Monthly Archives: March 2019

FQHC Statistics – Growth, Region, Performance and Revenue – Federally Qualified Health Centers across the USA

What are Federally Qualified Health Centers (FQHCs)?

Federally Qualified Health Centers (FQHCs) in the United States are non-profit entities that are composed of clinical care providers, who operate at comprehensive federal standards. FQHCs were originally intended to provide the medically underserved population with quality care to minimize patient load in hospital emergency rooms.

According to Medicare and Medicaid statutes, FQHCs receive federal funding under Section 330 of the Public Health Service (PHS) Act to provide comprehensive primary care services to uninsured and underinsured populations thus ensuring that comprehensive care is available to all, regardless of income or insurance status. Medicare pays FQHCs based on the FQHC Prospective Payment System (PPS) for medically necessary primary health services and qualified preventive health services given by an FQHC practitioner.

To receive federal funding, FQHCs 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 FQHC

The Growth of FQHCs

In the early 1960s, there were only 8 health centers in the U.S. Ever since then, the numbers have increased exponentially. By 2001, there were 748 health centers at 4,128 service sites around the nation, serving approximately 10 million individuals.

Federal funding for health centers has increased from $750 million in 1996 to $2.2 billion in 2010. Federal support has increased tremendously over the last 10 years. In 2011, there were 1,128 health centers providing care to more than 8,000 rural and urban delivery sites in the U.S. and territories. Today, there are 1,400 organizations with 11,200 facilities serving about 25 million individuals every year.

The above chart shows the growth of health centers from its inception in 1980 till 2020. The chart also shows the exponential increase in the number of patients served over the years.

FQHCs in various regions across the U.S

State	State Code	Number of FQHCs
California	CA	178
Texas	TX	73
New York	NY	70
Florida	FL	48
Ohio	OH	47
Illinois	IL	45
Pennsylvania	PA	44
North Carolina	NC	40
Michigan	MI	39
Massachusetts	MA	39
Georgia	GA	35
Louisiana	LA	36
Oregon	OR	33
West Virginia	WV	31
Tennessee	TN	30
Alaska	AK	28
Missouri	MO	28
Washington	WA	27
Virginia	VA	26
Indiana	IN	25
Kentucky	KY	23
New Jersey	NJ	23
South Carolina	SC	23
Arizona	AZ	21
Mississippi	MS	21
Colorado	CO	21
Oklahoma	OK	20
Maine	ME	20
Kansas	KA	18
Maryland	MD	17
Montana	MT	17
New Mexico	NM	17
Wisconsin	WI	18
Connecticut	CT	17
Minnesota	MN	16
Alabama	AL	15
Hawaii	HI	14
Iowa	IA	14
Idaho	ID	14
Puerto Rico	PR	14
Utah	UT	13
Arkansas	AR	12
New Hampshire	NH	11
Vermont	VT	11
District of Columbia	WDC	8
Rhode Island	RI	8
Nebraska	NE	7
Nevada	NV	7
Wyoming	WY	6
South Dakota	SD	5
North Dakota	ND	4
Delaware	DE	3
Virgin Islands	VI	3
Guam	GU	2
Northern Mariana Islands	MP	2

Performance of FQHCs

Figure 2 – Health Centers Perform Better on Ambulatory Care Quality Measures than Private Practice Physicians

The above chart shows how health centers have outperformed private practice physicians in every aspect of service.

Figure 3 – Health Centers Provide More Preventive Services than Other Primary Care Providers

The above chart shows a comparison between health centers and other providers based on the number of patient visits for various ailments.

Figure 4 – Health Center Patients Are More Satisfied with the Overall Care Received Compared with Low Income Patients Nationally

The above chart shows the level of satisfaction of low-income patients. Health center patients have a huge level of satisfaction as compared to other low-income patients nationally.

Financing and Reimbursements for FQHCs

FQHCs are required by law to provide services to all people, regardless of ability to pay. The uninsured are charged for services on a board-approved sliding-fee scale, which is based on a patient’s family income and size.

FQHCs are financed through various methods. These include a mix of Medicaid and Medicare reimbursements (with different payment methodologies), direct patient revenue, other third-party payers (private insurers), state funding, local funding, philanthropic organizations, and grant funding from the Bureau of Primary Health Care (BPHC) of HRSA of the U.S. Department of Health and Human Services (HHS).

The above chart shows the revenue distribution of FQHCs based on payer source (2018).

FQHC Revenue across all regions in the U.S (approx. 2018)

Source:
George Washington University analysis of the Health Resources and Services Administration’s Uniform Data System. Special Data Request, September 2019.

Location	Medicaid	Medicare	Private Insurance	Self-Pay	Federal Section 330 Grants	Other Grants and Contracts	Other	Total
United States	$12,958,743,457	$2,260,247,981	$3,048,512,406	$1,248,741,884	$4,829,287,467	$3,336,624,219	$1,007,447,180	$28,689,604,594
Alabama	$52,785,795	$17,803,287	$17,114,860	$12,744,350	$83,625,546	$13,471,556	$4,344,085	$201,889,479
Alaska	$102,348,854	$18,671,815	$37,698,230	$6,477,465	$67,692,068	$119,544,705	$2,756,393	$355,189,530
Arizona	$337,972,854	$47,634,000	$71,949,881	$23,395,361	$83,428,217	$41,485,739	$5,472,766	$611,338,818
Arkansas	$62,148,511	$24,046,228	$30,622,521	$12,429,111	$54,555,352	$9,120,521	$1,735,385	$194,657,629
California	$3,704,343,504	$411,514,109	$291,192,054	$148,976,225	$658,760,061	$615,047,232	$334,581,140	$6,164,414,325
Colorado	$319,775,816	$39,134,784	$48,657,089	$30,779,398	$106,101,957	$95,942,011	$20,709,084	$661,100,139
Connecticut	$228,434,332	$32,127,164	$26,544,878	$11,568,619	$59,696,129	$50,791,682	$10,598,421	$419,761,225
Delaware	$11,773,644	$1,479,685	$2,463,464	$4,386,233	$13,557,989	$5,219,063	$470,309	$39,350,387
District of Columbia	$160,105,430	$22,175,379	$32,105,709	$5,512,030	$27,476,019	$31,943,055	$7,236,844	$286,554,466
Florida	$391,497,340	$60,674,510	$209,954,679	$81,714,253	$236,911,216	$193,834,424	$17,832,728	$1,192,419,150
Georgia	$66,177,853	$48,142,417	$57,295,748	$30,758,262	$117,787,006	$28,848,026	$9,877,675	$358,886,987
Hawaii	$107,408,992	$15,806,563	$17,253,126	$5,783,071	$31,398,131	$32,520,603	$3,907,118	$214,077,604
Idaho	$45,572,373	$21,289,644	$50,122,229	$22,535,206	$45,993,298	$25,577,164	$3,267,335	$214,357,249
Illinois	$455,197,448	$56,238,990	$131,100,822	$64,116,380	$201,027,383	$137,469,419	$29,398,121	$1,074,548,563
Indiana	$200,004,374	$20,647,447	$30,284,051	$18,433,251	$75,547,860	$28,756,217	$30,759,622	$404,432,822
Iowa	$83,853,103	$13,542,737	$23,553,367	$12,655,645	$38,528,294	$19,319,034	$1,624,245	$193,076,425
Kansas	$37,808,462	$19,789,301	$26,840,099	$15,221,728	$44,761,541	$16,668,896	$4,665,564	$165,755,591
Kentucky	$176,573,940	$46,631,367	$68,598,016	$24,819,874	$80,881,354	$6,773,516	$6,597,845	$410,875,912
Louisiana	$146,815,697	$31,043,111	$59,995,751	$11,587,230	$100,474,957	$30,961,276	$4,441,509	$385,319,531
Maine	$41,882,541	$35,423,228	$47,436,524	$12,099,407	$43,787,648	$11,360,335	$6,280,495	$198,270,178
Maryland	$150,688,381	$29,260,626	$73,964,146	$13,146,680	$57,449,364	$35,657,860	$21,090,583	$381,257,640
Massachusetts	$362,280,706	$103,012,238	$165,134,454	$27,248,100	$128,238,080	$258,007,270	$160,820,426	$1,204,741,274
Michigan	$314,285,715	$68,214,766	$79,638,020	$28,291,497	$127,807,919	$44,375,118	$9,855,849	$672,468,884
Minnesota	$75,452,268	$12,577,519	$16,837,190	$11,935,453	$42,977,632	$29,987,097	$4,128,981	$193,896,140
Mississippi	$32,037,428	$18,436,338	$22,813,575	$21,440,111	$74,626,865	$14,886,816	$1,657,237	$185,898,370
Missouri	$255,311,813	$26,546,831	$59,184,521	$28,003,100	$110,804,809	$33,834,797	$10,235,337	$523,921,208
Montana	$34,073,242	$12,203,723	$17,685,163	$7,521,912	$42,126,575	$10,185,208	$6,307,871	$130,103,694
Nebraska	$19,899,828	$1,982,820	$13,342,672	$7,991,555	$22,106,057	$22,906,355	$1,933,464	$90,162,751
Nevada	$33,773,688	$11,166,606	$12,531,690	$3,172,460	$21,069,529	$15,948,721	$706,509	$98,369,203
New Hampshire	$21,695,854	$17,132,960	$22,653,425	$5,099,829	$24,039,213	$11,899,812	$2,725,189	$105,246,282
New Jersey	$158,938,887	$11,758,143	$14,145,131	$21,606,309	$81,666,571	$69,281,662	$5,982,249	$363,378,952
New Mexico	$132,429,129	$26,364,684	$24,132,532	$15,923,683	$76,523,082	$57,190,428	$4,530,396	$337,093,934
New York	$1,461,356,192	$201,623,297	$250,926,163	$50,171,017	$269,626,284	$385,124,022	$91,523,863	$2,710,350,838
North Carolina	$90,190,949	$59,012,065	$65,516,943	$50,837,624	$133,899,942	$40,248,341	$26,574,283	$466,280,147
North Dakota	$11,640,795	$3,863,326	$9,419,592	$4,474,860	$10,746,019	$908,251	$1,001,661	$42,054,504
Ohio	$261,827,729	$51,042,970	$58,596,828	$25,007,037	$146,210,064	$41,839,517	$21,051,011	$605,575,156
Oklahoma	$58,934,312	$20,089,581	$28,480,968	$19,992,107	$58,679,531	$10,582,038	$2,883,612	$199,642,149
Oregon	$394,118,738	$51,503,384	$31,974,615	$15,310,703	$91,700,505	$91,028,195	$7,602,558	$683,238,698
Pennsylvania	$315,531,242	$68,519,997	$104,374,387	$17,072,987	$128,243,325	$37,490,171	$10,326,309	$681,558,418
Rhode Island	$109,670,334	$15,761,096	$19,797,174	$5,830,348	$28,040,434	$14,890,907	$4,960,361	$198,950,654
South Carolina	$95,328,346	$89,583,350	$103,316,045	$25,145,381	$89,314,251	$31,444,029	$18,322,528	$452,453,930
South Dakota	$11,514,028	$4,903,220	$10,207,221	$6,525,886	$17,900,812	$3,435,235	$1,231,547	$55,717,949
Tennessee	$80,779,671	$26,920,974	$41,375,639	$15,091,806	$87,348,642	$31,856,403	$3,747,729	$287,120,864
Texas	$405,350,935	$68,050,313	$170,985,325	$92,159,958	$258,162,160	$309,998,557	$26,687,781	$1,331,395,029
Utah	$29,700,875	$11,520,256	$16,681,038	$13,794,751	$39,878,950	$24,880,704	$3,574,692	$140,031,266
Vermont	$47,210,527	$31,973,872	$34,695,192	$23,137,643	$23,463,366	$7,348,657	$8,511,984	$176,341,241
Virginia	$54,549,880	$39,744,588	$42,438,653	$26,005,991	$85,805,735	$20,677,091	$4,357,021	$273,578,959
Washington	$769,937,162	$89,428,910	$129,151,433	$58,320,292	$139,027,744	$94,896,347	$14,596,022	$1,295,357,910
West Virginia	$116,781,516	$57,847,408	$83,808,357	$28,402,025	$68,591,429	$16,910,711	$12,143,151	$384,484,597
Wisconsin	$149,327,704	$8,202,250	$27,257,452	$10,451,845	$45,790,614	$27,262,928	$7,630,433	$275,923,226
Wyoming	$6,918,264	$4,226,082	$5,490,411	$3,411,365	$7,478,734	$1,763,502	$477,559	$29,765,917
American Samoa	$786,753	$0	$0	$0	$3,082,370	$0	$0	$3,869,123
Federated States of Micronesia	$0	$0	$24,112	$84,319	$3,186,592	$0	$0	$3,295,023
Guam	$2,451,828	$53,941	$17,002	$132,489	$2,173,874	$2,330,520	$137,227	$7,296,881
Marshall Islands	$0	$0	$0	$31,865	$1,061,772	$1,086,917	$0	$2,180,554
Northern Mariana Islands	$98,987	$641	$7,161	$11,185	$677,559	$0	$122,655	$918,188
Palau	$0	$0	$259,006	$1,461,345	$940,810	$50,000	$0	$2,711,161
Puerto Rico	$153,566,707	$33,237,486	$10,276,689	$7,922,019	$103,150,074	$16,880,374	$3,452,418	$328,485,767
U.S. Virgin Islands	$7,822,181	$665,954	$589,383	$581,248	$3,678,153	$4,875,184	$0	$18,212,103

Definitions:
*Medicaid*: also includes the Children’s Health Insurance Program (CHIP), family planning programs, and state-funded coverage programs.

*Private Insurance*: includes employer-sponsored insurance and insurance purchased in the individual market (including the Marketplaces).

*Federal Section 330 Grants*: grants provided by the Health Services Resources Administration, Bureau of Primary Health Care under Section 330 of the Public Health Service Act.

*Other Grants and Contracts*: includes federal grants other than Section 330 grants, grants from state and local governments and private foundations, payments from state and local indigent care programs, and contracts.

*Other*: includes non-patient related revenue, such as fundraising, interest income, rent from tentants, etc.

Future of FQHCs

FQHCs have had significant growth in the past decades. The statistical data indicates that FQHCs have the potential to serve more patients by improving the quality of care. To provide quality care and improve patient experience, FQHCs must invest in the right technology like HealthViewX Care Orchestration Platform which provides the best solutions for the major challenges faced by the health centers.

Reference:

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/fqhcfactsheet.pdf
Kaiser Commission on Medicaid and the Uninsured (data from the National Association of Community Health Centers and the Uniform Data System (UDS) of the Health Resources and Services Administration (HRSA).
Goldman, LE et al. Federally Qualified Health Centers and Private Practice Performance on Ambulatory Care Measures. American Journal of Preventive Medicine. 2012. 43(2):142-149. *Fontil et al. Management of Hypertension in Primary Care Safety-Net Clinics in the United States: A Comparison of Community Health Centers and Private Physicians’ Offices. Health Services Research. April 2017. 52:2.
2015 Uniform Data System. Bureau of Primary Health Care, HRSA, DHHS. National Center for Health Statistics. NCHS Data Brief. No. 220. November 2015. Hypertension Prevalence and Control Among Adults: United States, 2011 – 2014. National Committee for Quality Assurance. Comprehensive Diabetes Care, The State of Healthcare Quality (2016).
Shi L, Tsai J, Higgins PC, Lebrun La. (2009). Racial/ethnic and socioeconomic disparities in access to care and quality of care for US health center patients compared with non-health center patients. J Ambul Care Manage 32(4): 342 – 50. Shi L, Leburn L, Tsai J and Zhu J. (2010). Characteristics of Ambulatory Care Patients and Services: A Comparison of Community Health Centers and Physicians’ Offices J Health Care for Poor and Underserved 21 (4): 1169-83. Hing E, Hooker RS, Ashman JJ. (2010). Primary Health Care in Community Health Centers and Comparison with Office-Based Practice. J Community Health. 2011 Jun; 36(3): 406 – 13.
Shi L, Lebrun-Harris LA, Daly CA, et al. Reducing Disparities in Access to Primary Care and Patient Satisfaction with Care: The Role of Health Centers. Journal of Health Care for the Poor and Underserved. 2013; 24(1):56-66.
George Washington University analysis of the Health Resources and Services Administration’s Uniform Data System. Special Data Request, March 2018.
Community Health Center Revenues by Payer Source.

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.

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.
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.
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.
Improved communication – HealthViewX Referral Management Solution supports messaging and calling features for the referring and the receiving providers to stay connected.
Data Management – The solution is HIPAA compliant and enables secure data exchange of all patient-related documents.
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.
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.
Smart Search – HealthViewX Referral Management solution has a smart search facility that helps in finding the right provider for the treatment required.
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!

How Can Federally Qualified Health Centers Improve Patient Engagement With HealthViewX Patient Referral Management Software?

Patient Referral Program in Federally Qualified Health Centers

FQHCs are high outbound referral setups, meaning they send out numerous referrals. A patient visits the clinic when he/she is suffering from an illness. Depending on the need for specialist examination or additional diagnosis, the PCP might refer the patient to an imaging center for further diagnosis or a specialist practice for advanced treatments.

Most of the FQHCs have a team of referral coordinators or RN’s, LPA’s, MA’s operating across various locations handling the referrals today. This team sends out referrals and ensures effective referral coordination. With the help of the patient demographics and diagnosis details available from the referral order, the referral coordinator does the insurance preauthorization and finds the right imaging center or specialty practice for the patient. Following that, the coordinator creates a referral that includes the details of patient demographics and the required diagnosis. Then the referral is sent to the relevant imaging center or specialty practice.

What factors plague the traditional referral process?

The traditional patient referral process in FQHCs are riddled with flaws. The primary shortcomings of the process are improper communication and the far-reaching consequences of follow-ups. Let us consider the following stats,

According to the Archives of Internal Medicine, only half of the referrals result in a completed appointment.
An Archives of Internal Medicine study shows that PCPs do not receive consult reports from the receiving providers about 40% of the time.
The Journal of General Internal Medicine found that 68% of specialists receive no information from the PCP prior to referral visits.
The Journal of General Internal Medicine found that 63% of PCPs and 35% of specialists were dissatisfied with the current referral process
An MGMA study found that 53% of Appointments with more than three weeks of lead time resulted in a no-show

Given these statistics, it is fair to conclude that PCPs are not satisfied with the existing referral program in Federally Qualified Health Centers.

Challenges in the existing referral workflow

The following are the most common problems faced by Federally Qualified Health Centers. Let us consider the challenges with a typical referral scenario to understand it better.

Finding the right specialist/imaging center – Due to the increasing amount of imaging centers and specialists, it takes a lot of time and effort for the referral coordinator to narrow down the referral coordinator’s search and find the right one. It is also less likely for an FQHC to have the updated list of imaging centers and specialty practices.
Insurance pre-authorization – The referral coordinator must check the pre-authorization requirements, health plans, etc. They must retrieve patient-specific data like the history of medications, medical diagnosis and insurance coverage. They must then send it to the insurance company to validate these records. This exhaustive process increases the burden for the referral coordination team.
Time Spent – As referrals are handled manually, a referring coordinator spends approximately half-an-hour to one-hour for creating a referral and even more time in following up.
Tracking the referral – Specialists are usually busy and do not have the time to inform physicians about the progress of referrals. This causes physicians to lose track of referrals. They get no information about appointments, referral loop closure, or feedback from specialists or patients.

Improve Patient Referral Workflow with HealthViewX Patient Referral Management

As per the report from the Journal of General Internal Medicine, referrals managed electronically are twice as likely to result in better referral adherence. This proves that web-based referral management optimizes patient satisfaction and care. HealthViewX has thoroughly analyzed the workflow of FQHCs. We have implemented the following features for many of our FQHC clients thus positively impacting their workflow.

EMR/EHR integration – Our System integrates directly with electronic health records (EHRs). This enables healthcare professionals to easily obtain prior authorizations in real-time at the point of care. It also eliminates time-consuming paper forms, faxes, and phone calls.
Insurance pre-authorization automation – There are two ways in which HealthViewX solution automates the insurance pre-authorization process. The first one is the API-based method. Through this, we retrieve information regarding the forms and communicate information back and forth between the FQHC and the insurance company. The second one is the Form Automation method. Through this, we get all payer-specific forms, fill in the necessary information and send it to the insurance company via e-fax.
Intelligent Provider Match – The system has a smart search feature that enables PCPs to filter receiving providers according to their preferences. The list is always up to date with the newly added specialty and imaging centers which makes it easy for the PCP.
To and fro Communication – The PCP and the center can communicate with the help of the inbuilt secure messaging and voice call applications at any time of the referral process. This allows physicians to get referral updates easily.
Referral Analytics – Customizable dashboards and reports provide information about the number of referrals sent, referrals in various statuses, referrals that were missed, processed and pending. It gives a clear picture for the FQHC and helps them in making informed decisions.

Web-Based Referrals Encourage Patients to Engage With Your FQHC

Patients can use electronic resources within HealthViewX Patient Referral Management System to contact providers regarding questions or concerns. This feature

minimizes unnecessary visits and re-referrals
improves provider availability for other patients who need an in-person appointment.

Electronic referrals also enable PCPs to spend less time on administrative tasks, giving them more time to engage with their patients. Web-based referral management improves accountability and patient satisfaction while reducing costs, allowing providers to effectively close gaps in healthcare.

Automating referrals and related processes enables practices to eliminate 70% of tedious administrative duties so they can focus on improving care delivery. Patients are more likely to schedule and keep appointments when physicians are consistently available and receive accurate patient information to provide optimal care.

Reference

https://www.mgma.com/getattachment/Products/Products/Maximizing-Patient-Access-and-Scheduling/PatientAccessSchedulingResearchReport-INTER_FINAL.PDF.aspx

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495590/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553012/

4 Ideas To Improve Your Patient Referral Process In 2019

Patient Referral Program in hospitals

An effective patient referral system plays an important role in large enterprise hospitals, specialty hospitals and health systems. It is an integral way of ensuring the patients receive optimal care at the right time by the right care providers.

Unfortunately, like a chain, a patient referral process is only as strong as its weakest link. Often referral systems are weakened by the use of old-fashioned fax machines to process referrals. It compromises the system and creates hazzles for providers and patients to navigate. This reasons why only 54% of referrals result in a completed appointment.

With focused efforts and the right resources, it is possible to enhance the existing referral process and make it more efficient and timely. The referral process must improve office practices and increase patient satisfaction and referral compliance.

Most common problem

Majority of healthcare providers experience major issues related to coordination or communication between relevant departments in their referral systems. These issues tend to have a bad impact on patient satisfaction, clinical care and outcomes.

For instance, according to the Journal of General Internal Medicine, more than two-thirds (68%) of specialists receive no information from primary care physicians (PCPs) prior to referral visits. According to the Archives of Internal Medicine, an astounding 40% of PCPs do not receive consult reports back from specialists following referrals.

Any referral inbound-heavy healthcare system would have faced the above issues. These issues would jeopardize an organization’s reputation, revenue streams and professional relationships. Referrals in inbound-heavy healthcare systems were often mishandled or dropped altogether, forcing referring providers, patients or their representatives to intercede and quarterback the referral process themselves.

It is recommended that such inbound-heavy healthcare systems require a standardized, enterprise-wide process for handling referrals. The healthcare system needs a better solution to support referring providers’ needs, which would significantly improve the handling of incoming patient referrals.

4 Ideas to Improve Patient Referral Process

The following steps can be used by any referral inbound-heavy healthcare organization interested in improving their referral process,

1. Identifying the current and desired state

Before defining what is needed for a desired future state, any healthcare organization must first review and assess their current state. The healthcare system must create a team to determine

How the current referral system works
How the current referral system is not fully competent
Where and how the existing referral process requires changes
Who would be handling such changes
What next steps are needed

Now the healthcare system can achieve the desired future state with ease as the current state is clear.

2. Charting the desired future course

The next action would be to chart and determine the various referral handling scenarios. These scenarios should range from the seemingly simple, such as a referral to an orthopedic specialist for a fractured limb, to the more complicated ones, such as the referral of a patient with multiple complex chronic illnesses. All possible types of referrals must be accounted for, to ensure that they would be handled appropriately and consistently.

3. Shifting to electronic referrals

Healthcare systems who receive referrals are heavily reliant on fax-based referral systems. These systems require staffers to manually re-enter referrals is time-consuming, error-prone and a major bottleneck. Instead, healthcare systems must receive referrals in electronic forms. Electronic referrals save time for staffers, less prone to errors and are also easy to manage.

4. Creating a new standardized process

The team should then create a new, standardized process for inbound referrals and leverage the referral benefits offered by electronic channels of referrals. Critically, this should include plans for internally training their staff members on this new process. It will also overcome referring providers’ previous impressions of the healthcare system mishandling patient referrals.

You Can Too!

By following the steps listed above, it is possible to see improved referral-handling within just a few months. More importantly a healthcare system must invest on the right provider portal like HealthViewX.

It will provider tremendous improvement in return on investment. Patient satisfaction will improve with easier and more efficient access to quality care. And physicians and staff will no longer need to engage in time-consuming and costly rework, data entry and investigations simply to ensure that referrals are correctly processed. A true win/win for all!

Reference

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2686771/

How Can Large Enterprise Hospitals Overcome The Challenges In Patient Referral Workflow?

Did you know? There are about 8000+ large enterprise hospitals in U.S. Recently, Becker’s Hospital Review released the list of top 50 large health systems. 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 broader needs of the community. 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.

Considering the huge number of patients in such hospitals, the referral numbers are also high. So such large health systems face challenges such as operational inefficiency, patient dissatisfaction, care discoordination and missed referral updates in their referral process. Let us go through the patient referral workflow in detail to understand their challenges better.

Patient Referral Workflow in Large Enterprise Hospitals

In order to understand how a patient referral works in a large enterprise hospital, let us consider a scenario,

XYZ hospital is a large enterprise hospital with 10,000 plus PCPs and specialists. It is a busy hospital that sends and receives 1000 plus referrals in a day. In the workflow explained below, Mark is the patient who visits his PCP, Dr.James.

Mark visits the hospital – Mark hurt his leg and was bleeding. Even after three days, the wound did not heal. He visited his PCP, Dr. James. After examining Mark, Dr.James wants him to consult a diabetologist.
Dr.James does the insurance pre-authorization – The PCP does the insurance prior authorization manually. He places a request with the insurance company and waits for their response. The process takes time and forces Mark to wait. After about four hours, Dr.James gets the consent of the insurance company for the diagnosis.
Dr.James has difficulty finding the right specialist – The hospital had recently acquired a specialty clinic. Dr.James is not aware of the specialists recently added to the network. So he misses the famous diabetologist within the network and looks for someone outside the network. After considering many factors like the patient’s comfort, specialist’s availability, distance from the patient’s residence, specialist’s experience etc, he finally chooses a receiving provider.
Dr.James sends the referral – Dr.James finally sends the referral to Dr.Hales after trying to reach the specialist office via phone. The line seems to be engaged. He looks for many other ways which will be easy to send referrals but to his disappointment, Dr.Hales accepts only referrals through phone or website.
Dr.Hales schedules appointments – After receiving the referral, Dr.Hales schedules an appointment with the patient. Mark was not notified clearly about the appointment. So he fails to show up. It results in revenue loss for the specialist and patient dissatisfaction with the PCP. Mark who is still suffering from pain and waiting for the specialist to examine him. After two missed appointments, Mark finally visits the specialist.
Referral progress updates and loop closure – Throughout the referral process, Dr.James is in the dark. Dr.Hales is busy and fails to give referral updates to Dr.James. He is anxious to know if Mark was taken care of. Without referral updates, Dr.James cannot close the referral loop.

Challenges of Patient Referral Workflow in Large Enterprise Hospitals

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.
Finding the right specialist – A Large Enterprise Hospital has 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.
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.
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 reputation of a provider, lack of knowledge or insight and patient’s choice that lead to patient leakage.
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.
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.

HealthViewX Patient Referral Management Features for Large Enterprise Hospitals

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.
Intelligent Provider Match – The HealthViewX “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. This saves a lot of time for the referring provider.
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.
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.
Timeline View to track referrals – 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. The chances of a referring provider missing out on referral updates are very less.
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.
Referral Analytics – Helps in tracking the number of referrals and gives complete information about the referrals processed, missed, scheduled etc with the help of a Referral Data-centric Dashboard.

HealthViewX Patient Referral Management solution 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.

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