Author Archives: Vignesh Eswaramoorthy

Track & Manage The Referral Life Cycle Efficiently for Healthcare Organizations

Referral networks are becoming larger and more complicated day-by-day. This makes closing a medical referral loop nearly impossible and ultimately results in care fragmentation. Tracking and managing a referral life cycle is a tedious task. Providers are at loss in trying to close the referral loop manually.

In a referral loop, a referring provider is the one who initiates the referral. The referring provider faces many difficulties in following up with the imaging centers or specialists and close the patient referral loop. Community Clinics or County Hospitals are clinics that have general physicians or PCPs who mostly refer patients out for specialized care.

For eg: Dr. Felix’s patient is suffering from chest pain. After diagnosing the patient, the doctor wants to refer him to a cardiologist who will have more expertise in this regard. After the referral is done the doctor was not receiving any updates regarding the progress of the referral. Did the receiving provider follow up with the patient? What will happen to the patient referral loop?

When does a referral life cycle remain unclosed?

There are many factors due to which a medical referral loop cannot be closed. Let us see it from the perspective of a referring provider

Time Spent – On an average, the referring provider spends about half an hour to one hour for creating referrals and even more time in following up the same.
No Updates – The referring provider is not updated on the progress of the referral by the receiving provider or the patient.

Why care about closing a patient referral loop?

Patient’s Benefit – The patient may be in need of immediate care and attention. So processing and closing it at the earliest will be the best for the patient.
Patient’s Experience – If the patient is not followed up on time he/she may not feel good about it and there are high chances for him to move out of the network.
Referral Data Analytics – PCPs require concrete data of how many referrals were converted to an appointment by a specialty care or an imaging center. It will help in analyzing who responds quickly and to whom the PCP can direct future referrals.
Costs of poorly managed referral system – Millions of referrals are clinically inappropriate every year. Almost half of the physicians do not know if their patients saw the specialists. For each missed referral opportunity is a loss of revenue.

Managing referral life cycle with HealthViewX solution

A typical Community Clinic does a lot of outbound referrals where the PCP’s refers his patient to a specialist practice when the patient need expert advice or advanced treatment for a specific problem. The PCP generates a referral request with EHR system to a central team that has referral coordinators. The patient’s insurance is pre-authorized, the patient is referred to the specialist or imaging center. This is how a referral is done. It involves a lot of manual work and keeping track of the referral is highly impossible because a referral coordinator deals with thousands of these in a day.

This is when an automated Healthcare Patient Referral Management System comes in handy. Electronic healthcare referral management system helps healthcare organizations in the seamless processing of the referral process.

HealthViewX solution has implemented a referral consolidator that brings all the referrals in a single queue. The referral coordinator can validate the documents, attach new ones, merge it to an existing referral, create a new referral for it etc. The feature also lets the referral coordinator validate the patient insurance eligibility. Based on the specialist availability the referral coordinator can create a referral. The system can integrate with EMR/EHR and can also coordinate between the referring and the receiving sides. A referral has a status attached to it looking at which the referring provider can understand in what stage the referral is. Any referral has a timeline view which is common to both the receiving and the referring providers. In the timeline view history of the referral can be seen for eg: patiently related notes, previous status of the referral, etc. Documents attachment and status change can also be done at any time of the referral process. With the help of HealthViewX Patient Referral Management solution, the referring and the receiving provider can always have an eye on the referral and also close it in time.

HealthViewX Patient Referral Management Solution features

Seamless communication – HealthViewX solution has an inbuilt audio calling and messaging application which is secure and enables faster communication
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.
Referral history – The timeline view provides the history and current status of the referral. A status helps in knowing the referral progress.
Data Analytics – A comprehensive dashboard helps to track the number of referrals in a queue and shows the number of referrals in different statuses. This helps in knowing how fast the referrals are getting closed.
Report Consolidation – The data regarding the referrals and timeline view can be printed as a report anytime in pdf/excel form.
No change in the current process – HealthViewX Patient Referral Management solution can be integrated with EMR/EHR and can write data of referral into any system if required. It is almost zero deviation from the current workflow a practice is using.

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 effectively the referral life can be tracked and managed. To know more schedule a demo with us.

Annual Wellness Visit vs. Annual Physical Exam

Annual Wellness Visit (AWV) is becoming increasingly significant in preventive healthcare services and there are many questions surrounding AWV and its actual benefits. Here is our answer to some of the trending questions:

Is Annual Wellness Visit the same as an Annual Physical Exam?

The immediate answer is a No, AWV is not the same as an annual physical exam. Medicare will cover an Annual Wellness visit but not an annual physical exam. Under the Affordable Care Act (ACA), Medicare covers AWV completely, with no co-payment and no patient deductible. This is only valid if the services provided during the visit meet specific criteria for information-gathering, assessment, and counseling.

What’s the difference between AWV and Annual Physical Exam in terms of patient assessment?

The premise of an Annual Physical Exam is to study the body and determine if there is any physical problem with the patient. On the other hand, the Annual Wellness Visit is to identify risks and then mitigate those risks by referring the patient to an appropriate resource.

Medicare Wellness is a holistic assessment routine

Annual Physical Exam is a measurement routine

The Doctor will measure height, weight, blood pressure and other routine measurements
The Doctor will assess your risk factors and treatment options
Review Health Risk Assessment questionnaire
Updating list of providers and prescriptions
Looking for signs of cognitive impairment
The Doctor will set up a screening schedule for appropriate preventive services
The Doctor will review your medical and family history

The Doctor will measure height and weight; blood pressure; BMI
The Doctor will assess your risk factors for preventable diseases
The Doctor will perform head and neck; lung; abdominal and neurological exams
The Doctor will check vital signs and test your reflexes
The Doctor may conduct any blood work or lab tests
The Doctor will review your medical and family history

The purpose of Annual Wellness Visit under Medicare is to record the current state of health and to create a starting point for the future. Medicare also covers a number of other preventive services such as preventive cancer screenings, bone density measurement, and flu shots free of cost.

The most important question would be – How is the delivery of an AWV— a preventive care service related to HealthCare Technology?

As a service, AWV is good for both patients and for HealthCare System’s Strategic Objectives. The manual processes involved in delivering AWV can be guided by an automated workflow tool. This tool can enable providers to create an assessment, create personalized care plans, set automated reminders, streamline documentation and educate the eligible population.

AWV intervention points for a tool/software platform like HealthViewX –

Patient eligibility verification	Assessment/Scheduling of patient visit	Patient visit/ Conducting the routine	AWV reports	Billing of Medicare	CCM Suggestion
Done by HealthViewX	Done by HealthViewX	Done by Provider	Done by HealthViewX, reviewed by Provider, shared with patients	Done by Provider	Suggest providers to enroll eligible patients for CCM

Empower your practice with HealthViewX’s smart and streamlined AWV and make the most out of Medicare’s profitable wellness program both for your practice and your patients.

Human-Centric Design In Healthcare

Human-Centric Design in Healthcare – A total game changer to strengthen your referral network, increase your revenue and boost patient engagement

Referrals are key for any Healthcare Specialities or Imaging Centres to generate a steady, strong and sustainable referral pipeline. Health systems need to understand that today’s referral is tomorrow’s repeat patient. Thus, adopting industry’s best practices or solutions will help them to improve patient experience and patient referral rates. Traditionally referrals come through multiple sources like fax, phone, direct messaging, virtual print, etc. and regardless of how they are referred, responding to patients’ health needs and keeping them within the network is vital for all businesses. A good referral relationship requires a systematic, streamlined and scheduled amount of time and attention.

Health Systems and Hospitals should know the financial impact of losing patient referrals and ascertain those lost revenue opportunities.

The technology in healthcare is exponentially advancing and rapidly changing the industry for the better. Both, small and large health systems, and imaging centers have more options to select a suitable solution than ever before. But, before choosing it is important to evaluate, analyze the options and adopt the right solutions to achieve their business goals or needs.

In the referral process, it is important for the referring physicians to know if their patients actually see the recommended specialist. Research has demonstrated that 25% – 50% of referring providers do not know if their patients completed the referral, both the referring and receiving provider may not communicate, and studies show that around 50% of providers do not have contact with one another. And, 61% of patients would switch providers if it were more convenient to schedule an appointment.

Today’s patient referral system is a paradigm shift from fee-for-service to value-based-care. This shift towards increased collaboration, improved overall access to care, lower cost, better outcomes, etc., demands a technology that is human-centric. Such design will improve communication and collaboration, transparency, efficiency for coordinated care to align with the business objective to improve efficiency and deliver better patient care. In order to achieve this, healthcare systems need to change their longstanding approach to keep the referrals within their network and learn to be agile. The new solution should enable workflow optimization and improve financial performance when combined with operational best practices to provide timely care, improved appointment conversion, and completion rates.

So how to get a steady, strong and sustainable growth for your business?
1. Invest in the right technology
2. Diversify – build a strong referral network, keep your referring physician informed, collaborate better for an improved outcome and have a steady patient inflow
3. Grow and sustain your revenue stream

Then, sustain and grow to the next level
1. Learn to be agile – agile provides compelling competitive advantages
2. Follow industry best practices – Engage| Interact| Build Trust
3. One of the most important responsibility is to make your patients feel safe and truly valued
4. Keep your referring physicians informed about the referral, build trust and get more patients referred to you

Most PCP’s and other healthcare providers remain the most important source of new patient acquisition. Driving new patient acquisitions and retaining them within the network is an ongoing requirement for successful practices. To succeed in business, providers need to

– Effectively manage referrals from multiple sources, utilize a standard deep-rooted process
– Communicate instantly with referral sources to fill in the missing information
– Respond to referrals quickly to reduce referral leakage
– Customizable dashboards to give instant information for informed decisions
– Ensure to have a key metrics to track, study and measure real-time metrics for referral volume and patient leakage
– Improve overall quality of care across the care continuum
– Have a well-orchestrated customizable workflow

Once a referral comes in it is important to analyze – who needs to be involved, what has to happen, and when – the timelines. This has to be documented and technology can be of great help to have all the parties involved. With the help of industry experts, human-centric designs often involve out-of-box thinking and lead to creative and highly innovative solutions when compared to that of traditional designs. To create a successful human-centric design it is important to share and discuss what you’ve made with the people you’re designing for and further refine it according to their requirement and current business challenges. By understanding the customer needs, technology providers will be primed to innovate successfully.

Our powerful solutions are tightly focused to give your business the winning edge, improve your patient experience and achieve operational excellence. Understanding the customer needs and developing solutions is our hallmark. Sustainable development means adopting solutions that best suit your business needs. The sustainable growth of any business is the result of forces working together. Let’s get started!

Referral Network & Its’ Complexity Decoded

Why generate referrals?

When a patient suffers from any illness he seeks the advice of his Primary Care Provider(PCP). If the illness lies within the PCP’s specialty he can initiate and complete the treatment – a need for the referral arises when additional tests, diagnosis, and therapy are beyond the scope of the PCP. There is also an additional need where a specialist intervention may be required for more advanced specialized treatments.

A care provider prefers to refer his patient to the practice because it increases the chances of the patient being referred back to him after additional treatment. It also helps the PCP generate more revenue by retaining the patient in his reach, thereby minimizing patient leakage. This way the PCP, imaging centers and specialists generate referrals for each other and the patient is retained in their ecosystem. There are two categorizations of medical referrals between physicians and PCPs. In-network, when a patient is referred to the practice and Out-of-network when he is referred out of the practice.

Sources of Referral

A hospital or imaging center can get referrals through multiple channels such as direct messaging, email, fax, virtual print, phone, patient walk-in etc. In a day an imaging center or hospital can have numerous referrals in hard copy or faxed option sent through emails and/or EMR.

What complicates a referral network?

There are many factors that can cause the failure of a referral. Let us take the following instances to understand why tracking a referral becomes tedious:

Dr. Anderson a Cardiologist attends to many patients in a day. He is treating a patient with cardiac arrest who fell down and suffered a fracture, he would need the assistance of an orthopedic to treat the fracture. Dr.Anderson would need to refer the patient to an orthopedic based on both their availability. The patient’s progress will have to be tracked after the referral has been made. If the patient fails to update Dr. Anderson, how would he know the status of the diagnosis?

Dr. Matthews gets a referral for asthma. He does not get the case history or the previous reports of the patient. He tries to contact the referring provider but to no avail. So he makes the patient repeat the tests to diagnose his condition and to continue with the treatment. This is a waste of time for both the patient and the provider.

Mr. Andrews is referred to a specialist from a famous hospital. As the hospital does not accept diagnostic reports from other clinics, Mr.Andrews is forced to spend money on the same tests again. He is made to wait for a long time which forces him to look for another specialist. This leads to an unclosed referral loop and patient referral leakage.

To summarize the key points,

Tracking a referral manually is tedious for both the referrer and receiver.
It is difficult for the patient to coordinate between the PCP and the specialist or imaging center

Why does referral leakage happen?

Patient leakage or referral leakage occurs more in an out-of-network referral than in an in-network referral. There could be many factors leading to patient leakage.

A reputation of the Provider – Sometimes, a provider will refer their patients out-of-network in order to have them see another provider who is more reputable in a certain field, specialty, or procedure.
Lack of Knowledge or Insight – Sometimes the providers are not aware of the specialists in their practice and tend to refer out of their network.
Patient’s Choice – If the patient decides to move out of the practice due to unavoidable reasons then referral leakage becomes inevitable.

Why should it be curbed?

It is important to process and close a referral as soon as possible because the patients may be in need of immediate attention.
Patient referral leakage ultimately leads to unclosed referral loops.

How can HealthViewX Referral Management solution help?

The patient referral is contributing factor for patient volume in the case of imaging centers and hospitals. The current process of referral is very time consuming and tedious with no tracking and periodic updates to the referrer, patient, and the receiver. An updated system that will help make the process streamlined and seamless would enhance the overall experience of the PCP and patients and also curb the referral leakage and patient no-show rate.

How great would it be if referrals from all possible channels and forms can be brought into a single queue? That is how exactly HealthViewX works.

HealthViewX Referral management helps to implement a multi-channel referral consolidation system. Let us take an imaging center that receives referral requests. The referrals usually have an attachment in pdf form which will be non-editable. Any imaging center will have a form that has to be filled out with the details given in the referral. HealthViewX referral Management comes to play here. Using Optical Character Recognition(OCR) the information from the referral will be read and the form is prefilled with the required details. Now the referral coordinator can just validate the details and create a referral and assign it to the person concerned. The referral information can also be channelized based on the request of the user for eg: Two referrals forms can be filled in if it concerns people in different locations. The solution can be integrated with EMR/EHR/RIS and can write the updated information back the system used by the imaging center.

Impacts

Multi-channel referral consolidation – Fax, Phone, Email, Online form referrals are captured, managed and monitored in a single interface
No change in current process – PCP’s continues to send the referrals without any change in the current process(Fax/Phone/Email/Online form)
OCR – Optical Character Recognition (Helps avoid manual errors and reduces the referral processing time for referrals through eFax)
Patient Appointment Scheduling and notification – Increase the conversion of referral to patient appointment by automated reminders and notifications for pre-requisites (through SMS and/or email)
Referral Analytics – Helps in making informed decisions with regards to the future investments, GTM strategy, and workforce increase
PCP, Patient, and Imaging Centre Communication – Streamlined and secure communication

Are you looking for a solution to solve your referral complexity? A 30-minute demo with our HealthViewX team will help. Our experts will walk you through the HIPPA compliant solution that makes the referral workflow simple but significant. Schedule a demo with us to know more about HealthViewX – Referral Management Solution

Improve Your Referral Management System – Where To Start?

Here’s what HealthViewX did at one of our key clients, a leading imaging center in the US – where we implemented an efficient, patient-centric system for managing referrals.

Imaging centers are under growing pressure as gaps in the referral processes and the resultant loss of referrals is adversely impacting revenues. The main gaps in the process are improper referral data exchange, lack of visibility on referral status aside and delayed delivery of reports.

An answer to solving this challenge cannot be merely expanding staff or teams. To justify the productivity of a large team will be an additional challenge.

Before embarking on a solution that would fit the need, we presented a few questions to the client team:

Which point in the process are we losing patients?
What constitutes an “appropriate” referral?
Are we providing the right response, at the right time, at the right frequency, for the right duration?

The answers to these questions pointed us to certain parts of referral routine that needed intervention. The flow of patient information, the capture of historic data & detailed patient information and tracking of follow-up information stood out as major improvement areas. A much-needed interoperability strategy backed by our referral management system to streamline workflows, enhance referral networks and increase referrals was put in place. In the new system, there is provision to establish a communication channel between all stakeholders involved, trigger notifications on status changes, track status until referral closure and be on top of the referrals at any point.

In addition to these mandatory features that create direct impact on the problem statements, there are also options to create customized templates based on the specialty they serve like for a cardiology scan centre, orthopaedic centre; ability to create orders in external systems and pull data/reports from external devices/applications and share it with referring provider/ practices thereby reducing the processing time for each order and resulting in quick turnaround time. To enable true interoperability, the platform safely and securely exchanges this patient data with physicians. Automated delivery to distribute images and reports directly to a referring physician was made possible.

To summarize some of the key benefits:

By adopting a platform that offers advanced interoperability, apart from important benefits of streamlined workflows, the growth of referral networks and improvements to the bottom line, clients also see a reduction in unnecessary imaging. By streamlining the workflows and eliminating time-consuming calls/ to and fro communication for authorization we were able to dramatically reduce the cost of unnecessary and inappropriate imaging.

But before embarking on a technology journey to improve the referral scenario at your practice or center we need to start by asking the right questions and most often, all answers point to enabling interoperability. ‘Care’ to start here? Schedule a demo

Chronic Care Management – Decoded (FAQ)

Chronic diseases are a long-term illness that needs special care and periodic evaluation. Conditions such as diabetes, cancer, heart diseases, high blood pressure and so require continuous care and help.

Both diagnosis and treatment cost of any chronic disease is very expensive. And, if a person has multiple chronic conditions, the costs will skyrocket. That’s where Medicare comes to play, like other health insurance it pays half of the treatment and care cost.

What is Medicare?
Medicare is a health insurance program administered by the U.S. Federal government for people aged 65 or above, and for people with certain disabilities and end-stage renal disease of any age.

What is Medicare Chronic Care Management service?
Under Medicare payment, a Chronic Care Management service will be provided to patients with multiple (two or more) chronic conditions by a physician or skilled professional per calendar month.

Examples of the chronic condition include, but not limited to, the below list

- Alzheimer’s Disease and Related Dementia		 - Heart Failure
- Arthritis (Osteoarthritis and Rheumatoid)		 - Hepatitis (Chronic Viral B & C)
- Asthma						 - HIV/AIDS
- Atrial Fibrillation					 - Hyperlipidemia (High cholesterol)
- Autism Spectrum Disorders				 - Hypertension (High blood pressure)
- Cancer (Breast, Colorectal, Lung, and Prostate)	 - Ischemic Heart Disease
- Chronic Kidney Disease				 - Osteoporosis
- Chronic Obstructive Pulmonary Disease		         - Diabetes
- Depression						 - Stroke
- Schizophrenia and Other Psychotic Disorders

What is CPT 99490?
Chronic Care Management Services, takes at least 20 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month, with the following required elements:
● Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient
● Chronic conditions place the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline
● Comprehensive care plan established, implemented, revised, or monitored

What are the new complex CCM codes?
CPT 99487 – Complex Chronic Care Management Services, with the following, required elements:
● Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient
● Chronic conditions place the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline
● Establishment or substantial revision of a comprehensive care plan
● Moderate or high complexity medical decision making
● 60 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month

CPT 99489 – Each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month

How do physicians get paid for CCM services?
Mostly primary care physicians can bill for CCM service and in some cases, specialists involved in care can also bill. But only 1 practitioner can be billed per patient per calendar month for either complex or non-complex code.

What is the best way to keep track of chronic care minutes?
Care providers generally keep track of the service time. A tracking software can be used to track every minute spent on care and documentation is done for reimbursement purpose. Based on the service offerings, time will be tracked for every interaction made with the patient on a monthly basis.

How to start Chronic Care Management to patients?
Patient with multiple chronic conditions first needs to enroll for CCM care service. Then physician or care professionals will provide care according to needs of the patient. This service will be then documented for billing.

Is there any chronic disease Self- Management Program?
Yes!. A low-cost Chronic Disease Self-Management Program (CDSMP) helps chronic patients to learn how to manage and improve their own health. An interactive session will be conducted for patients with the common disease by doctors that cover pain management, nutrition, exercise, and medication use.