Author Archives: Vignesh Eswaramoorthy

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.

DPRP – An Initiative To Control Diabetes

It is estimated that more than twenty-nine million of the population in the United States are affected by diabetes and it is listed as the seventh leading death causing disease.

Diabetes Mellitus is a high blood glucose level that results in either because of inadequate insulin secretion or body cells that do not respond to insulin. This disease without treatment will damage many body parts leading to complications such as strokes, heart disease, and kidney failure.

Prediabetes is a stage before diabetes. An elevated blood sugar level but below the threshold of diabetes condition is a symptom of prediabetes and it is becoming more common in America. One out of every three Americans have prediabetes and many of them are not aware of it. Prediabetes can gradually develop to Type 2 diabetes.

The other condition called Type 1 diabetes, where the human body does not secrete insulin. This type is referred to as insulin-dependent diabetes, juvenile diabetes, or early-onset diabetes. Type 1 is not common as Type 2 diabetes. On average 5% of diabetes patients belongs to Type 1.

In an effort to prevent this, the Centers for Disease Control and Prevention (CDC) established a program called Diabetes Prevention and Recognition Program (DPRP).

Diabetes Prevention and Recognition Program (DPRP)

Diabetes Prevention and Recognition Program (DPRP) is a program facilitated by CDC. It provides information about Type 2 diabetes to people who are at risk, providers and also to the health insurers. The motive of this initiative is to recognize and give quality assurance measures for organizations to effectively deliver the Lifestyle Change Programs.

DPRP program is initiated based on many studies, and it is a part of a successful program called Diabetes Prevention Program (DPP).

The focus of DPRP is to provide assistance to people who are expected to be affected by Type 2 diabetes and to educate them about diabetes prevention measures.

CDC gives a detailed description of DPRP standards for Type 2 diabetes prevention lifestyle intervention program and it explains how to apply, earn and maintain recognition.

Organizations which have the knowledge and skilled staff for lifestyle coaching can apply for recognition. After getting approval from CDC the organization should implement the lifestyle program, regularly monitor the program, provide guidance to coaches and ensure the program achieves the desired results.

Like any other program, DPRP also ensures quality reporting, recognized organizations are expected to submit data every 12 months to CDC. Organizations who fail to submit the evaluation data will lose their recognition and need to re-apply for it.

The organization will enroll the participants if they are

1. A minimum of 18 years old with BMI of ≥24 kg/m2 or ≥22 kg/m2, if Asian.

2. A minimum of 50% participants must have self-blood test report or any claim code that indicates they have prediabetes within the past year (maybe self-reported)
a. Fasting glucose of 100 to 125 mg/dl
b. Plasma glucose measured 2 hours after a 75 gm glucose load of 140 to 199 mg/dl
c. A1c of 5.7 to 6.4
d. Clinically diagnosed GDM during a previous pregnancy (maybe self-reported)

3. A maximum of 50% eligible participants is from CDC Prediabetes Screening Test of the American Diabetes Association Type 2 Diabetes Risk Test or on a claims-based risk assessment.

Diabetes is a preventable disease. The fluctuation in blood sugar level can be controlled so people can live a normal life. But when it is not controlled the condition gets worse sometimes even causes death.

The importance of DPRP program is to postpone diabetes and its terrible side effects. The main reason for this increase in diabetes population is primarily due to lack of awareness. DPRP is employed to create awareness in order to control the disease.

Redesigning the Healthcare Delivery Model To Suit The Future

The WHO predicts that in the decades to come to the population of people above 65 will surpass that of children under 5 years of age. Analyzing the current trends, it can be concluded that many of these senior citizens are prone to have one or more chronic conditions.

Chronic conditions could mean more expenses for the payers and more pressure to the system. This is a volatile situation, where the social and demographic changes resulting will have a negative impact on efficiency and per capita cost factor.

To cope with this rise in senior population with chronic conditions, healthcare systems will have to manage the following:

1. Adding human resources:
Perhaps the most obvious but the most important step to adapt is to invest in human resources. It has been observed that human interactions cannot be substituted, healthcare delivery centers who focus on having optimum qualified resources in their care delivery system have more often proved to deliver the better patient experience.

2. Precision Medicine:
Precision medicine is understanding and acknowledging that different patients react to medication and treatment differently due to genetic disposition. Treatment and medication must be engineered to get the best result as possible.

Connected devices and health monitoring equipment that aids in gathering patient information near to real-time helps best possible health outcomes achievable even in the most complex scenarios.

3. Overcoming impending shortage of healthcare professionals:

The proportion of healthcare providers to that of the population is already less than ideal. This trend is said to continue even as the number and necessity of patients multiply. Healthcare providers must find a way to bridge the gap between demand and supply in healthcare. One way to do it is to create new models of care delivery using technology to stretch help across geographic distances. Telemedicine is a viable option available for healthcare professionals to augment their services in order to do more with less time and resources.

4. Holistic Medicine:

Decades of focus on specialization has made healthcare professionals see a disease or its symptom as an isolated case, and the patients are considered cured by only removing the disease. In practice, a person might be suffering from multiple health issues and a simplified isolated view might do more harm than good to a patient.

5. Leading cause and concentrated efforts

In the coming years and even now, termination of a patient’s life is more likely to occur due to traceable lifestyle choices or practices than from any infection or diseases. For example the relation between obesity and disease has for long been proven beyond any doubt, furthermore, obesity and related illness will increase the cost of treating a patient. Therefore a concentrated effort to reduce obesity can bring about a positive result in reducing the possibility of heart disease and stroke.

Like obesity, scientific observation can identify key causes of a disease and healthcare providers can make a concentrated effort in reducing the causes in a population.

These are the most important steps a healthcare provider will have to consider in improving healthcare outcomes.

The transition to a more technology involved healthcare delivery management can tremendously help providers be agiler and more effective with necessary amendments.
Healthcare strategies must be relooked to have a more holistic & flexible approach not only to accommodate CMS led changes but also to benefit the entire population.

Era of A Personalized Care

Humans differ in terms of DNA & Genome Composition. This factor may not necessarily surface as a disorder or a disability but will create variations in the manner each person responds to drugs and treatment for a disease or a condition. In any given population, there is a chance that a group exists who do not respond to any given medication in the desired manner.

Personalized medicine is the practice of designing and conducting medicine tailored to suit an individual patient’s needs with procedures, drugs and treatment approaches. Personalized medicine has been the war cry for many healthcare reformists for decades, but now there is more likelihood of the general healthcare practice widely adopting the idea because of the following reasons.

Change in regulation
Change in attitude
Healthcare technology
The current model is ineffective

Change in regulations:

The US healthcare regulations are changing giving way to implement the new methodology of care delivery and management. The provider reimbursement is being made flexible allowing healthcare professionals the space to adopt their practice for the benefit of each individual. Change in regulations also will lead way to alterations in the structure of organizations; the organizations will be revamped to be more collaborative and serve a population that is demanding quality and services that match any other industry’s methodology.

Change in attitude:

Providers of today have many tools at their disposal and partially due to this reason providers are more willing to embrace change and improve the lives of those whom they serve. The complexity that the modern medicine requires and the practice of handling a large amount of data is almost impossible to manage and generate result without healthcare IT.

Healthcare Technology:

Healthcare Technology is improving and evolving tremendously, allowing both providers and the patients not only to keep track but actively engage in Care Management. The data that is collected by connected devices and the quality of information that is gathered by hospital systems allows for an in-depth analysis of healthcare conditions and concerns.
For those not residing in cities, Healthcare IT means fast care with the focus on those suffering from chronic conditions. In personalized medicine, Healthcare IT can be used to gather personal information and monitor the effects of treatment and medication, and also play as a channel to direct personalized care.

The current model is inefficient:

The current model is inefficient and rigid to incorporate the necessary changes that need to be made to accommodate all the variations required in care delivery. The results are varying and the outcome cannot be accurately predicted. The healthcare sector now works under the assumption that reaction to a medication or procedure is the same for every individual. This is a risky assumption and one which is costing the public their health and money.

Personalized medicine is the future of healthcare, it is the next big idea that is going to shape healthcare delivery for the times to come incorporating technology. We at HealthViewX understand this, and we are determined to create healthcare delivery tools that collect useful patient information to help providers make choose the right path always.

Patient Engagement – A Key To Reduce Readmission

Many buzzwords are battling around healthcare practices and patient engagement is not new. Healthcare is reforming constantly by implementing new technologies and methods. The reforms in technology make hospitals function better while the changes made in quality measures bring better care quality. The bottom line of any provider is to provide quality care to improve the health outcome through cost-effective methodologies.

Though hospitals have been trying to bring out transitions in patient care with emerging technology they are constantly facing same issues over a period of time called readmission. Hospitals that are registered under Medicare bears the pain of being penalized if their patients get readmitted. In Chronic Care Management, patients get 20 minute of care after their discharge and CMS pays for it. The reason behind this payment is to reduce preventable readmission, and emergency room visits.

Each individual’s health outcome depends on the consistent effort taken by primary care physicians, registered nurses, care coordinators, community health workers, family members and the patients themselves. If there is a readmission then it means there is either a gap in care flow or in communication flow. The only solution to this problem is to engage patients in their own care through simple user-friendly technologies.

Smartphones to engage patients

The smartphone is a good companion for every single individual. People spend most of their time interacting with their smartphones. After smartphones hit the market it has opened a door for many portable health devices which now act as an effective tool in engaging patients in their own health.

It is found that 1 out of every 6 people who are aged above 65 have access to tech devices. Growing population adapt technology faster which means many of them in the next Medicare age group will have smartphones. If the providers pay attention to this stat then it is easy to reduce the readmission. The answer to the question “How smartphones can reduce readmission?” is engaging patients through smartphones.

Mobile technology allows the patient to know about the details of their disease, medication plan, sends appointment reminders to both patient and doctor if any wrong occurs, it helps physicians to create care plans and communicate any time with their patients. At the same time, monitoring devices help to continuously observe the health conditions and send messages to the hospital providers to get instant care.

Educating Patients

Some mobile applications have an inbuilt library which has all the details of medical diseases with their causes, symptoms, medications, treatment procedures, risk factors, and preventive measures. This acts as a reference resource for the patients and they have access to all information in one small handy device. Some tracking and monitoring apps take one step further to engage patients more effectively.

Proper Communication

Some hospitals have also seen a positive outcome in simple and secure text messaging. The message will be sent to the patient and physician as an appointment reminder. Patients who reply back are considered as active patients and they have the low possibility of getting readmitted. These responses will also help providers to check the patient availability to fix up the meeting, also it saves time.
Mobile technology also facilitates timely follow up with patients. Chronic Care Patients who have early follow-up within 7 days have lowered the readmission rate.

CCM Readmission Preventive Measures

1. Send the detailed patient medical summary to outpatient care team immediately after discharge
2. Knowing the patient’s immediate point of contact
3. Follow-up with a week after discharge
4. Educating patient about their health condition before discharging
5. Maintain EHR in such a way to reduce medical errors

Better outcomes come from a better system. Collecting proper patient data and involving patients in engagement activities will help in reducing readmissions.