Why is Patient Referral Management important for hospitals?

Patient begin a journey with the hospital when they are referred to that hospital to improve their health condition. Their expectation of the referral is usually high as they have sought another hospital for better experience and treatment. So hospitals must try to live up to the expectations of their patients. In order to manage huge volume of referrals, a hospital must have an effective Patient Referral Management System in place. This blog highlights challenges faced by operations manager, revenue cycle manager, healthcare IT department, patient referral coordinators and care providers (physicians and specialists) and how HealthViewX Patient Referral Management Software can help.

Challenges faced by physicians and specialists

Physicians and specialists play pivotal roles in the patient referral process. Physicians or PCPs hold the responsibility of initiating referrals. A patient visits the PCP and it is the discretion of the PCP to refer the patient to a specialist. What problems do physicians face in a referral process?

1. Manual and time-consuming process – The process of creating a referral is too manual and time-consuming. In every stage of the referral, the physician has to put in a lot of effort. Here are few instances,

• The physician has to wait for the insurance pre-authorization process to be done
• Finding the right specialist takes a lot of effort from the physician’s side
• After sending the referral, the physician has to wait for referral updates from the specialist.

From a specialist’s perspective the referral process is cumbersome. A specialist faces the following challenges,

1. Multiple referral channels – For the specialist/imaging center who receive referrals face more difficulties than the referring provider. The receive referrals through various channels like fax, email, direct message, website, user-filled forms, etc. Managing and tracking all of it manually is a tedious task. The chances of missing out on a referral are high.
2. Poor communication framework – The existing referral process has no quick mode of communication to contact the PCP or referral coordinator for missing information. The specialist has to wait till he/she gets the necessary information before starting with the referral process.

Challenges faced by referral coordinators

After a referral request is initiated, then it is the job of the referral coordinator to create a referral. A referral faces the following challenges,

1. Insurance pre-authorization – A referral coordinator has to consult the insurance company if the diagnosis prescribed meet the insurance requirements of the patient. This process takes time as the referral coordinator has to wait for the insurance company to respond.
2. Finding the right specialist/imaging center – The next big step after insurance pre-authorization is finding the right specialist or imaging center for the patient. The referral coordinator has to consider many factors like the patient’s convenience, specialist’s availability, new specialists in the locality, etc. This is time-consuming as there will be many specialists and imaging centers. Narrowing down the search manually will be difficult for the referral coordinator.
3. Handling multiple software – A referral coordinator has to handle an EHR, fax system, appointment scheduling software all at the same time. The coordinator has to
   • Collect the patient information and demographics from the EHR
   • Do the insurance pre-authorization
   • Find the specialist
   • Send out the referral as a hard-copy fax

Handling so many things at the same time is tedious for the referral coordinators

Challenges faced by an operations manager

1. Patient Referral Leakage – An operations manager will be primarily worried about how many patients are referred out of the network. Patient referral leakage is a determining factor in a referral network. In many cases, the patients are referred out-of-network even when there are appropriate specialists within the network.
2. Referral Analytics –  As a large number of referrals flow in and out of the network, it is difficult to track the exact number. It is also tedious to track the number of referrals in various status and to close referral loops. The operations manager also needs to know how many referrals were sent or received, how many were processed, how many are yet to be processed, etc.

Challenges faced by a revenue cycle manager

1. Patient no-show rates – After receiving the referral, the specialist/imaging center schedules appointments with the patient. In some cases, the patients are not notified clearly about the appointment. When patients do not show up, it is difficult for the specialist/imaging center to track. It results in revenue loss and patient dissatisfaction.
2. Costly software – As mentioned earlier, a referral process needs an EMR/EHR, appointment scheduling software and a fax integration system. So many softwares for a single process is not efficient.

Challenges faced by an IT strategist

1. Handling sensitive patient data – Patient data must be handled securely. Considering the current manual process, it is difficult to maintain data security.

How can HealthViewX solution add value to the process?

• 1. Insurance pre-authorization process – HealthViewX automates the insurance pre-authorization process. The provider need not coordinate with the insurance company for prior authorization. The HealthViewX solution will do it for them. This reduces the manual effort of the referral coordinators.
  2. Intelligent Provider Match – The HealthViewX “Smart Search” feature makes it easy for the referring provider in finding the right provider. It has smart filters and search options that help in narrowing down the specialist based on the requirements. This saves a lot of time for the referral coordinators.
  3. Timeline View to track referrals – With the help of a referral status, the referring provider can get to know what stage the referral is. A timeline view shows a history of stages through which the referral has progressed. The chances of a referring provider missing out on referral updates are very less.
  4. Referral closure and feedback – The referring provider can close the referral when it gets completed. The receiving provider and the patient can give a feedback on the referral process to the referring provider. Thus the referring provider can make it easy for the other the next time.
  5. Multi-channel referral consolidation – The HealthViewX solution can capture fax, phone, email, online form referrals or any other referrals in a single interface. It makes it easy to monitor and manage all channels of referrals in a single queue.
  6. Patient coordination framework – After finding the receiving provider, the referral coordinator refers the patient. When the receiving provider receives the referral, the provider will get notified of the referral. Even the patient will be notified of the referral. The receiving provider can schedule appointments based on the patient’s comfort. This will cut down patient no-show rates.
  7. Referral Analytics – Helps in tracking the number of referrals and gives complete information about the referrals processed, missed, scheduled etc with the help of a Referral Data-centric Dashboard. It helps the operations manager in taking informed decisions.
  8. HIPAA compliance – The solution is completely HIPAA compliant which enables secure patient data exchange.

HealthViewX Patient Referral Management solution smooths the referral process and solves challenges faced by people in different designations in healthcare. Do you want to know more about HealthViewX HIPAA compliant Patient Referral Management solution? Schedule a demo with us.