Tag Archives: hipaa compliance

How Can The Healthcare Industry Equip Their Senior Patients For Chronic Care Management?

Healthcare organizations and chronic illness

By 2029, estimates show that senior patients will make up 20% of the population and a considerable share of healthcare spending. As it stands now, senior patients and patients with chronic illness make up to 5% of the population but nearly 50% of healthcare spending. How can healthcare organizations cap these rising costs.

According to a report from BDO Center for Healthcare Excellence & Innovation, healthcare organizations are taking more responsibility when it comes to older adult care and chronic care management,

From NEJM Catalyst survey, it was found that healthcare organizations are looking into

Home health services
Strong chronic disease plans
Health IT

to address the needs of a growing aging population.

How can healthcare organizations achieve patient-centric and value-based care?

As mentioned earlier, healthcare organizations are looking into home health services and care plans to treat patients with chronic diseases.

Home healthcare services – Home healthcare is a wide range of health care services that can be given in your home for an illness or injury. Home health care is usually less expensive, more convenient, and just as effective as care you get in a hospital or skilled nursing facility. Examples of home health services include:

Wound care for pressure sores or a surgical wound
Patient and caregiver education
Intravenous or nutrition therapy
Injections
Monitoring serious illness and unstable health status

In general, the goal of home health care is to treat an illness or injury. Home health care helps you:

Get better
Regain your independence
Become as self-sufficient as possible
Maintain your current condition or level of function
Slow decline

Strong chronic disease plans – Patients with one or more chronic diseases need doctor’s attention almost every day. The physicians create care plans for such patients with vitals, measurements, activities, pain, etc that need to be monitored. This will help in keeping chronic patients healthy if they follow the care plan strictly.

HealthViewX Care Management and Chronic Care Management solution to ease the process for healthcare organizations

Information technology helps in making the process simpler for healthcare organizations by reducing their time and effort. HealthViewx software provides Care Management and Chronic Care Management solutions which help in providing home health services and also care plans for chronic patients.

HealthViewX Care Management solution supports the following features,

Care plans to enable remote care – A provider can create a care plan for a patient depending on the vitals, treatments, measurements, etc that need to be tracked. The patient-centric application helps in logging data for the vitals specified in the care plan. If needed the care plan can also be printed.
Customizable dashboards to suit the need – Dashboards comprising of graphs and tables show a comprehensive data of the number of patients in different care plans depending on the patient diagnosis.
Scheduler to keep track of the appointments – An inbuilt scheduler keeps track of the appointments and sends timely reminders to both the patient and the provider. The chances of missing out an appointment are very less.
Audio and video calling features – HealthViewX Care Management solution support inbuilt audio and video calling features which help in connecting with the patients for follow-ups.
Patient-reported data – Patients can record data for all attributes in the care plan. Summary graphs and table data helps the providers in monitoring the patient vitals. The patient records can be anytime printed in pdf or excel report form.
Health device integration – HealthViewX Care Management solution can integrate with any wearable device like Fitbit, apple watch, etc. Hence the patients need not waste time in logging data in the application if they are already using wearables.

HealthViewX Chronic Care Management solution supports the following features,

Automated call log feature – After a call, care plan creation or any action related to CCM health services, the system automatically adds call logs. It reduces the physician’s manual effort is logging the call logs.
Preventive Care plans – HealthViewX solution supports care plans for the Chronic Care Management service for a patient. The physician can create a care plan depending on the patient’s health report. It helps in monitoring the patient’s vitals.
Chronic Care Management Analytics – Dashboards with intuitive charts and tables give complete analytics of the Chronic Care Management services. It provides a clear picture of the revenue perspective.
Consolidated Report – The physician can generate a consolidated report of the Chronic Care Management services given for a particular period. This makes it easy for the billing practitioner for getting the Medicare reimbursements.
HIPAA compliance – HealthViewX Chronic Care Management is HIPAA compliant. It facilitates secure data exchange. The solution manages all patient-related documents securely.

HealthViewX Care Management and Chronic Care Management solutions have features that suit healthcare organizations best. To know more about our solutions, schedule a demo with us.

How Is CMS Changing The Face Of Remote Patient Monitoring And Patient Access?

CMS has finally issued its 2019 Physician Fee Schedule Proposed Rule. It has highly anticipated new reimbursement policies for telehealth, remote monitoring, with a stronger focus on patient access to health information.

The new codes for Patient Remote Monitoring

The 2019 Proposed Rule offers three codes through which providers can get reimbursements for integrating remote monitoring data into their practice.

The first two are practice expense codes, which include resources providers spend such as office rent, supplies, and medical equipment. The third code tracks the amount of time a care provider spends managing patient care using the remote monitoring data.

990X0 – Remote monitoring of physiologic parameter(s). Covers the time providers spend on setting up the technology and explaining to patients how it works.
990X1 – Remote monitoring of physiologic parameter(s). Covers device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.
994X9 – Remote physiologic monitoring treatment management services. Covers 20 minutes or more of clinical staff, physician, or other qualified healthcare professional time in a calendar month. The code requires interactive communication with the patient and/or the patient’s caregiver during the month.

There are some challenges in the proposed codes. These codes only cover the exchange and interpretation of “physiologic” data; yet many providers today would agree that there is a wealth of patient data that is helpful at the point of care, including patient-reported outcomes or behavioral data, that would fall outside the definition of physiologic.

Further guidance may be helpful to determine exactly which providers on a care team can spend time working with remote monitoring data. While the code definition states “clinical staff, physician, or other qualified healthcare professional,” elsewhere in the PFS proposed rule refers to the term “practitioner,” which “is used to describe both physicians and non-physician practitioners (NPPs) who are permitted to bill Medicare under the PFS for the services they furnish to Medicare beneficiaries.”

New Reimbursement for “Communication Technology-Based Services”

CMS acknowledges the evolution of physician services furnished through communication technology. So Medicare enacted the telehealth services statutory provision for patients with chronic conditions. Recognizing the many statutory restrictions on telehealth in Section 1834 (m) of the Social Security Act, CMS has taken the interpretation that there are physician services that involve interaction with a patient via remote communication technology that are not considered telehealth services and therefore are not covered by these restrictions.

CMS proposed several new HCPCS codes that are not considered “telehealth” services and as such, not subject to the conditions of Section 1834 (m):

HCPCS code GVCI1 – Brief Communication Technology-Based Service, e.g. Virtual Check-in. This would include the kinds of brief non-face-to-face check-in services furnished by a physician or other qualified healthcare professional, using communication technology, to evaluate whether or not an office visit or other service is warranted.
HCPCS code GRAS1 – Remote Evaluation of Pre-Recorded Patient Information. This covers physician time spent reviewing patient-submitted video or images to determine if a follow up visit is needed.

CMS acknowledges modern communication technology that allows for “the kinds of brief check-in services furnished using communication technology that are used to evaluate whether or not an office visit or other service is warranted.”

Beginning January 1, 2019, CMS is proposing to pay providers for utilizing these types of preventative technology services, even in cases where the activity means that a follow-up office visit is not scheduled. Where the check-in services precede an office visit or follow a visit within the previous 7 days, they would be bundled into the payment for the visit, but where the service does not lead to an office visit, there could be a separate payment.

CMS is seeking comments on the implications of this approach, as well as more information from industry about the types of technologies in use today to achieve these goals. Additionally, CMS seeks insight from industry as to if,

These services are appropriate for new patients
They are only for existing patients
Patient consent is required

Health Information Technology to simplify the process

Information Technology can greatly simplify the process by making remote patient monitoring easy for the hospitals. HealthViewX is a healthcare product that provides solution for remote patient monitoring, chronic care management and referral management. Our product has many unique features that simplify the workflow and improves patient satisfaction. To know more about our solution, schedule a demo with us.

References

https://s3.amazonaws.com/public-inspection.federalregister.gov/2018-14985.pdf

Attract And Retain Patients Within Your Network In Seven Simple Steps

Did you know? More than 80% of the patients rely on online reviews to evaluate patients. 8 out of 10 Americans internet users have researched topics including diseases, treatments, health insurance, a particular doctor or hospital. They do not go to the specialist just because they were referred to. Indeed patients spend a lot of time researching about the hospital and other options. Hospitals try to seek the attention of the patients through advertisements. But in this world of growing technology, ads through radios and billboards have become old-fashioned. So the hospitals are quite lost with the following questions in mind,

How can we reach our ideal patients at the right time with the right message?
How can we keep them happy and loyal?
If potential patients are no longer reacting to traditional advertising and promotional methods then what are they responding to?

It is through Patient Value Journey.

The way a patient chooses their health care provider shows what consumers want from a product or service. Below is the 7-step Patient Value Journey that can help practices turn patients into appointments and advocates of their practice.

The Patient Value Journey

Millions of Americans are embracing technology. From online search to wearables, they are transforming the patient journey at record-breaking speed. Google receives 63,000 searches per second on any given day and health care is the third most searched topic.

Considering the present reality, how can a practice drive more patient appointments both online and offline? The best marketing strategies begin and end with how a patient finds a practice and the process that flow after their first appointment.

1) Attaining Patient Awareness

A potential patient first becomes aware of the practice and its doctor(s) during the Patient Awareness Stage. Perhaps they have a health problem or concern, are researching a health condition and potential treatment.

In this early phase of the patient journey, the patient has a problem. The practice must present their solution while showing them what differentiates them from other practices. Potential patients can become aware of a practice in the following ways:

Seeing an advertisement
Finding the practice on social media
Receiving a referral from another doctor, friend or family member
Viewing the practice website as a search result on Google
Meeting at a health fair or community event

All these avenues present significant opportunities for a practice to reach potential patients both online and offline.

2) Patient Engagement

After becoming aware of the practice, a potential patient will take action to learn more of their doctor(s). After grabbing their attention, the practice must trigger them to interact with you or their social circles. Downloading a digital asset (white paper, checklist or eBook) from your practice website

There are numerous ways patients can engage with the practice including:

Searching specifically by name for the practice on Google
Visiting physician review sites to check their overall score
Sharing, commenting or liking one of their social media posts
Clicking on an ad or post that drives back to their website
Asking peers (online or offline) about their experience with the practice
Visiting the practice website

Digital marketing, social media, and website strategies are critical for bringing the patients to the subscription phase. When new visitors arrive at the practice’s website, it must impress the users in a few minutes. The site must have an eye-catching design, have killer content, and be easy to navigate. In addition to being desktop-friendly, the website must also be mobile-friendly.

3) Patient Subscription

In stage 3, potential patients will opt in to view or receive additional content from the practice. Here, a prospective patient likes what they have seen so far, but isn’t ready to commit to an appointment just yet. They are, however, seriously considering that practice for their health care needs.

What patient actions can the practice expect in this phase of the journey?

Joining an email list for the practice’s newsletter
“Liking” the page(s) on social media to receive updates in their newsfeed
RSVPing to attend a talk or seminar
Signing up for a webinar discussing a particular pain point or treatment option

There are several tactics a practice can employ to optimize patient subscriptions.

Keep blogs updated and post relevant content that readers can share across their social networks
Respond (ideally in real-time) to comments on their social media pages
Add social sharing buttons to their blog posts, newsletters, and general emails
Encourage readers to share their posts on their social media networks

4) Conversion

In the Conversion phase, the potential patient is satisfied with their research and is now ready to become a patient of the practice with a scheduled office visit. Upon entering the conversion stage, a patient will:

Book an appointment and schedule an office visit via the website or by phone
Set up a time for an in-office consultation about services
Not cancel the appointment

To ensure a patient’s smooth flow from subscription to conversion, the practice must make the transition easy for them.

If a potential patient spends precious minutes on the website trying to figure out how to contact or book an appointment, they’ll just give up in frustration. The site must make it easy for patients to schedule a visit on every single page.

5) Achieving Diagnosis and Treatment

In the diagnosis and treatment phase of the patient journey, the medical team diagnoses and prescribes treatment to the patient. The patient receives immediate value in the form of a diagnosis or treatment plan following the appointment.

Depending on the condition, the patient is under observation or conservative treatment over multiple visits and monitoring.

6) Ascension

As part of their journey, patients may or may not be prescribed additional treatments. It depends on their condition and their response to initial treatment(s) in the diagnosis and treatment phase.

Some patients will receive continued treatment as needed. Some others may be referred to supplementary services in or outside of the practice. While others may require surgery and rehabilitation.

7) Advocacy

In the Advocacy stage, the patient has completed their treatment protocol and is satisfied with the outcome of their care. They are now in a position to advocate for the practice both online and offline.

Patients can share positive feedback with the world by:

Providing an online review or rating on the physician(s) review website(s)
Taking part in a video testimonial to share their brilliant outcomes and benefits with other potential patients
Become the subject of a case study

Patient advocates are one of the most valuable assets for a practice. Patient success stories create a connection, build trust, credibility, and interest to motivate potential patients to answer a call-to-action.

Making the Patient Value Journey Work For You

The patient-physician relationship is a symbiotic two-way relationship. The patients can provide transparent feedback which can positively impact the start of other patient journeys.

Mapping the medical practice’s goals with Patient Value Journey helps in understanding the audience’s mindset and behavior. It can hone the practice’s short-term, quarterly wins and activities that contribute to reaching their long-term goals.

Using technology to solve patient-related problems

If your practice is facing problems related to managing patient traffic, patient referrals, chronic care management, remote patient monitoring or anything at all, HealthViewX is always there to solve your operational issues and optimize the workflow. To know in detail about our solution, schedule a demo with us.

References

http://www.internetlivestats.com/google-search-statistics/

https://www.healthcareitnews.com/news/pew-study-health-information-third-most-popular-online-pursuit

http://www.nbcnews.com/id/3077086/t/more-people-search-health-online/#.W4zdVc4zbIW

https://www.softwareadvice.com/resources/how-patients-use-online-reviews/

How Can A Hospital Tackle Their Operational Problems With The Help Of A Software?

Hospitals are crucial in giving care to patients who come to them with various problems. With increasing health problems, the number of patients visiting the hospital is also increasing. As per the survey by Statistics Portal, Community hospital expenses per inpatient stay in the U.S has been increasing. Are hospitals doing enough to manage the increasing number of patients? Many hospitals are still managing their process and workflows manually. So what challenges do they face in handling such huge patient data and process manually?

Challenges faced

Let us a scenario based example to understand the challenges better. James is suffering from a headache for the past two days. He thought it would get better if he takes rest but it only became worse. He realized that he was running a high temperature and decided to visit the doctor.

The patient is trying hard to fix an appointment with the doctor – James had heard about a famous doctor nearby. Nothing was mentioned online about their opening or closing hours or if they were working today or not. Luckily he found the contact details. James calls up the doctor. The line was engaged. It was a holiday so many patients were trying to reach the clinic. He tried for half an hour before his call got connected. By that time most of the appointments were booked for the doctor. James finally got a slot to meet the doctor at 4 pm. This did not go well with James as he was already suffering from a severe headache. He felt that the hospital must have some means of scheduling appointments without any hassle during busy days.
Patient waiting to visit the doctor – James reached the clinic at 3.30 pm. He thought that his visit would be fine as he had already booked an appointment. He was surprised by the crowd. He found that there were ten more patients before him waiting to visit the doctor. He was not happy with the clinic as he had to wait for one more hour to visit the doctor. Why should he wait even after having booked an appointment? He regrets choosing this clinic as his headache is getting worse. The clinic had nothing interesting like magazines or tv to while away the time. That one hour of waiting was really bad for James. After meeting the doctor, James felt better. He finally came out of the clinic at 5.30pm after getting his medications.
Patient engagement – The clinic does not collect patient feedback about their visit to their health. James was looking for something like a feedback to make the clinic aware of his concerns. It seemed like they were too busy to hear him out. He went out of clinic thinking to never return to this place.

It is obvious that James is going to tell some other friends and family about his bad experience in this clinic. The chances of patients visiting the clinic after listening to him are less.

The above were the challenges faced by patients. But what challenges prevent the clinic from meeting the patients’ expectations?

Appointment scheduling – The clinic has an outdated method of fixing appointments over phone calls. There are no systematic methods of collecting patient requests and processing it as appointments. There is an extent to which appointments can be managed manually. When the number exceeds and when managed manually, it leads to patient dissatisfaction and also affects the workflow of the clinic.
Patient no-show rates – Many patients do not show up for appointments. The reason can be anything. The patient might have forgotten, visited another doctor or might have got better. There is no way of tracking which patients did not show up and why. The patients do not get reminders of the appointments which is an important reason for the increasing no-show rates.
Remote patient monitoring – There is no chance for the patient to get in touch with the physician in case of an emergency. Physicians are usually busy and are not available to patients for support. Though they are busy, it is good to make them available to the patients. It might be a case of emergency and the doctor’s advice might be crucial in that case.

How can a Software help in solving the challenges in the healthcare industry?

With the above-mentioned challenges, it is not good for a practice to manage its workflow manually. This is when Information Technology can help. Many physicians are skeptical about the cost a software will incur. They are not aware that healthcare software can solve their challenges and thereby reduce manpower. HealthViewX solution has the best features that can easily solve the problems of any practice.

No change in the current process – The HealthViewX 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.
Appointment scheduling and management – The HealthViewX solution has an application for the patients. They can conveniently fix appointments with the doctor depending on the schedule. The application also gives timely reminders to the patient and the physician about the appointment. It reduces patient no-show rates, patient waiting time and patient leakage. It has a positive impact on the workflow and patient’s experience.
Electronic Care Plans – The solution enables care plan creation. It helps in monitoring patient’s vitals, measurements, etc. If required, it can also be printed and handed over to the patient. This feature is in order to keep the patients engaged and encourage them to stay healthy by adhering to the care plan.
Audio and Video Calling features – It has an inbuilt audio calling and messaging application which is secure and enables faster communication. In case of an emergency, the patients can easily contact the doctors.
Patient Reported Data – Patients can record data for all attributes in the care plan. Summary graphs and table data helps the provider in monitoring the patient’s vitals. The patient medical records can be anytime printed in pdf or excel report form.
Health Device Integration – HealthViewX solution can integrate with any wearable device like Fitbit, Apple watch, etc. Hence the patients need not waste time in logging data in the application if they are already using wearables.
Report Consolidation – The data regarding the patients’ health attributes can be printed as a report anytime in pdf/excel form.
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.

HealthViewX software solves most of the challenges faced by the practices. It increases the revenue and efficiency reduces manpower. Do you want the solutions HealthViewX offers in detail? Schedule a demo with us.

References

https://www.statista.com/statistics/459772/community-hospital-expenses-per-inpatient-stay-in-the-us/

Why Is HealthViewX The Next-generation Software In Patient Referral Management

What is Patient Referral Management?

When patients need advanced treatment or additional diagnosis that is not available within the practice, physicians refer them to a specialist/imaging center. The process of managing all the patient referrals that are received or sent is called patient referral management. It is a laborious process for FQHCs who refer patients to other specialists or imaging centers.

Challenges faced by FQHCs

One of our established clients based out of California is an FQHC who faced the following challenges in their patient referral network.

1. No single system for Referral Coordinators

The PCPs can create referrals on their EMRs. However, the referrals coordinators have to extract the referral lists that have been tasked on to their workgroup. They must manually pull down respective documents from patient chart to get the referral packet ready for Insurance pre-authorization. Then the referral coordinators must manually bundle the referrals and send those to the insurance company via fax. Post receipt of pre-auth acceptance, they have to manually track the rest of the activities. They have to communicate and coordinate with the specialist and patient, etc thus driving the referral to closure. In this workflow-intense process, the referral coordinators must hop through multiple systems like EMR, eFax, and spreadsheets etc. There is no system for the Referral coordinators to maintain and track the further status of the referral through the rest of its life cycle.

2. Cumbersome Insurance Pre-Authorization

Our FQHC client sends about 600 plus authorization requests per day to 15 plus different payers. Every authorization or referral packet has 14 plus pages. Some payers have their own physical forms that have to be manually filled in. These forms must be attached to the rest of the patient documents pulled from the EMR manually. Some payers have online portals for the above process. Considering the volume of authorization requests sent every day, it is not advisable to rely on a fully manual function. It makes the process cumbersome and prone to errors.

3. Specialist & Patient Referral Communication

From their EMR, referral order letters go to the patient. But the EMR has issues with its patient referral order template. Hence the referral coordinators have to manually design the template using MS Word and send it out. Specialist cover letters and reminder notifications in the EMR do not meet the requirements of the referral coordinators. They wish to customize and automate it.

4. Referral loop closure

Following up with the Specialists, receiving the reports back from the Specialist, and attaching it back against the patient chart in the EMR are completely manual time-consuming. Relying on only Fax & phone based communication for the same makes it cumbersome to manage as it has no effective means for tracking

5. Meeting Meaningful Use (MU) requirements with the EMR Share feature

Though the EMR SHARE’s main purpose was to help providers meet the MU requirements. In order to meet MU, the FQHC has to get the specialists to enroll on a direct message service so that they can use SHARE to transfer all orders. Though the FQHC already has the technology to meet the MU requirements, the issue is on the specialists’ side. Hence the EMR SHARE is not helping them meet the MU requirements.

HealthViewX is the Next-Generation Patient Referral Management Solution

1. End-to-End referral lifecycle management with bidirectional EMR/EHR Integration HealthViewX platform supports dynamic forms, workflows, task lists, reports, data visualization and has great integration capabilities. It has enabled our FQHC client to automatically pull referral orders from their EMR in real-time. It has also helped them in configuring all other referral coordinator workflows and tasks with maximum automation. Thus our platform has helped them achieve an efficient end-to-end referral management system.

2. Payer-specific prior authorization process automation

HealthViewX platform has a payer management module that maintains and manages

different payer details
their modes of prior authorization
direct authorization procedures
payer forms
online portal links

With this information already present, it provides the referral coordinator the capability to automate

prior authorization submission
status checks coupled
fax integration

3. Automated Specialist / Patient Notification & Reminders with Customizable templates and configurable channels of communication

HealthViewX – Template engine platform along with the communication engine gives the flexibility to the referral coordinators to

choose the relevant format and mode of delivery for Specialist / Patient communication
tie it along with the referral workflows by setting trigger rules and reminder rules.

4. Secure Online referral portal for Specialists with easy touch points via Fax /SMS/Email

HealthViewX clearly understands the specialists’ referral preferences by,

Multi-channel referral consolidation that brings all the referrals from every possible source into a single queue.
Detailed referral information through which that the Specialist receives all the necessary referral details.
Ability to communicate back and forth (electronically or via fax) in a simple and secure way.

These are few notable features of HealthViewX that have enabled referral loop closure from the specialist side.

5. Free secure Specialist online accounts with both sides integration capabilities to meet Meaning Use requirements

As mentioned earlier, the problem with MU requirements was not, it was not met by the specialists. HealthViewX solution provides free online accounts for such specialists. It was highly useful to our FQHC client as we supported seamless integration between both ends. It helped the specialists meet the MU requirements.

HealthViewX Patient Referral Management application is the next-generation software for patient referral management. It has provided the best solution to the challenges faced by FQHCs. To know more about HealthViewX solution, schedule a demo with us. Our patient referral management experts will guide you through our HIPAA compliant solution.

Five ways In Which HealthViewX Referral Management Can Fix The Referral Problems Of Enterprise Hospitals?

Existing Patient Referral Management Workflow in Large Enterprise Hospitals

In order to understand how a patient referral works in a large enterprise hospital, let us consider a scenario,

XYZ hospital is a large enterprise hospital with 10,000 plus PCPs and specialists. It is a busy hospital that sends and receives 1000 plus referrals in a day.

Mark visits the hospital – Mark hurt his leg and was bleeding. Even after three days, the wound did not heal. He visited his PCP, Dr. James. After examining Mark, Dr.James wants him to consult a diabetologist.
Dr.James does the insurance pre-authorization – The PCP does the insurance authorization manually. He places a request with the insurance company and waits for their response. The process takes time and forces Mark to wait. After about four hours, Dr.James gets the consent of the insurance company for the diagnosis.
Dr.James has difficulty finding the right specialist – St.Luke’s hospital had recently acquired a specialty clinic. Dr.James is not aware of the specialists recently added to the network. So he misses the famous diabetologist within the network and looks for someone outside the network. After considering many factors like the patient’s comfort, specialist’s availability, distance from the patient’s residence, specialist’s experience etc, he finally chooses a receiving provider.
Dr.James sends the referral – Dr.James finally sends the referral to Dr.Hales after trying to reach the specialist office via phone. The line seems to be engaged. He looks for many other ways which will be easy to send referrals but to his disappointment, Dr.Hales accepts only referrals through phone or website.
Dr.Hales schedules appointments – After receiving the referral, Dr.Hales schedules an appointment with the patient. Mark was not notified clearly about the appointment. So he fails to show up. It results in revenue loss for the specialist and patient dissatisfaction with the PCP. Mark who is still suffering from pain and waiting for the specialist to examine him. After two missed appointments, Mark finally visits the specialist.
Referral progress updates and loop closure – Throughout the referral process, Dr.James is in the dark. Dr.Hales is busy and fails to give referral updates to Dr.James. He is anxious to know if Mark was taken care of. Without referral updates, Dr.James cannot close the referral loop.

Challenges faced by Enterprise Hospitals

Insurance pre-authorization – The process of waiting for the insurance company to respond and approve the procedures or medication is time-consuming. If this process is automated it would save time and efforts of providers, insurance companies, and patients.
Finding the right receiving provider – As many of the enterprise hospitals are joint ventures or acquisitions, the PCPs are not completely aware of the specialists within their network. Many times, the PCPs refer their patients to specialists out of their network. Finding the right provider outside the network is the greatest challenge as the PCP has to consider many factors. It is time-consuming and prone to errors when done manually.
Patient Referral Leakage – When a PCP refers the patient out-of-network, it leads to referral leakage. PCP can avoid Patient referral leakage if the patient is referred within the network. When that is difficult, patient referral leakage is inevitable. If the patient is referred out-of-network and is not happy with the care given, the chances of the patient coming back to the PCP is less. Referral leakage causes revenue loss and patient dissatisfaction.
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.
Referral updates and referral loop closure – When PCP refers patients out-of-network, the chances of getting referral updates are minimal. The specialist is usually busy and does not update the referring provider about the referral. Referral updates are crucial in closing referral loops.

HealthViewX Patient Referral Management Workflow in Large Enterprise Hospitals

Let us consider the same scenario used earlier and see the benefit of HealthViewX referral software to the existing workflow in Large Enterprise Hospitals,

Mark visits the hospital – Mark hurt his leg and was bleeding. Even after three days, the wound did not heal. He visited his PCP, Dr. James. After examining Mark, Dr.James wants him to consult a diabetologist.
Dr.James does the insurance pre-authorization – The PCP does the insurance authorization in the HealthViewX application. HealthViewX places a request with the insurance company and coordinates with them thereafter. The process takes place quickly and gets over in about 15 minutes Dr.James gets the consent of the insurance company for the diagnosis.
Dr.James finds the right specialist in no time – St.Luke’s hospital had recently acquired a specialty clinic. Dr.James is not aware of the specialists recently added to the network. He need not worry as the HealthViewX application is updated with the current list of providers. With the help of the Intelligent Smart Search feature, Sr.James found the right specialist in his network.
Dr.James sends the referral – Dr.James sends the referral to Dr.Hales via HealthViewX application. It supports many channels of referrals like email, website forms, type-enabled pdf, fax, online forms, etc. With the HealthViewX solution, sending out referrals takes not more than five minutes.
Dr.Hales schedules appointments – After receiving the referral, Dr.Hales schedules an appointment with the patient. Mark is notified clearly about the appointment. He meets the specialist on time and gets treated. This improves his satisfaction and Mark plans to visit the hospital in case of any illness.
Referral progress updates and loop closure – HealthViewX application supports a Timeline View that is available to both the referring and receiving providers. It says all about the referral and its history. Dr.Hales is not required to update Dr.James as it is taken care of by the application. Without referral updates, Dr.James can close the referral loop without any delay. Dr.James can receive feedback about the referral from the patient and the specialist. Depending on their remarks, he can improve the process in future.

HealthViewX Patient Referral Management solution is the best choice for Large Enterprise Hospitals. Are you a Large Enterprise hospital looking for a referral management solution to solve your referral challenges? Schedule a demo with us. Our solution experts will be happy to guide you through our HealthViewX HIPAA compliant Patient Referral Management solution.