Tag Archives: referrals

It’s time to stop faxing referrals – Why are we still faxing patient referrals?

One out of every three patients is referred to a specialist each year. These referrals are sent to specialists, imaging centers, etc., through multiple channels like phone calls, fax, emails, website forms, etc., and fax is the most commonly used channel. Despite the array of digital patient referral management software available in the market, health systems are still following the old school model of referring patients through fax machines and paper-based letters. Ironically, there could be multiple barriers like the reasons listed below for not using the electronic referral communication software

Traditional workplace culture
Not having the right technology in place
Not understanding the software usage
Peers not using eReferrals

Healthcare professionals need to understand the usability, security, and interoperability of the solutions available in the health IT market. Health systems need to adapt to more secure means to send and receive referrals. With that being said, Referral Management Solution is progressively vital for better patient experience and care coordination. Today, in most health systems referral workflows are poorly documented, insecurely sent and are not effective in providing quality care for patients.

Knowing the security consequences of maintaining paper-based systems and physical paper letters is critical – as they could be easily misplaced and accessed by unauthorized people. Some health systems still depend on their EMR to manage their referral process but they need to understand that EMR’s are not equipped enough to handle the end-to-end referral process. Health systems should understand the need of having a good patient referral solution.

Why do health systems need a good patient referral solution?

The healthcare industry is constantly scrutinized for inefficiencies in processes, systems, operations, etc. As a result, health systems are under more pressure to do more with fewer amenities. Inefficient referral processes lead to long lead times and are inconvenient to both patients and providers. A referral solution can streamline communication between the referring provider, receiving provider, patient and other healthcare providers, save time, enhance care quality and a lot more for both patients and providers.

The Role of Referral Management in Value-Based Health Care

What is Value-Based Care?

Value-Based Care is a care delivery model in which healthcare providers are paid based on the health outcomes of the patient. Value-based is a quality-based care model that drives “better health for all” and benefits the community, providers, and payers as a whole. Value-based care helps healthcare providers by helping patients improve their health and reduce the prevalence of chronic illness. This care model is a potential swap for fee-for-service reimbursement based on quality. The providers are paid based on the health outcomes of the patients and are rewarded for helping patients’ improve their health. The ultimate goal of value-based care is to optimize the care for the patient population.

What are the benefits of Value-Based Care?

For Patients – Reduced cost and better health outcomes

For Providers – Better patient satisfaction and improved care efficiencies

For Payers – Stronger control on costs and lowered risk

For Community – Reduced spend on healthcare and improved overall wellbeing

What is a Patient Referral Management Solution?

Patient Referral Management Solution is a patient referral tracking tool for end-to-end referral communication and management. The solution is designed for healthcare organizations to enable them to provide better care with a well-orchestrated customizable workflow. Its primary goal is to enhance and streamline interaction among all care providers involved in patient care for better patient outcomes.

Role of Patient Referral Management Solution in Value-Based Care

Right from small to large, healthcare providers face a lot of challenges in their referral process. Poor communication and referral workflow among providers lead to diminished care quality and patient experience. Lack of timeliness of the information and inadequate patient information or reports all contribute to poor care continuity, patient dissatisfaction, and poor health outcomes.

A well-orchestrated and automated patient referral solution has the potential to transform referral workflows and help providers improve their patient health outcomes. It helps provide value-based care through better care coordination throughout the care journey. A referral management solution can help improve efficiency, reduce time spent on redundant tasks, cut down on overhead costs, reduce referral processing time thus helps both providers and patients. Streamlined workflows lead to better patient outcomes. The prime objective of the solution is to improve patient-physician interaction and provide value-based care for better patient outcomes.

Why is Referral Management crucial for Healthcare Providers?

Referral Management is very crucial for healthcare providers to track and manage referrals, and ensure better patient outcomes. Referral management is essential when

referring and receiving providers have different EMRs/EHRs
healthcare providers are coordinating between in-network and out-of-network providers
health systems are looking to improve patient health outcomes and reduce no-show rates
providers want to increase revenue and reduce operational cost
health systems want to focus on quality care by using value-based care models

A major challenge in the current referral process is that most EMRs are not equipped enough to handle the end-to-end referral process. A referral management solution helps healthcare providers to track and manage their end-to-end referral process with complete transparency. The solution helps streamline workflow, reduce clinical errors/delays, cut down the processing time by automating multiple touchpoints, and obtain strategic data/facts for informed decision-making. The prime objective of the solution is to enhance communication among healthcare providers involved in patient care.

By leveraging technology the healthcare industry can provide value-based care for their patients and better patient experience. An end-to-end patient referral tracking ensures timely care, improves care coordination and better outcomes. HealthViewX referral management solution is designed to suit any practice, customized to meet user requirements, and enables data-driven decision support, and provides real-time insights of patient-reported data to promote better care delivery. Schedule a demo today to understand more about our HIPAA Compliant SaaS-based referral solution from our experts.

Advantages FQHCs Gain From A Patient Referral Management Solution

Community health centers or federally qualified health centers provide critical primary care services to tens of millions of people every year. Their role in healthcare makes them necessary access points for patients coming into the vaster healthcare system. Let us see how these organizations use patient referral management systems to leverage their role as a crucial source of patient referrals and enhance the care they can provide for their populations.

1. Making a more combined provider network:

Right from small to large, FQHCs are moving towards providing value-based care for their patients. Many FQHCs have discovered that requests for better care coordination with specialists go unheard until there is a change in the current referral process. FQHCs have realized that technology can provide them with the ability to differentiate from their competitors while helping them deliver quality care to their patients and closing referral loops. An efficient referral management solution will help them organize, quantify, and ultimately shape their referral stream and improve care coordination.

2. Improved patient support and access to care:

Insurance prior authorization is one of the major challenges in the patient referral process. Finding the right specialist, insurance prior authorization, ensuring the patient visits the specialist, getting the information back, and updating the information back to the EMR is all crucial inpatient care. A referral management solution helps FQHCs to automate end-to-end referral process and helps them close referral loops with ease. This improves patient experience and increases their access to quality care.

3. Improved referral workflows:

Many FQHCs lack care coordination in their current referral process. Manual processes are both time-consuming and tedious. Simplifying the referral workflow will not only help referral coordinators and patients but will also help the FQHC performance as a whole.

4. Better care coordination and patient outcomes:

In an efficient referral process, patients get the care they need. This involves referring the patient to the right provider, ensuring insurance pre-authorization, scheduling appointments, sending reminders, and updating the patient information back into the EHR. All these steps contribute to better care coordination and patient outcomes.

5. Increased referral loop closures and MU Credits:

Receiving a report from the provider to whom the patient was referred to and updating that information back into the EHR is critical for FQHCs. Referral loop closure is essential for better care coordination and will help FQHCs improve patient experience and outcomes. A referral solution that is MU stage 3 certified can help the practice with MU credits, as referral transferred using the platform can be counted for MU credits.

Talk to our solution experts to know more about Patient Referral Management Solution.

How to reduce referral leakage in large hospitals?

For many large enterprise hospitals, referral leakage may amount to millions of dollars in lost revenue. Patient referrals are an important revenue generator for hospitals and losing patients to other providers can cost these hospitals upto 20 percent of their revenue. Dissatisfaction with the current referral process is widespread and every patient seeking care elsewhere is now, and potentially in the future a lost revenue opportunity for the hospitals.

Signs of an underperforming referral management system that results in referral leakage:

Inability to get complete information to process referrals at one go:

Communicating complete patient information at the time of specialty referral is crucial for high-quality consultation and coordinated patient care. The inability to get complete information leads to patient dissatisfaction, delay in processing referrals and referral leakage.

Difficulty in finding the right provider within the network:

One of the major causes of patient referral leakage is difficulty in finding the right specialist within the network. Nearly half of the physicians surveyed said they have trouble determining who is in-network. Physicians could avoid referring out-of-network if they had information about all in-network providers.

More time spent in processing each referral:

On average referral coordinators take 15-20 minutes or sometimes more to process each referral on the receiving end just for checking missing patient information. The staff time spent coordinating referrals and their visits is tedious and time-consuming.

High patient no-show rates and referral leakage:

Patient no-show rates or missed appointments cost the U.S. health systems more than $150 billion a year. Lack of quality care and coordination among care stakeholders leads to higher no-show rates or referral leakage, due to which patient experience takes a big hit.

Manual communication and tracking systems:

Manual processes like insurance preauthorization, checking for missed patient information, etc are time-consuming Such time-consuming and cumbersome manual processes may lead to patient dissatisfaction.

Lack of referral analytics for informed decision making:

Lack of data of the referrals flowing in and out of the network affects decision making. Referral analytics gives comprehensive data on the number of patients with various referral status.

The ability to significantly improve the effectiveness of the referral process lies in the referral process standardization and technological capabilities.

Here’s how to reduce referral leakage

Standardization of processes:

Inconsistency in the patient referral process between the referring provider and the receiving provider is common. Right from obtaining prior authorization, finding the right specialist for the patient, collecting the required information for the referral, coordinating for patient appointments, etc. large hospitals are often challenged throughout the process. Hospitals need to streamline their referral workflow to achieve efficiency and have standard workflows and processes to streamline the end-to-end referral process. Achieving this efficiency in the referral process requires well-defined workflows.

Technology solution and capabilities:

Despite having an approach to monitoring and managing patient referrals, existing systems are often unable to simplify referral workflows to effectively manage the end-to-end referral process. Right from tracking authorization status, scheduling appointments, calculating referral conversion rates, staff productivity, etc. all are challenging in the current referral process. A referral solution that is efficient, technologically advanced, and has the capability to automate the end-to-end referral process is the need today. Connecting the information to objectives, understanding the workflow to obtain the information, and most importantly getting the data analytics for informed decision making will be more valuable.

Referral Management Solution – A worthwhile investment

A focused referral management process has the potential to maximize utilization, standardize processes, and enable streamlined workflows. Hospitals need to invest in solutions that will reduce referral leakage and increase patient volumes.

HealthViewX Patient Referral Management solution has features that best suit a hospitals’ Referral Management System. A 30-minute demo with our team will help you understand how effective our solution can track and manage the referral life cycle.

How to become a preferred health system for patients and referring physicians?

Healthcare technologies like telehealth, remote patient monitoring, referral management, etc., have simplified the process for health systems to deliver care for their patients. These advancements are uniquely qualified to help health systems attract patients to their facility and build their brand.

So how do you become the preferred health system? What are the strategies behind becoming a preferred health system for your patients, and also for physicians referring patients to your health system?

Care coordination is the responsibility of any system of care and has the potential to transform healthcare delivery, improve the overall effectiveness, and efficiency of any health system. Thus, the key to becoming the preferred health system for patients is to have well-executed care coordination.

For effective care coordination, it is important to connect your entire physician community with specialists and make sure they work in unison to ensure your patients’ health needs are met and the required care is delivered.

If care coordination is done in the right manner, it can improve health outcomes and patient experience along with the growth of the healthcare system. This way, patients, providers, and payers can get benefited. Though there are different definitions for care coordination, in the end all of them point to the same goal which is to become patients’ preferred care provider.

Here are a few tips to become patients’ preferred health system

1. Connecting an entire network of physicians and specialists:

It is important to connect your entire set of physicians and specialists to provide quality care for each and every patient. HealthViewX end-to-end patient referral management connects your entire care network and helps you achieve this with ease.

2. Improve care coordination:

The major priority of all healthcare providers is to achieve care coordination and improve patient care but unfortunately, it still remains a challenge in the industry. The right coordinator may differ from patient to patient. Critical patient information should be readily available for all involved inpatient care. Improved care coordination results in better patient outcomes and patient satisfaction.

3. Effective communication channels and methods:

Software solutions that support upsurge communication and engagement among providers are still lacking. Manual processes (phone call, email, fax, etc.) can lead to fatigue and operational inefficiency. An end-to-end automated solution would help eliminate this challenge. One can improve the quality and continuity of care provided to patients by focusing on improving the transfer of patient information.

4. Gaining the trust of out-of-network providers/physicians:

PCPs prefer hospitals that are easy to work with. It is essential to build and maintain a strong referral base from out-of-network providers/physicians. Hospitals need to work to become a referral partner of choice for physicians and so creating a strong referral base with the referring physicians will pave the way to steady patient inflow. Hospitals should work to encourage out-of-network physicians to become more actively involved in patient care. Lack of communication can lead to poor patient health outcomes.

5. Closing the referral loop:

Planned integration of patient care between providers will help attain better service. As health systems grow more complicated, it is essential to close the referral loop for patient record and safety. The goal of referral loop closure is to track and support patients when they obtain services outside the practice. Closing the referral loop is one of the ways to become a preferred provider.

Health systems need to adopt new healthcare technologies that have the potential to improve patient care and satisfaction. One such technology that health services need to implement is patient referral management. The present referral management is complex, and coordinating care is hard for the health systems. Navigating the healthcare system or care set-ups can be tiring for patients too. Poor coordination can result in reduced quality of care, higher readmission rates, increased no-show rates, referral leakage, and higher cost of care. Better care coordination may result in more satisfied patients.

End-to-end referral tracking and follow-up is a must for effective patient care. Patient Referral Management is one such solution that can solve major challenges faced by health systems in their referral process.

Schedule a demo with HealthViewX Referral Management Solution experts today!

Patient Leakage – A major problem to hospitals and health systems

Patient leakage is a rampant problem that healthcare providers are dealing with on a day-to-day basis. Hospitals/health systems rely on patients being referred by out-of-network physicians.

Poorly handled or mismanaged patient referrals are a significant problem for many health systems that can lead to patient leakage and in-turn revenue loss. Patients being referred out of network is one of the main causes of patient leakage. Health systems are said to lose up to 20% of revenue due to patient leakage.

Patient Leakage – How does this happen?

In some cases patient leakage is inevitable. For example, if a person has to be referred to any particular specialty care or treatment that is unavailable within the network then the referring provider has no choice other than referring the patient out-of-network.

Conversely, there are several other reasons where in-house providers refer patients out of their network

1. Provider Reputation

At times the provider may refer the patient out-of-network depending on the specialist availability, reputation, experience, specialist rating, and patient satisfaction. It can also be due to unavailability of that specialist within the network. Providers are responsible for their patients’ health, so they would ensure they give the best possible treatment or reference for their patients. This is the main example of how patient leakage happens.

2. Unawareness:

New providers who have joined the health system may not be aware of all the specialists available within the care network. There are high chances that providers may refer patients out of network if they are unaware of specialists within the network.

3. The patient chooses the specialist he/she wants:

The provider has to accommodate patient needs and ensure the patient is satisfied with the care provided. Patients’ may choose the provider based on their convenience or preferences like distance, personal preference, specialist rating, etc. Finally, the decision of choosing the specialist completely depends on the patient’s decisions. This is one of the reasons why patient leakage happens.

4. Provider-Patient Relationship:

This is also a prime reason for patient leakage. It is important that the providers build a strong relationship with their patients through quality and value-based care models and if this lacks chances are high that patient may leave the care network.

5. Distance:

Distance and location play a major role in patients opting/choosing their providers. If competing facilities are much closer than the location you refer, patients would prefer the location of their convenience.

Do Health systems understand the amount of revenue loss?

Health systems/ large hospitals do not realize the actual amount of missed revenue due to patient leakage and missed patient appointments. Health systems have lost millions of revenue due to patient leakage and they do not properly track patient leakage. Even though health systems leaders track these leakages it is difficult for them to have a clear understanding of how to reduce this leakage or where and why it occurs in some cases.

A lot of health systems use the EHR system to manage and track their patient referrals and EHR’s can’t show why and where the patient’s left the network. However, efficiency in tracking and managing patient referrals still remains challenging.

HealthViewX HIPAA compliant referral management solution streamlines your end-to-end referral process and manages patient referrals better, improves patient satisfaction, reduces patient referral leakage and gives you clear insights of referral analytics for informed decisions. The best way to avoid patient leakage is to elevate patient experience and ensure you track each and every referral that comes in and goes out of network.

Schedule a demo with us and our patient referral management experts will guide you through our HIPAA compliant patient referral solution.