Author Archives: Vignesh Eswaramoorthy

Why Referral Matters for Population Health?

Population Health has been the buzzword for some time now and is used excessively by healthcare providers of all kinds and large employers amongst others. One reason for this is, of course, the concept is in itself broad and can include many things.

The basic concept of population health can be defined as understanding healthcare needs of a patient population and proactive intervention based on group variations of healthcare requirements to achieve population health quality outcomes.

Population Health Management proposes a holistic approach to healthcare delivery and better outcome, that is the reason why managing referral network becomes important in the process.

Ensure Continuity of Care

The Providers participating in a population health model have a bigger stake in the continuity of care their patient population has been receiving.National statistics on referral indicates more than 40% of the referred patients do not go to recommended specialists therefore maybe unsettling to general providers. A referral Management solution can most definitely improve those numbers or at least identify the reasons why patients are reluctant to see a specialist.

Keeping the PCP in the Loop

An intelligent medical referral solution allows PCPs to consult with the specialist and make an informed decision in directing patient care. Referral management solution will ensure a good level of communication during and after the referral is complete. Primary providers in the absence of a medical referral solution have no means of knowing the status of the referral at regular intervals. After a referral Primary provider may not be able to know the specialist’s diagnosis and understand the outcome of the process closing the referral loop

Patient Population Requirements

The PCPs who consult several patients a day have no reliable well-documented source to understand the various needs of the population that they serve. The result of lack of capabilities will push PCPs to refer patients to specialists outside of their network to serve and address the needs of a patient.

Employing Analytics

Identifying the right data set from different sources to achieve the measureable outcome is not an easy task. Healthcare industry is slowly adapting to new age technologies and leveraging data insights from the information gathered by analytics tools. For example, if a PCP is able to evaluate the data from the past 6 to 12 months, it will help him understand the strength, weakness and yield more revenue opportunities for the practice and prevent revenue leakage through referrals made outside of the network.

Referral Leakage And Ways To Prevent It

Referral leakage (also called as Network Leakage) happens when primary care physician (PCP) refers their patients to health care provider or specialist (outside the network). When this referral process tends to take place repeatedly it will lead to loss of revenue.

Referrals are made to provide better care to patients by avoiding medical complications. PCP’s will not refer patients to other practice specialists until there is a necessity. The PCP send patients to outside providers because they don’t have proper facility, or lack in quality equipment, resource to treat them and in some situation, the patient wishes to get referred or there is a medical emergency.
Referral leakage not only eats up the revenue but also results in patient leaving your network. So if organizations are making many referrals to outside providers then you need to identify why the physicians are referring them out. Because the patients whom you are referring out may not return back which means you are losing your valuable patient. Followings are some reasons why health organizations lose their patients due to referral leakage:

Not enough resources available or when the organization has limited access
Patients who want to seek a second opinion from the specialist
When geographical location or distance is a concern
When patient-physician meeting did not happen at the scheduled time
Expensive specialist
Poor facility and service
The gap in patient-provider communication

To have a tight hold of your patients, you will need an effective software system which must have the capability of capturing or tracking data to disclose all the referral network pattern. Implementing referral system into your practice will make your practice management steps easier.

Identify a software with following capabilities:

Ability to track the referral network pattern (both inside and outside)
Identifies patients who leave your organizations
Captures reason for being referred out (i.e. lack of resources or specialist, emergency etc.)
Records all details related to a referral made (such as outside provider name, location, referred physician, the reason for referring)
Dashboard which has all detailed about IN & OUT referral that help to get better insights

Tools will give all required patient details which will also help to update patient information within the network. Using data analytics will help to get insights about data that will help prevent leakage by focusing on three key areas: Network Pattern, Network Optimization, and Growth Planning.

Understanding current network pattern
Analyze and understand the behavior of patients both inside and outside of the network across practices, physicians, and locations. Using web-based solutions, track these data to reveal the referral pattern. Using that pattern to educate in-network providers to minimize the referral leakage.

Perfecting current process to prevent leakage
Daily reporting on patient’s health status and usage of tools help to gather information to trace patient behavior pattern. So providers need to improve physician awareness with reporting tools.

It is providers’ responsibility to keep their loyal patients. To retain their patients they first need to identify what’s patient expectation from competitors practice. Identify the gaps and implement it in practice to avoid a patient shift to other networks.

Building a better care system
Equipping health systems with software tools will help to optimize referral networks. By focusing on network optimization, we not only reduce referral leakage it also directs healthcare system on the right path. So healthcare organizations need to build clinical integration networks.

Referrals impact adversely in the revenue cycle of providers, and they most often fail to realize the importance of losing a patient and revenue while directing patients to a specialist outside of their network which could be prevented by building clinically integrated networks that will help to analyze problems within the network and prevents referral leakage.

Accidental Violation of HIPAA Compliance

Patient information secrecy is of utmost importance for any healthcare organization and medical professionals due to the risk of being compromised, exposed or accessed. With initiatives and innovation in healthcare IT space by various federal agencies (particularly CMS) and health care providers throughout the country over the years, have embraced healthcare IT innovations to secure healthcare data.

Most providers even today use conventional processes to send and receive medical referrals which could lead to an accidental violation of HIPAA (Health Insurance Portability and Accountability Act of 1996) rules which sets the standards to the use and share of patient-related information to ensure security.

In best practices, referrals are managed by referral coordinators who are in charge of sharing patient information, setting appointments and ensuring closure of the referral loop. The referral coordinator and other staff may be committing HIPAA violations in the following manner:

1. Triplicate Forms– Commonly, medical referrals are conducted using triplicate forms and it contains patient identification information. Such forms are circulated to the Specialists’ office and a copy is kept at the PCP’s office.

2. Patient Information Faxing– Hospitals and clinics relay a lot on faxing. Patient information for referrals are sent via faxes and it is not uncommon for providers to misplace such documents.

3. Use of Personal Portals and Storing Devices– For the ease of communication healthcare providers and referral coordinators repeatedly make use of their personal communication devices or portals like emails, cell phones etc.

According to HIPAA, all those above scenarios fall under the category of accidental violation of HIPAA regulations and such violators are subject to a penalty ranging from $100 dollars to $50,000 per violation depending on how the violation is categorized as.

It is not rare for providers to find themselves in these circumstances like many have in the recent past. Some due to negligence don’t comply with HIPAA regulations and on the other side of the spectrum for criminal activities involving staff misuse. Providers could take immediate actions against this issue and cut their risk in half.

a. Educating your staff on the threat to patient information, HIPAA violation and penalties involved.
b. Establishing standard procedures for staff to follow while dealing with medical referrals.
c. Likewise establishing security infrastructure to secure health data in hospital servers and cloud.

In the long run, these measures will not be enough. These methods do not have the capacity to manage large numbers of medical referrals and providers cannot divert much of their resources to maintain an IT team when there is always a shortage of helping hands.

Healthcare providers need to move away from paper triplicate forms and fax machines and embrace Referral Management Solution.

HealthViewX Referral Management Solution is a comprehensive, multi-channel solution that is secure as it is functional.

DPRP And Diabetes Care Management

The United States has been seeing a significant increase in the rate of newly diagnosed diabetes over the past decade. Diabetes will change the total lifestyle of a person. Once you get it, you have to bear with it throughout your lifetime. Diabetes ranks seventh in the list of the world’s most killing diseases. Though it is quite well-known most of the Americans are still not fully aware of the consequences of diabetes.

More than 29 million Americans are currently surviving with diabetes and three fourth of American adults are having prediabetes. Prediabetes is a health condition that has the high risk of developing type 2 diabetes, which without immediate attention and health counseling may lead to heart attack and strokes.

American Diabetes Association has estimated that every year over $322 billion is spent to treat diabetes and prediabetes. Every year more people get added to diabetes population list yet the good news is that type 2 diabetes is completely preventable. Prevention can be made by engaging prediabetes patients with a good medical care plan, creating awareness and education, and by involving each of them in their own care.

DPRP and Diabetes Disease Management

The peril of diabetes has a huge impact and it is right to say prevention of diabetes needs more attention than ever before. So the Centers for Disease Control and Prevention (CDC) established the CDC Diabetes Prevention Recognition Program (DPRP) as part of the National Diabetes Prevention Program(DPP). The center is pioneered to spread awareness about diabetes, and to find people with prediabetes condition to involve them in a lifestyle intervention program concerning to reduce the risk of getting type 2 diabetes.

To make this program a success it requires active participants. However, if people are less interested it is difficult to accomplish. DPRP will recognize organizations who can provide lifestyle intervention to prediabetes people. Also, these organizations have to report to CDC every year. The key reasons for organizations adopting Diabetes Disease Management Program in practices are to better clinical outcomes, reducing medical costs and utilization, and improving patient satisfaction.

Educating patients using evidence-based practice guidelines, and providing assistance to prevent complications will substantially reduce the utilization cost. This program also encourages people’s participation in self-management. Self-care is much needed because no two diabetic people can follow the same medication process. Each individual patient has to be treated one other way.

Why diabetic patient needs more care?

A study states that half of type 2 affected diabetes individuals are above 60 years of age with the highest ratio found in above 80 years age group, and this number is expected to multiple doubles within few years. This aged population requires good caretakers (like practitioner nurses or care coordinators).

Diabetic patients need daily monitoring, frequent changes in diet plan and care plan, periodic blood glucose test, proper maintenance of reports and all these tasks require quite a lot of human efforts. A good Care Management Tool will ease the process only when health providers choose the best one from the market.

Simple solution for better heal

With technology in hand, providers can bring miracles in patient’s life. Alerts, notification, e-consult, tracking, feedback and lot more features are readily available as a simple integrated solution. The Providers just have to pick up one right suitable management software to make use of it.

Wouldn’t it be useful if a software intimates a physician if there is any change in the patient’s blood glucose level, allows the physician to immediately reach to that patient to identify the reason for rising in glucose level, create and push the care plan to respective care coordinators and make changes in diet plan? It not only improves immediate care but also reduces costs, patient wait time, and more importantly it helps to avoid emergency room visits.

Our HealthViewX DPRP Solution is one such simple software designed to bring a better change in patient health and to ease the work of health professionals.

Why Are Medical Referrals So Important?

It’s a usual day, several in-patients are under your care, many scheduled patients are already seated in the waiting area and the ambulance has brought in an emergency case. On top of this, a pile of paperwork promises to cut your lunchtime in half. In between, scheduled patients come in and some of them need to be referred out. While Patient referrals can be time-consuming and tedious, they are an imperative process in healthcare operations.

Theoretically, the referral process is simple – if the initial diagnosis concludes that the patient needs special care or medical guidance then the patient’s primary provider will suggest providers or schedule an appointment with a specialist. The patient fulfills their end of the bargain by going to the specialist and getting treated.

In practice, the provider may only suggest a specialist because they know them and checking for availability and getting an appointment with the specialist is easier said than done. Even if this criteria is met, the patient may end up going to another specialist, or not get treated at all.

There is more at stake here than just a few missed appointments. Statistics show that the number of medical referrals are on the rise in the US and with referrals gaining importance, is it critical for both the patients and the practice. Following are a few reasons why referrals are important:

Care Outcome: In an industry under transformation from fee-based to performance-based, the medical outcome and patient experience will continue to become more important, a trend most visible in an Accountable Care Organizations (ACOs) setup. ACOs are responsible for the health of the population they serve and shares the cost of care with Medicare. If the cost of care exceeds the preset limit and/or the quality is not up to the standard then it could affect ACO reimbursement. Most of the time the referring provider does not know about the cost of the specialist or the quality of care.

Revenue Management: Referring a patient could be a risky gamble from a revenue management perspective. It is often observed that the only revenue inflow from a referral is for the specialist. Once a primary provider refers a patient out of his practice to a specialist, the patient is out of the provider’s control. The patient may further be referred to another specialist or even to a rival hospital system. Even if the provider has sent the patients to the right specialist, the patients have been going to another specialist unbeknownst to the provider. Ultimately, the provider’s practice is losing future revenue without even knowing.

To Refer Or Not To Refer: A patient is referred to a specialist when a provider determines a reason for specialist care or the complexity of the patient’s condition is beyond the range of the primary provider. While issuing referrals appears straightforward, the parameters that would necessitate the initiation of referrals are vague at best. Wrong decisions on referral can cause serious problems for the provider.

How big a problem? Consequences range from unwanted costs to legal action. Wrong referral leads to uncalled expense, if the primary provider refers to a specialist whose capabilities cannot fulfil the patients requirements. The patient’s conditions could worsen because of the primary provider’s delay in facilitating the needed treatment, and the patient in question can file a legal case against the provider.

Our healthcare system relies heavily on referrals. For quite some time the healthcare sector favored specialty over primary physicians (evident in the disproportion of primary providers we have) but evidence now compels us to look at the care delivery pyramid and amend necessary changes for better care delivery and efficiency.

The importance of referral is that it is not just the next step in care delivery, but for patients who may need desperate treatment, an efficient referral could lead them on the path to recovery.

Create and Manage your Medical Referral Network Better!

Referral Management Solution helps providers to send patient referrals and to keep track of them. The purpose of the solution is to achieve a better outcome by improving communication and coordination between healthcare providers and patients.
Electronic Referrals or e-Referral enables endless patient information sharing throughout the care continuum in a secured way without violating HIPAA complaint. It also makes hospital referral process simple, manageable and reviewable at any given point.

Referral software integrates with EMR and will soon eliminate paperwork and documentation. A study suggests that paperless referrals have increased the follow-up rates up to 30-40%.
The Healthcare process workflow is considered to be one of the most challenging environments with regards to the complexity and security involved, Referral Solution helps to extemporize the hospital’s process flow and enables quick referrals.

The followings are the features of Referral Solution:

1. Better Access

The focus of Referral software is to improve the doctor-patient communication to provide better care and to improve health outcome. Physicians can send seamless referrals within or outside the network and the patients can communicate to their specialist anytime. This endless access helps patients to engage better in self-care.

2. Manage Referrals

Referral Solution helps to send right information to the right person at the right time. It also helps the provider to manage the workflow of information back and forth. PCP who usually initiates the referral can view the referral history and can track and drill down to check the status in detail for any number of referrals initiated from their facility.

3. E-Consultation

E-consultation reduces unnecessary face-to-face hospital visits. The well -designed Referral Solution makes it easy for patients and caregivers to exchange messages and medical diagnostic attachments like X-rays, screening images, and clinical notes with the specialists. A specialist or PCP can instantly get connected to their patient for e-consultation either via texts, calls, or video calls.

4. Reminders and Alerts Notification

Both physicians and patients get reminders about their upcoming scheduled meetings. The solution will allow you to manage all these alerts. Automated alerts are also sent to keep physicians informed if they miss any alerts or in case of emergency.

5. Schedule Appointments

The physician can quickly fix appointments with their patients if they are under risk conditions. Scheduled appointments can be managed online through portals in case if they want to postpone or cancel the meeting after seeing improvements in patient’s health condition.

6. Post Feedback and Loop Closure

Feedback along with all treatment details will be sent back to the referred PCP from the specialist for EMR update. Once the patient record is updated PCP will close the referral loop.
Some hospitals find reducing referral leakage and readmissions after implementing Referral Management Solution at their practice.

7. Referral Leakage

Medical records are highly confidential and it requires a safe and secure transfer. Also, the probability of leakage of data is high when PCP is looking at multiple cases on a given day.

In order to avoid leakage, providers need to update the physician’s directory list frequently.
This problem can be solved by encrypting the file with a password. People who have credentials are the only ones who will be able to access, view and share the patient record.

HealthViewX Referral Management Solution helps to send referrals secure and seamlessly, provide quick access to patient data, send notifications and alerts, and share information throughout to ensure closure of referral loop.