Referral Management Process in healthcare

Patient Referral Management in healthcare plays a vital role in treating patients. The physician identifies the need for a referral and sends it to the most relevant imaging center or specialty practice. A patient referral goes through the following steps,

1. Referral Initiation – The referring physician identifies the need for a referral and initiates medical referrals.
2. Insurance Pre-authorization – If the patient has an insurance coverage, the referring physician has to validate the same. The physician must do this to find the imaging center/specialist care practice comes under the patient’s insurance coverage.
3. Finding the right provider – Depending on the treatment required, insurance coverage and patient’s convenience, the physician will narrow down the search and find the right receiving provider for the referral. Dr.Miller is a primary care physician. A patient visits his clinic complaining of chest pain. After the initial diagnosis, the physician refers him to a specialist for better treatment. The referring physician looks for the best cardiologist in the city. Considering the patient’s and specialist’s comfort, the referring physician initiates the referral.
4. Sending out the referral – After finding the right provider, the referring physician shares the patient information and the diagnosis details with the receiving provider. The referral is sent via phone, fax, email, etc depending on the source, the receiving provider is comfortable in getting the referrals from.
5. Following up with the referral – After the receiving provider receives the referral, the specialist may communicate with the referring physician for missing information. The physician should get things sorted and continue with the referral. The provider should schedule appointments with the patient and follow-up with the same. The specialist should give the referring physician timely updates on its progress.

The referral process is quite demanding for the physicians. Communicating and giving timely updates is not easy with the current workflow. Considering the complexity of referral networks, an effective Referral Management Software is the need of the hour.

Ten Advantages a Referral Management Software should Offer

The current process of referral is very time-consuming and tedious. It has no tracking system or cannot give periodic updates to the referring physician, patient, and the receiving provider. An updated electronic referral management system is required to streamline the referrals. It would enhance the overall experience of the PCP and patients, curb referral leakage and patient no-show rate. A Referral Management Software reduces manual intervention and makes the process simpler. It should offer benefits that will improve the physician-specialist equation, improve hospitals’ operational efficiency and increased revenue. The hospital must consider the following benefits before choosing a Referral Tracking Software,

1. Multichannel Referral Consolidation – The receiving provider gets multi-channel referrals through sources like FAX, online forms, direct messaging, email, virtual print, direct walk-ins, etc. An Inbound Referral setup must have a Referral Management software that consolidates all referrals into a single queue. After the first step of multi-channel referral consolidation, it is easier to process the referrals.
2. Reduced Referral Leakage – Referral Leakage is the single huge problem faced by high referral inbound setups. Referral leakage for any health system is between an average 55% to 65%. This, in turn, leads to high revenue loss. A Referral Management Software should ease the processing of several referrals on time. The Referral Tracking Software must help in finding the right specialist and also make sure that no tests are repeated. The Referral Management Software must make the patient documents available to both the referring and receiving physicians. Scheduling patient appointments and following up to see if the patient completed a referral visit will reduce the referral leakage.  
3. Increased Operational Efficiency – It is the efficiency of hospital staff to manage referrals and check the progress of the treatment. A Referral Tracking Software must make the process simple by reducing the time spent on referral initiation. The software must make referral information available to both the referring and receiving physicians. Multi-channel referral consolidation, specialist smart search and increased referral tracking will improve operational efficiency.
4. Automated Scheduling – The Referral Management Software must support an inbuilt scheduler. It schedules automated appointments with the patients and gives prompt reminders to the patient and the physician. This will never let a patient or physician miss their appointments thus reducing patient no-show rates. It helps the physician manage all their appointments on time. It thus leads to reduced patient referral leakage.
5. Improved Referral Tracking – Manual referral tracking is a tedious job for hospitals. The referring physicians are least informed about the progress of the referral. This affects referral completion and referral loop closure. The Referral Management Software must always keep the referring physicians informed about the referral’s progress.
6. Referral Completion – 25 to 50% of referring physicians do not know if their patients actually visit the specialist. Referral loop closure is very important for the referring physicians. Referral completion cannot happen when the referring physician is not informed about the progress of the referral.  The Referral Management Software must aid in referral completion by providing a secure platform for the receiving and referring physicians to communicate. Referral tracking and feedback for the referral from the receiving physician aid referral loop closure.
7. Streamline the Flow of Referral – A Referral Management Software must streamline the flow of referral. It should consume less time for each step with minimal efforts of the patient, receiving and referring physicians.
8. Enhanced communication between PCPs and specialists – The primary care physicians and the specialist find it difficult to communicate about referrals. The physicians may need to communicate for missing referral information, referral tracking or referral completion. The referral tracking software must have inbuilt messaging, audio and video calling features to enhance the communication between the primary care physicians and specialists.
9. Improved Patient Satisfaction –  The patient faces difficulties in acting as a bridge between the referring and the receiving medical care physicians. This leads to patient dissatisfaction and patient referral leakage. Timely response to referrals, minimal diagnosis, and full insurance coverage improve patient’s experience with the referral. A Referral Tracking Software must cut down patient waiting time, improve the relationship between PCPs and specialists and the overall patient satisfaction. Improved patient experience directly results in increased revenue.
10. Complete Referral Analytics – The Referral Management software should give complete data of the referrals flowing in and out of the network. Visualized data in the form of graphs, tables, charts, etc help in tracking the referrals in the pipeline. It helps in scheduling patient appointments with available documents. It gives a comprehensive data of the number of patients with various referral status and follow-up reminders for a day. The physician can customize the dashboard to show the preferred receiving physicians, the average revenue generated per patient referral, etc.

HealthViewX Patient Referral Management solution features

HealthViewX Patient Referral Management solution has features that best suit a hospitals’ Referral Management System.

1. Seamless communication – HealthViewX solution has an inbuilt audio calling and messaging application which is secure and enables faster communication
2. HIPAA compliant data security – The solution is HIPAA-compliant and offers secure data exchange. It supports almost all formats of files and keeps the patient documents safe.
3. Referral history – The timeline view provides the history and current status of the referral. A status helps in knowing the referral progress.
4. Data Analytics – A comprehensive dashboard helps to track the number of referrals in the queue and shows the number of referrals in different statuses. This helps in knowing how fast the referrals are getting closed.
5. Report Consolidation – The data regarding the referrals and timeline view can be printed as a report anytime in pdf/excel form.

With HealthViewX Patient Referral Management solution in hand managing a referral life cycle is very easy. A 30-minute demo with our team will help you know how effective our solution can track and manage the referral life cycle. To know more schedule a demo with us.

Reference

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

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3160594