and will ask the same questions to the patient which can annoy the patient. The physicians being busy may not always follow-up with the patient. Instead, the physician will have a nurse to do that for him.
  • No effective modes to communicate – The system of care is still stuck with paperwork and following up or interacting with the patient is more of a documentation work than inquiring his well-being. There are no effective means to communicate with the patient. Following up manually is always prone to errors and leads to patient dissatisfaction.
  • Unable to reach physicians – Patients may always have to come to the hospital for even small problems as the physician is unavailable over phone calls or messages. It makes it difficult for the patient to get in touch with the physician every now and then.

These factors lead to care fragmentation and affect the health of the patients and also damage the reputation of the provider. Care fragmentation will ultimately lead to frustration between the patient and the provider.

Tips to strengthen physician-patient relationships

Following are five tips to strengthen physician-patient relationships,

  1. Follow-up appointments
  2. Get Feedback
  3. Being available at all times
  4. Staying in touch
  5. Embracing Technology
  • Follow-up appointments – Scheduling follow-up appointments with a patient after discharge is very essential for continued conversation between doctor and patient. It can help in having a check over patient’s health and also improve physician-patient relationships. Follow-up appointments need not be a  face-to-face visit always. The physicians’ can follow-up with their patients through audio or video calls eliminating the effects of poor communication in healthcare. A software to manage appointments and patient demographics can be a very useful physician communication strategy.
  • Get feedback – A lesser known tip for strengthening physician-patient relationships is by getting feedback from the patients. Feedbacks can be taken through a patient survey on the quality of care and treatment, phone calls, personal conversation with the patients, etc. Feedbacks can be useful in improving patient-physician relationship, knowing how good the service is and the areas for improvement.
  • Being available at all times – The physician must be available over calls or messages. This will make it easy for the patients to reach out to the physicians at the time of need. A nurse can also assist and bring it to the doctor’s attention if required.
  • Staying in touch – Though there are no appointments scheduled with the patient, it is always good to have a team of nurses following up with such patients occasionally. This will make the patient feel good about the physician and thus the patient-physician relationship will improve.
  • Embracing Technology – Technology is simplifying healthcare. With the help of a software, scheduling follow-up appointments, improving network connections, getting feedback from the patients, marketing a hospital, etc are made easy.

What HealthViewX solution offers?

HealthViewX Care Management Solution can help the physicians to check on their patients’ health even after hospital discharge. It results in effective communication within the practice and also between the provider and the patient thus improving the physician-patient relationship. The following are the key aspects of HealthViewX Care Management Solution.

  • Care plans to enable remote care – A provider can create a care plan for a patient depending on the vitals, treatments, measurements, etc that need to be tracked. The patient-centric application helps in logging data for the vitals specified in the care plan. If needed the care plan can also be printed.
  • Customizable dashboards to suit the need – Dashboards comprising of graphs and tables show a comprehensive data of the number of patients in different care plans depending on the patient diagnosis.
  • Scheduler to keep track of the appointments – An inbuilt scheduler keeps track of the appointments and sends timely reminders to both the patient and the provider. The chances of missing out an appointment are very less.
  • Audio and video calling features – HealthViewX Care Management solution support inbuilt audio and video calling features which help in connecting with the patients for follow-ups.
  • Patient-reported data – Patients can record data for all attributes in the care plan. Summary graphs and table data helps the providers in monitoring the patient vitals. The patient records can be anytime printed in pdf or excel report form. 
  • Health device integration – HealthViewX Care Management solution can integrate with any wearable device like Fitbit, apple watch, etc. Hence the patients need not waste time in logging data in the application if they are already using wearables.

HealthViewX Care Management Solution provides real-time communication between the patients and the providers thus enhancing the relationship between them. Schedule a demo with us to know HealthViewX HIPAA compliant Care Management solution better.

Community Clinics Missing Out On The Progress Of A Referral – Know More!

What are Community Health Centers and what they do?

Community Health Center (CHC) in the United States is a non-profit entity comprising of clinical care providers, that operate at comprehensive federal standards. The care providers in CHC are a part of the country’s health care safety net, which is defined as a group of health centers, hospitals, and providers who are willing to provide services to the nation’s needy crowd, thus ensuring that comprehensive care is available to all, regardless of income or insurance status. CHC is a dominant model for providing integrated primary care and public health services to low-income and underserved population. There are two types of CHCs, one receives federal funding under Section 330 of Public Health Service Act and the other meets all requirements applicable to federally funded health centers and is supported through state and local grants. To receive federal funding, CHCs must meet the following requirements.

  • Be located in a federally designated medically underserved area (MUA) or serve medically underserved populations (MUP)
  • Provide comprehensive primary care
  • Adjust charges for health services on a sliding fee schedule according to patient income
  • Be governed by a community board of which a majority of members are patients at the CHC

Patient Referral Program in a Community Health Center

Community Health Centers constitute Primary Care Providers (PCP) who serve the underserved population. CHCs 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 to a specialist practice for advanced treatments.

Any Community Health Center will have a dedicated referral coordination team to send out referrals and take care of the community care coordination program. With the help of the patient demographics and diagnosis details available, the referral coordinator will go about doing the insurance preauthorization and finding the right imaging center or specialty practice for the patient. After that, the coordinator will create 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.

Challenges faced

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

  • Finding the right specialist/imaging center – The number of imaging centers and specialist practices is increasing day-by-day. 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.
  • Time Spent – As the referrals are handled manually, a referring coordinator spends about half-an-hour to one-hour for a creating referral on an average and even more time in following up the same.
  • No Updates –  After a referral is sent, both the referring and the receiving providers get busy. It is not possible for both of them to be updated on the referral progress. So the specialist/imaging center and the patient fail to update the clinic on the progress of the referral. This results in open referral loops.

Why are referral updates important to a clinic?

  1. The patient’s well being – Any physician would always want to check on his/her patients’ health. So it is essential for a provider to want to know if the receiving provider accepted the referral, scheduled an appointment with the patient, the patient recovery status, or how severe is the illness, etc.
  2. Referral loop closure– Open referrals are a result of the referring provider not getting to know 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 indirectly proves that the patient was taken care of.
  3. Data AnalyticsPCPs 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.
  4. 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 to whom he can refer and to whom he should not.
  5. 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.

Be updated about referrals with the HealthViewX solution

The major problem with a Community Clinic not getting updates is that everything is manual. A software solution can solve this problem quite easily. HealthViewX Patient Referral Management solution enables creating a referral in three simple steps thus providing a successful referral program. After the referral is created, it can be tracked with help of the status. Both the referring and receiving providers will be notified of the appointments, test results, treatment recommendations, etc. The system 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 always keep you updated on the progress of the referral thus simplifying the referral process and helps in closing 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.

Referral – What a PCP and Patient need to know!

Communication is a critical aspect of healthcare. Most healthcare providers across the country have systems, processes, and procedures implemented to ensure smooth flow of communication. However, such innovations are largely focused on improving in-facility communication, resulting in poor communication between facilities.

The ability to send and receive information between facilities can not only improve the patient healthcare outcome but also enhance healthcare efficiency. A referral management software would simplify procedures between primary care physicians and patients. It would also help PCPs to closely monitor the progress or the outcome of the patients who are referred to a specialist.

Problems With Conventional Referrals:

  1. Physician refer patients but cannot follow up
  2. Lack of communication between primary physicians and patients
  3. Patients not meeting the referred specialist
  4. It is impossible to send follow-up information

The existing problems listed above highlight the Complexity in current referral procedures. The root of these issues can be traced to the physician’s practice because they are the ones who initiate a referral.

Here are some key points that PCPs are expected to validate before sending out a referral to a specialist.

Get to Know Your Patients More

Knowing a patient is as important as knowing about the problems they have. The patient outcome should be foreseen before a referral is made. Most patients visit one PCP whom they trust to a great extent. If the referral process does not meet their expectations, the patients may seek alternative options.

In some cases, patients get the second opinion from another physician after getting suggestions from a specialist. This scenario happens quite often despite being a reverse process. This shows the importance of PCP in the referral cycle as it is their responsibility to ensure patients’ smooth transition and get the required care.

Do Patients Really Need Specialists?

Once a patient selects their PCP, they generally don’t see any other physician or specialist unless a need arises. Here PCPs are the generalists who take full responsibility for their patient. Before getting a patient to step into the specialist’s office they must identify a clear need for the specialist’s visit.

Also, general practitioners could solve many of the patient’s problems without the need for a specialist’s help. Only in some cases do physicians require additional visits to identify the problem. If after multiple visits they cannot diagnose the problem they will send patients to a specialist at the time of need as they are primarily liable for their patient’s care.

Managing the Referral

To avoid any delay in patient diagnosis, some physicians make referrals frequently. But referring more does not mean it is the optimal approach.

Most referrals happen within the network. Physicians send patients to specialists who are known to them and these specialists can easily follow up to them, which helps in closing the referral loop. When this process does not go as planned then the PCP will stop referring to that particular specialist as referral closure is important to identify the patient’s health status.

Key points a patient must be aware of:

  1. Referral is an important process in healthcare
  2. Referral success partially depends on patient cooperation
  3. The referral will require some patient-related data transfer and some methods of data transfer are safer than others.

How Not to Share Patient Information For Referral

The medical referral process is an important part of ambulatory care in the US. Medical referrals have a direct connection to patient health outcome and the provider’s revenue flow. Patient-specific information and the need to keep it safe is even more important.
To protect patient information from falling into the wrong hands, healthcare providers use various procedures and processes to ensure maximum security but when it comes to referral workflow there are no standard procedures nor any secure technology to ensure information safety.

Gigabytes of patient records are compromised each year because providers do not have processes, the required technology or is unaware of HIPAA regulations. Here is how not to share patient information during referral.

Email Is Not What You Think It Is:

Many providers rely on emails to send and receive patient information instantly. Emails are easy and a lot faster than faxes but the problem with emails is that the files sent through with emails are generally un-encrypted when transmitted or when saved leaving patient information sensitive to theft. Using emails to share patient-related data is against HIPAA compliant and according to HIPAA, the provider is held responsible for any breach.

Beware Of Faxes:

Faxes are the most common format to send and receive patient information between practices. Regular faxes are affected by the problem of encryption; since these files are not encrypted, this information could be accessed by an individual with access to phone lines and basic knowledge of the system. Faxes are slow and time-consuming and do not support all type of file formats. Received faxes are usually kept in the machine for some time exposing patient information to unauthorized people. Faxes leave a paper trail of patient information which will practically result in making EMR/EHR systems useless.

Triplicate Form:

Although triplicate forms sound straightforward, practically triplicate forms transfer the process of referring a patient from provider to patient or patient’s skin. The patient is left with the challenge of coordinating between physician offices – calling referral coordinators, faxing files to specialists’ office. Often a patient will have to request an appointment with multiple specialists which means sending sensitive patient information to specialists office who may not be taking care of the patient at all.

Sharing patient information is crucial in the medical referral process, but the systems that the healthcare providers use are incompetent to do a fast transfer of patient file and transfer it securely to authorized providers.
Hospitals need to establish clear-cut procedures in case of sharing patient information. Such a procedure should be able to track the flow of patient data and establish standard norms and practices to minimize the possibilities of compromising data.

Referral Software To Reduce Medical Errors & Repeated Efforts

With time and a strong push from Information technology, the healthcare industry is evolving. Every year, health IT companies bring new devices and tools aimed at reducing the burden on healthcare providers.

One particular healthcare industry problem that still seems to be elusive to the prowess of technology is medical errors. Essentially, Medical Errors are preventable negative effects of diagnosis or treatment.

Previously errors occurred because of improper utilization of data. Nowadays errors are made due to over-utilization of data. Physicians who preferred to use hi-tech devices are now afraid to use it. They are afraid because practices now use Electronic Health Record (EHR) and if one fails to update, the entire people involved in care will face difficulties.

In the USA, except for few practices, others have already implemented EHR system. These records are used to treat, refer, and to make all important clinical decisions. Physicians are put in a situation to handle too many data having a chance of causing errors. Most of the medical errors are made by physicians while utilizing these records in their busy schedule and these mistakes are directly tied up with patient records.

Likewise, errors are also made while referring a patient. Sometimes there is a possibility of sending wrong data while referring a patient. These incorrect referrals are found when referral coordinators call the wrong patient to confirm the appointments. At the same time, the concerned patient who needs a specialist visit will be waiting for the call to fix an appointment. This small error adds up over-time to cost-time, effort and money.

Repeated procedures are also another problem that contributes to the additional cost to patients which is not yet addressed by many hospitals. Patients are often requested to run repeat diagnosis and tests.

As requested patients will also repeat certain tests multiple times unknowingly by putting themselves in danger. Tests like CT scan and other imaging causes exposure to some radiations. By taking these tests multiple times they will end up with the high risk of getting cancer. Procedure repeat could be avoidable when all scanning image records are synced with an EHR. Timely update of all the patient-relevant details into their EHR will help to develop a better workflow.

The poor integration of EHR technology or medical device within a hospital is also noted as a potential cause of medical errors. Also, patients keep switching the network when they don’t find the right specialist. A practice with referral software will help to solve this problem.

A referral software enables smooth communication between the specialist and the PCP, PCPs will receive information back from the specialists. Improved communication with the help of referral solution could reduce medical errors and curb repeated tests and diagnosis.

A Referral Management Solution can Help the practice too,

1. Identify the right specialist
2. Closes communication gaps if any by enhancing the doctor-patient communication
3. Increase the utilization of medical records
4. Makes process simpler and effective
5. Reduce effort, time and repeated tests
6. Decrease wait time and scheduling problems