Federally Qualified Health Centers are community-based health care providers that receive funds from the HRSA Health Center Program to provide primary care services in underserved areas. They must meet a stringent set of requirements, including providing care on a sliding fee scale based on ability to pay and operating under a governing board that includes patients.

The scope of services of a Federally Qualified Health Center

1. Basic Health Services
   • Health services related to family medicine, internal medicine, pediatrics, obstetrics, or gynecology that are furnished by physicians and where appropriate, physician assistants, nurse practitioners, and nurse midwives;
   • Diagnostic laboratory and radiologic services;
   • Preventive health services
   • Emergency medical services
   • Pharmaceutical services as may be appropriate for particular centers
2. Referrals to providers of medical services and other health-related services;
3. Patient case management services (including counseling, referral, and follow-up services) and other services designed to assist health center patients in establishing eligibility for and gaining access to Federal, State, and local programs that provide or financially support the provision of medical, social, educational, or other related services;
4. Services that enable individuals to use the services of the health center (including outreach and transportation services and, if a substantial number of the individuals in the population served by a center are of limited English-speaking ability, the services of appropriate personnel fluent in the language spoken by a predominant number of such individuals);
5. Education of patients and the general population served by the health center regarding the availability and proper use of health services
6. Telehealth/Remote long-distance health services
   • The CARES Act that has been established in response to the COVID-19 pandemic authorizes FQHCs to provide telehealth services
   • This act removes the previously existing barriers that restricted the scale of services that physicians and practitioners could exchange to patients remotely
   • Price has been set at $92 for claims with the code G2025

Patient Referral Program in a Federally Qualified Health Center

Federally Qualified Health Centers constitute Primary Care Providers (PCP) who serve the underserved population. FQHCs are high outbound referral setups i.e they send out numerous referrals. A patient visits the clinic when he/she is suffering from an illness. Depending on the severity, the physician might refer the patient to an imaging center for further diagnosis or a specialist practice for advanced treatments.

An FQHC is recommended to have a dedicated referral coordination team to send out referrals and ensure effective referral coordination. With the help of the patient demographics and diagnosis details, the referral coordinator reviews the insurance prior authorization 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. Finally, the referral is sent to the relevant imaging center or specialty practice.

Challenges faced

The referral creation involves tedious manual work due to the following reasons.

• 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.
• 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.
• No Updates –  After a referral is sent, both the referring and the receiving providers may not be updated on the referral progress. In other words, the specialist/imaging center and the patient fail to update the clinic on the progress of the referral resulting in open referral loops.

Why are referral updates important to a Federally Qualified Health Center?

1. The patient’s well being – The primary role of a physician is to check on his/her patients’ health. Therefore, it is essential for a provider to know the status of the referral, the appointment, the patient’s condition, or illness.
2. Referral loop closure– Open referrals are a result of the referring provider not being updated on the referral’s progress. The ultimate aim of a referral process is to give the patient better treatment. Closing a referral loop is very important because it indicates that the patient was taken care of.
3. 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.
4. Referring to the right person – Depending on the progress of the referral and the patient’s feedback, the physician can get to know how good or bad the referral process has been. This will help the physician in knowing what step to take next.
5. Schedule follow-up appointments – After the referral is done, the physician has to schedule an appointment for the patient. For eg: If the physician is referring his patient to an imaging for X-ray, the physician must be notified once the test is done so that he can schedule an appointment and give treatment to his patient depending on the results. Structured appointments scheduled in a well-managed referral system is a constant source of new patient revenue.

Monitor your referral pipeline better with the HealthViewX solution

The major problem with an FQHC not getting updates is that everything is manual. A software solution can solve this problem quite easily. HealthViewX Patient Referral Management solution enables a referral in three simple steps thus providing a successful referral program. After the referral is created, it can be tracked with the help of the status. Both the referring and receiving providers will be notified of the appointments, test results, treatment recommendations, etc. HealthViewX can integrate with EMR/EHR and can also coordinate between the referring and the receiving sides. 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: notes related to the patient’s health, previous status of the referral, etc. Documents attachment and status change can also be done at any time of the referral process. HealthViewX Patient Referral Management solution can allow providers to be updated on the progress of the referral. This helps providers simplify the referral process and close the referral loop.

HealthViewX Patient Referral Management solution helps the referring provider to track the referral progress. Schedule a demo with us and our patient referral management experts will guide you through our HIPAA compliant solution.

Reference

(source:http://ldh.la.gov/index.cfm/page/797)