Tag Archives: referral

Solutions That Help Hospitals To Increase Referral Profitability

Did you know health systems or hospitals lose up to 60% of patients to another hospital due to inefficient referral process?

What Hospitals Need To Do To Increase Referral Profitability?

Today most of the healthcare systems are functioning in silos due to disparate systems that do not communicate with one another effectively. It is a well-understood fact that the current referral process makes it difficult for patients to get the care they need. None of the health systems can afford to lose more than half of their revenue to referral leakage effects. However, with the advent of new healthcare technology, it is possible to improve overall efficiency, increase referral profitability and improve patient outcomes.

Health systems are now pursuing strategies to improve patient flow such as orchestrating the entire referral process. Rethinking patient referral workflow in hospitals is vital to improve patient experience, make operations more effective and increase referral profitability. They are thinking beyond departmental boundaries about the entire journey of the patient in the process, how patient appointments are made and how their clinical information are fetched/ tracked and how the referral loop is closed. It is highly important that they seal referral leakage, reduce no-show rates to increase referral profitability.

Three Major Reasons For Referral Leakages

Poor patient-provider communication: Effective communication between patient-provider has the potential to enhance patient satisfaction and health outcomes of the patient. On the other hand, poor communication can hamper the relationship and lead to referral leakage.

Lack of Provider-to-Provider Communication: All providers involved in patient care need to have a better and convenient medium of communication. Referrals through multiple channels can actually lead to poor referral management and cause referral leakage. Providers need to have a secure HIPAA compliant solution.

Complex Workflow: It is important for the workflow to be smooth and keep track of patients’ right from the time a patient is referred until the referral loop closure.  

The one-key solution to increase referral profitability and address all of the above would be to implement an end-to-end referral management solution. Analyzing the referral patterns can help yield more revenue opportunities and increase referral profitability. Understanding patient behavior, communication among physicians, practices, and locations is key in the referral process. Overall, effectively tracking the network should help patients and providers with informed decisions.

Two main attributes that health systems need to look for while choosing a referral solution are

Interoperability for new technology in unexpected ways in integrating with any EMR/EHR

Sustainable design and product features, which can solve the current challenges in the referral process

Product features that health systems need to look for while choosing a referral solution are

Multi-channel Referral Consolidation: Referrals from various sources need to be brought into a single queue for an easy process of referrals and this can help in avoiding referrals getting missed in the process.

Automated Insurance Pre-authorization: This process is an arduous time-consuming task and can affect the clinical outcomes of patients, doctors, and specialists. An automated insurance pre-auth can save time and help in processing more referrals.

Finding the right receiving provider within your network: Many health systems/ large hospitals are joint ventures or acquisitions. Finding the right specialist within the network may be a challenge as PCPs and specialists may not be aware of all the specialists within the network. A feature like this can help find the right provider.

Dashboard and Referral Analytics: It is difficult to track all referrals that flow in and out of the network. A referral analytics dashboard will help in understanding the referral patterns, a number of referrals and many more data for informed decision making.

Patient Coordination Framework: A patient-centered care coordination is required for better clinical outcomes and to reduce no-show rates. This feature will help patients, receiving providers and the referring providers are updated through the process until the referral loop closure.

With the above features, hospitals/health systems can expect the below benefits

  • Reduced patient no-show rates
  • Reduced referral leakage
  • Increased operational efficiency
  • Patient satisfaction
  • Increased revenue
  • Streamlined referral life cycle management

And at the same time gain better insight into the business using analytics such as the metrics dashboard, referral volume, referral patterns leakage rate, wait times, etc.

HealthViewX Referral Management is the right choice for large hospitals and health systems to keep track of patient referrals throughout the referral life cycle. Schedule a demo with us to understand the Solution features and benefits in detail and increase referral profitability. Our solution experts will be happy to guide you through our HealthViewX HIPAA compliant Patient Referral Management solution.

 

How To Identify An Under-performing Referral System And Make Improvements For The Same?

For many health systems, referral leakage may equate to millions of dollars in foregone revenue. Every patient who seeks care elsewhere is a lost revenue opportunity now and potentially into the future. Thus it is important for health systems to increasingly focus on minimizing referral leakage while managing referrals. The following are the symptoms of an underperforming referral system which have a negative impact on referral leakage,

  • Disability to identify in-network or aligned providers.
  • Inept or unclear information on what patient types or conditions a provider treats.
  • Limited or no ability to measure the referral management team performance or financial outcomes.
  • Ineffective prioritization and workload management.
  • Increased authorization-related denials and write-offs.
  • Too much reliance on paper-based or manual communication and tracking systems.
  • Increased patient referral leakage due to complicated, cumbersome, or unclear referral processes.

Analyzing your organizations’ opportunity for improvement

The ability to make significant improvements in referral processing efficiency and patient retention depends on the following factors,

  • Degree of process standardization
  • Organization’s accountability
  • Underlying infrastructure
  • Organization of staff
  • Technological capabilities

Accountability and standardization of the process

There is a huge communication gap between the referring provider and receiving provider offices which makes the process inconsistent. Organizations often fail to standardize the process by defining who is responsible for

  • Obtaining prior authorizations
  • Locating a specialist with good access who will treat the patient’s condition
  • Gathering relevant medical records
  • Contacting the patient to schedule the appointment

Organizations with strong referral management programs have developed a consistent and standardized workflow that clearly delineates responsibilities by role. Achieving this level of efficiency requires that operational and clinical leadership collaborate to design and develop policies, procedures, standards, and workflows to support strong referral management practices.

Technology Systems and Capabilities

Despite having a thoughtful and disciplined approach to monitoring and managing referrals, technology systems are often unable to facilitate best practice workflows or deliver the performance data necessary to effectively manage the end-to-end process. Therefore, the following processes have been happening manually,

  • Tracking authorization status
  • Monitoring scheduled appointments
  • Calculating referral conversion rates, staff productivity, and downstream revenue

Furthermore, the inability to share information electronically among providers necessitates increased use of paper-based and faxing processes. Without the proper supporting technologies, there is increased processing effort and workload, risk of lost or inaccurate data, and, most importantly, the potential to delay patient care.

The following are the technological capabilities needed to support the best practice referral, management team,

  • Identifies providers in the referral system
  • Matches patients with the ideal scheduling providers
  • Prompts follow-up when appointments are not scheduled or care is not received
  • Facilitates the transfer of post-visit documentation between providers
  • Supports detailed reporting to manage performance

Close your referral loops with the HealthViewX Patient Referral System

Information Technology enables patient referral workflow automation. HealthViewX Patient Referral Management System simplifies the process and closes the referral loop on time.

  1. The Primary Care Provider (PCP) identifies the need for a referral and initiates the same through the EHR system.
  2. The referral coordination team then validates the referral and does the insurance pre-authorization with the help of HealthViewX solution.
  3. The Intelligent Provider Smart Search feature of HealthViewX Patient Referral Management System helps in finding the right specialist or imaging center easily.
  4. The referral coordination team then sends the referral with the necessary documents to the relevant specialist or imaging center through the HealthViewX platform.
  5. The receiving provider gets notified about the referral and can schedule appointments with the patient.
  6. The patient and the receiving provider get reminders of the appointments thus reducing no-show rates.
  7. The referring provider is also notified about the status of the referral and how it is progressing. HealthViewX timeline view makes tracking and managing the referral lifecycle easier.
  8. HealthViewX tracks and sends reminders to the receiving provider to update the diagnosis, treatment recommendations, care plans in the referral.
  9. HealthViewX makes it easy for the referring provider by automatically updating this information back to the EHR system.
  10. Thus the HealthViewX solution closes the referral loop on time and helps in easy monitoring of the same.

Features and Functionalities

  • Referral workflow automation reduces the time and manual effort spent on a referral. Thus HealthViewX solution improves the efficiency of the process.
  • Patient coordination framework achieved through the patient application that helps in managing appointments and log data for the care plans prescribed by the provider.
  • Automated insurance pre-authorization reduces the work of the referral coordination team and makes the process simple.
  • The Intelligent Provider Search feature helps in finding the right specialist or imaging center in no time.
  • Referral timeline view and communication enables an easy flow of information between the referring and the receiving ends.
  • Scheduler integration gives timely reminders and notifications to the patients and providers about appointments, lab tests, etc.
  • Referral insights and analytics gives the PCPs 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.

Benefits of closing the patient referral loop in the healthcare industry

  1. Increased Medicare reimbursements –  Medicare considers closing medical referral loop as a benchmark for giving reimbursements. Closed medical referral loops increase the opportunities for Medicare reimbursements for referral marketing.
  2. Streamline referral management – With HealthViewX Patient Referral System in place, the referral workflow is automated and streamlined.
  3. Improved patient care – Reduced waiting time gives patient satisfaction thereby improving the care quality.
  4. Increased productivity – Reduced operational time improves the efficiency of the patient referral system.

HealthViewX Patient Referral Management application helps in closing the referral loop and increases the revenue for the practice. To know more about HealthViewX solution, schedule a demo with us. Our patient referral management experts will guide you through our HIPAA-compliant solution.

Relevance and use of patient referral management software to FQHCs and large enterprise hospitals

Money inflow is very important for medical practices. Without a constant source of revenue, medical practices cannot pay bills, pay employees or take care of patients. Importance of revenue is no different for Federally Qualified Health Centers, Community Clinics, Large Enterprise, and Specialty Hospitals. One way to ensure constant revenue is by retaining patients within the hospital network and providing optimal patient care. To do this efficiently, hospitals use patient referral management software.

Role of FQHCs:

FQHCs play an important role in supporting their community and providing care services to the underserved. Due to this, they may experience financial issues at uncertain times. When budgetary resources are strained, it is critical for an FQHC to

  • Operate with maximum operational efficiency
  • Preserve financial security
  • Maintain staffing levels to continue operations

Inefficient and improper business processes will lead to patient dissatisfaction which will result in patients leaving the practice. FQHCs must concentrate on

  • Maximizing their business and staff efficiency
  • Minimizing financial risks

The relevance of patient referral management software to FQHCs

It is important for FQHCs to take good care of their patients. Factors such as waiting time, improper schedules, referring to the wrong provider, etc create patient dissatisfaction. Using referral management software, providers can access patient health records, schedule appointments and choose providers based on diagnosis and preferences. FQHCs can reduce patient-show rates, decrease referral leakage and also improve patient satisfaction.

FQHCs traditionally prefer working with EMR/EHR systems because they are comfortable with it. An EHR/EMR system has many advantages but when it is complemented with a Referral Management software practices can experience many more benefits.

The relevance of patient referral management software to Enterprise Hospitals

The following challenges in the patient referral workflow are common in enterprise hospitals across the USA.

  • Limited provider information – Physicians do not have information about the providers within their network. This is to blame for unnecessary out of network referrals. Providers who refer out of network could avoid at least one-third of these if they had access to more robust information about providers in their networks. Even when physicians have access to their health system’s provider directories, they are not using the directories because they don’t have the level of information that is needed.
  • Inadequate referral information – Even when physicians refer their patients out-of-network, the chances of a successful referral are less. This is because many providers who receive referrals rate referral information as poor. Without referral information, receiving providers cannot treat their patients effectively.
  • Inefficient patient appointment scheduling – For providers who schedule an appointment for the patient, they prefer doing it through the phone to shared electronic health records system. When heavy use of the phone occurs, it is difficult for providers to see capacity in their network to book the next available appointment. So they bypass the network and book the appointment before the patient leaves the office.

For FQHCs and Enterprise Hospitals, additional investment in a patient referral solution is recommended for the following reasons:

  1. Outbound and Inbound 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 – In HealthViewX Referral Management System, 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. Workflow and Task Management – A workflow can be defined by how the referral flow must be(business rules). Tasks can be created to manage referrals by assigning it to the respective person.
  4. Improved communication – HealthViewX Referral Management Solution supports messaging and calling features for the referring and receiving providers to stay connected.
  5. Data Management – The solution is HIPAA compliant and enables secure data exchange of all patient-related documents.
  6. Seamless Integration – The solution can seamlessly integrate with any EMR/EHR/RIS or Third Party application thus providing minimal disruption in the existing referral flow.
  7. 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 complete data regarding the number of referrals flowing out, the number of referrals in various status, patient follow-ups, etc.

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.

Patient Referral Management Simplified using Referral Management Software.

Following features of HealthViewX simplify patient referral workflow for FQHCs and Enterprise Hospitals:

  1. Outbound and Inbound 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 – In HealthViewX Referral Management System, 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. Workflow and Task Management – A workflow can be defined by how the referral flow must be(business rules). Tasks can be created to manage referrals by assigning it to the respective person.
  4. Improved communication – HealthViewX Referral Management Solution supports messaging and calling features for the referring and receiving providers to stay connected.
  5. Data Management – The solution is HIPAA-compliant and enables secure data exchange of all patient-related documents.
  6. Seamless Integration – The solution can seamlessly integrate with any EMR/EHR/RIS or Third Party application thus providing minimal disruption in the existing referral flow.
  7. 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 complete data regarding the number of referrals flowing out, the number of referrals in various status, patient follow-ups, etc.

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.

Common challenges of manual patient referral management in 2019

  1. Documentation – During the referral process, referring physicians tend to miss out valuable patient information. Many times vital symptoms and findings from initial tests are often not sent with the referral order, leading to health complications that could have otherwise been avoided.
  2. Leadership disconnects – The leadership team should know which doctors are referring patients to specialists. Well-connected team structure enables educational conversation between leadership and care providers regarding overutilization, referrals to high-cost specialists, or the importance of sending all necessary documentation with every referral.
  3. Lack of coordination among caregivers – Did you know? Lack of coordination among caregivers are endemic and contribute to an estimated 44,000 to 98,000 deaths from medical errors each year.
  4. Follow-ups – Many primary care practices do not follow-up after they’ve referred a patient to a specialist. They vest the responsibility of scheduling a specialist visit with the patient. According to the Archives of Internal Medicine, this process does not happen in 50-60% of referrals that are made, putting patients at risk.
  5. Delays – The patient faces extended delays between the time the referral is sent and the time at which the actual appointment is made. As mentioned previously, delays and frustrations with the scheduling process can cause patients to avoid making an appointment, or they may ultimately cancel an existing appointment if the wait is too long.
  6. High-cost referrals – Primary care practices that refer patients to high-cost providers are harming their own practice and their patients. Exorbitant price tags affect reimbursement for PCPs and scare patients away from the idea of seeing a specialist, despite their medical conditions.

Challenges Specific to Patient Referral Workflow in Large Enterprise Hospitals

  1. 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. EMR interoperability is their greatest challenge.
  2. Finding the right specialist – A Large Enterprise Hospital has a huge number of specialists. PCPs are not aware of specialists who were newly added or who came within their network as a result of mergers or acquisitions. So many times PCPs tend to refer their patients out of their network in spite of having the right provider within the network.
  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, a better specialist within the locality, reputation of the receiving provider, etc.
  4. Referral leakage – Did you know? Referral leakage for any 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. There could be many factors such as the reputation of a provider, lack of knowledge or insight and patient’s choice that lead to patient leakage.
  5. Patient dissatisfaction – Large enterprise hospitals should keep 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. 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 and to close referral loops.

Solutions for optimal patient referral management in 2019

  1. HealthViewX introduces a collaborative design that connects primary care providers with specialists on a single and uniform network.
  2. Electronically-connected specialists form a network of care collaboration, where both parties are responsible for the timely care of their mutual patients.
  3. Secure electronic notifications provide quick and reliable information between PCP and specialist.
  4. PCPs now have an enhanced ability to track referrals.
  5. Electronic Referral Management has decreased wait times for face-to-face specialty clinic visits.
  6. With Electronic Referral Management system, each step in the workflow prompts easy follow-ups and automatically closes the loop on all referrals
  7. End-to-End referral lifecycle management with bidirectional EMR/EHR Integration HealthViewX platform supports dynamic forms, workflows, task lists, reports, data visualization and has great integration capabilities. It can automatically pull referral orders from EMR/EHR in real-time. It also helps in configuring all other referral coordinator workflows and tasks with maximum automation.
  8. Multi-channel referral consolidation that brings all the referrals from multiple sources like email/phone/fax/notes into a single queue.
  9. Detailed referral information through which the Specialist receives all the necessary referral details.
  10. Automated Specialist / Patient Notification & Reminders with Customizable templates and configurable channels of communication
  11. Payer-specific prior authorization process automation – HealthViewX platform has a payer management module that maintains and manages
  • different payer details
  • their modes of prior authorization
  • direct authorization procedures
  • payer forms
  • online portal links

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.

Improve Your FQHC’s Operational Efficiency And Increase Your Revenue

Money inflow is very important for medical practices. Without a constant source of revenue, medical practices cannot pay bills, pay employees or take care of patients. It is no different for Federally Qualified Health Centers.

What are FQHCs and how do they operate?

FQHCs are community-based primary care medical practices. They provide comprehensive health care services for people of all ages, regardless of their ability to pay or health insurance status. They form a critical component of the health care safety-net as they provide

  • Primary care
  • Preventive care (oral health and mental health/substance abuse) services

FQHCs are also called Community Health Centers, Migrant or Homeless Health Centers, and 330-Funded Clinics.

The mission of FQHCs is to enhance primary care services to the underserved in both urban and rural communities.  They operate as nonprofit entities under the guidance of a board of directors selected from the community where they operate.  In return for providing care to the underserved and uninsured, FQHCs receive Federal government cash grants, cost-based reimbursements for their Medicaid patients, and malpractice coverage. These practices not only maximize the effect of the federal investment going to local patient care but also expands the impact of the Medicaid and Medicare programs.

Why should FQHCs concentrate on improving operational efficiency and increasing revenue?

FQHCs play an important role in supporting their community and providing care services to the underserved. Due to this, they may experience financial issues at uncertain times. When budgetary resources are strained, it is critical for an FQHC to

  • operate with maximum operational efficiency
  • preserve financial security
  • maintain staffing levels to continue operations

Inefficient and improper business processes will lead to patient dissatisfaction which will result in patients leaving the practice. FQHCs must concentrate on

  • Maximizing their business and staff efficiency
  • Minimizing financial risks

How can FQHCs improve operational efficiency and increase revenue?

FQHCs can improve business effectiveness and operational efficiency by making sure they follow these essentials steps.

1. Web portal for patients

It is important for FQHCs to take good care of their patients. Factors such as waiting time, improper schedules, referring to the wrong provider, etc create patient dissatisfaction. In order to prevent these, FQHCs should implement a web portal for their patients. Using the web portal, patients can access their health records, appointment schedules and choose providers based on their interests and preferences. When patients have the liberty to choose providers whom they can be referred to and also the appointment slot, they will show up for the appointments. Through this way, FQHCs can reduce patient-show rates, decrease referral leakage and also improve patient satisfaction.

2. Using technology

FQHCs prefer working with EMR/EHR systems because they are comfortable with it. So they do not wish to move out their EHR/EMR system. An EHR/EMR system has many advantages but when it is complemented with a Referral Management software practices can experience many more benefits.

How great it would be if a Patient Referral Management software could integrate seamlessly with an EMR/EHR system? It can help in ensuring end-to-end Patient Referral Management without disturbing the existing system.

HealthViewX Patient Referral Management solution provides easy steps to integrate with a practice’s EMR/EHR system. The patient demographics, diagnostic reports, test results or any sensitive information can be transferred safely. The solution is HIPAA-compliant with complete data security.

3. Improving staff behaviour

FQHCs must make sure that the people operating their front desk are friendly enough to deal with customers irrespective of their class status or bank balance. The more welcoming they are, the more the patients will feel comfortable and at ease.

Moreover, operational efficiency is the key to success. The more efficient the front desk operations team is at an FQHC, the more practice revenue the FQHC can generate. It can also help them facilitate additional patient visits; which mean that if more patients are adjusted and facilitated, the FQHC has the potential to make more money.

HealthViewX Referral Management Solution to aid FQHCs

HealthViewX Patient Referral Management Solution has the following features that aid FQHCs in improving their operational efficiency and referral workflow.

  1. Outbound 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 case of outbound referrals, it facilitates integration with the existing system to read the patient data and send out referrals.
  2. Referral Timeline – In HealthViewX Referral Management System, 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. Workflow and Task Management – A workflow can be defined on how the referral flow must be(business rules). Tasks can be created to manage referrals by assigning it to the respective person.
  4. Improved communication – HealthViewX Referral Management Solution supports messaging and calling features for the referring and the receiving providers to stay connected.
  5. Data Management – The solution is HIPAA compliant and enables secure data exchange of all patient-related documents.
  6. Seamless Integration – The solution can seamlessly integrate with any EMR/EHR/RIS or Third Party application thus providing minimal disruption in the existing referral flow.
  7. 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 complete data regarding the number of referrals flowing out, the number of referrals in various status, patient follow-ups, etc.

Having Trouble Maximizing And Managing Revenue?

Are you an FQHC facing difficulties in managing your business operations and workflow? Then you may have a revenue cycle problem. HealthViewX Patient Referral Management Software is custom-made to solve the challenges faced by FQHCs. Schedule a demo to know more about our solution!