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5 Benefits To Look For Before Choosing A Referral Management Software

Referral process in healthcare

A referral process in healthcare, a primary care physician creates a referral order in the EMR for a patient to see a specialist or imaging center for a specific medical service. PCPs hold the responsibility for managing and tracking their patient referrals throughout its life cycle. But the PCPs face challenges in managing the referral process. Challenges such as increasing patient referrals, new specialist and imaging centers opening up, manual referral follow-ups, etc prevent PCPs from managing the referral process effectively. This is when a healthcare referral management system comes to play.

Importance of referral management software in healthcare

There are many reasons for why having a referral management software is necessary. Healthcare processes are always criticized for being costly and inefficient. Referral management software is a potential solution to the healthcare problems. In this day and age, healthcare is moving towards improving quality and efficiency, while also decreasing the cost. It’s all about improving the experience for their patients. The entire industry is adapting technology for streamlining administrative operations.
Here are some alarming statistics that reiterate the need for a referral management solution,

  • Any health system will have an average referral leakage of 55-65%
  • Approximately 33% of patients do not follow-up with the specialist to whom they are referred
  • 25 to 50% of referring physicians do not know whether their patients see the specialist
  • Over 50% of the current referral process is redundant and repetitive

In order to reduce referral leakage, increase patient follow-ups and improve the current referral process, a referral management software is needed.

Benefits a referral management software should deliver

The following are the benefits that a referral management software should deliver in order to make the referral process efficient,

1. Reduced referral leakage

Referral leakage is a huge problem hemorrhaging health systems in the country. Missed referrals are the main reasons for millions of lost revenue.
After implementing an effective referral management solution, the health system will see an immediate reduction in referral leakage. It will have a positive impact on the health system by making it more efficient and better equipped to serve patients. The immediate effect a health system will recognize is fewer patients leaving the health system thus saving millions in lost revenue.
Click here to learn more about how a health system can reduce referral leakage in their network.

“HealthViewX reduces referral leakage by helping referral coordinators in identifying the right receiving providers within the care continuum”

2. Decreased lead times

Operational inefficiency hampers a referral network to a greater extent. Dead time or unnecessarily long lead times are an inconvenience to both patients and providers alike.
For eg – PCPs frequently refer patients to specialists without considering the benefit for the specialty. About 65% of referral created by PCPs are unnecessary. These unnecessary visits will lead to long waiting times for those who do need to see a specialist. This will in turn result in poor health outcomes.
These problems can be solved by investing in a referral management solution. It will make the process efficient, decrease lead times, shorten patient waiting times and improve patient satisfaction. Increased operational efficiency will lead to shorter patient waiting times and thus more patients being seen.

“HealthViewX improves operational efficiency by automating the primary care to specialist referral process in healthcare”

3. Improved referral closure rates

With a referral management system in place, it is easy to track referrals depending on the status. Improved referral tracking leads to increased referral loop closures.

“With HealthViewX Patient Referral Management Software, health systems can track referrals in real-time. It provides a timeline view that helps referring and receiving physicians to know in which status the referral is.”

4. Improved referral utilization

Tracking patients’ progress through the care continuum helps to improve utilization for both providers and staff. Referral Management Software will enable health systems to see more patients.
PCPs can easily send patients to specialists by searching through directories and evaluating providers based on reviews, quality, and even familiarity.
It’s even better when this whole process can be condensed into one application, allowing both doctors and staff alike to access provider directories.

“HealthViewX Patient Referral Management supports features such as Intelligent Provider Match and Online Scheduling. It enables better utilization of the existing staff in health systems.”

5. Additional patient time

Finally, and maybe most importantly, referral management software must save time on administrative processes. This will increase the time for the actual medical visit.

 

Reference
https://www.mass.gov/files/documents/2016/08/uy/2011-hcctd-full.pdf
https://www.beckershospitalreview.com/payer-issues/3-important-statistics-about-provider-referrals.html
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3160594

A Leading FQHC In California Chooses HealthViewX To Manage Their End-To-End Referral Process

About the Federally Qualified Health Center

Federally Qualified Health Center (FQHC) in the United States is a non-profit entity comprising of clinical care providers, that operate at comprehensive federal standards. The care providers in FQHC are a part of the country’s health care safety net, which is defined as a group of health centers, hospitals, and providers who are willing to provide services to the nation’s needy crowd, thus ensuring that comprehensive care is available to all, regardless of income or insurance status. This client is the health care safety net for their county’s poor and uninsured people. The FQHC gives the people access to high-quality health services that they needed and deserved. They are key regional health providers who treats more than 65,000 patients annually.

Challenges in the existing referral workflow of HealthViewX Federally Qualified Health Center client

The following are the major problems our Federally Qualified Health Center client wanted a solution for. Let us consider the challenges with a typical referral scenario to understand it better.

  1. Insurance pre-authorization – The physician must check the pre-authorization requirements, health plans, etc. He must retrieve patient-specific data like the history of medications, medical diagnosis and insurance coverage. The physician must then send it to the insurance company so that they can validate the same. This client did not a dedicated team or software to do insurance pre-authorization which increased their burden.
  2. Tracking the referral – Specialists are usually busy. They do not have the time to inform physician’s about the progress of referrals. So the physicians are unable to track referrals. They get no information about appointments, referral loop closure or feedback from specialists or patients.

How HealthViewX features helped this FQHC client resolve their challenges

Considering the existing workflow of the FQHC, their major problems are insurance pre-authorization and referral tracking. So how can HealthViewX Patient Referral Management solution help in solving these problems?

The following features made the pre-authorization  and referral communication easier for this FQHC client,

  1. EMR/EHR integration – Our System integrates directly with electronic health records (EHRs). This enables healthcare professionals to easily obtain prior authorizations in real time at the point of care. It also eliminates time-consuming paper forms, faxes, and phone calls.
  2. Insurance pre-authorization automation –  There are two ways in which HealthViewX solution automates the insurance pre-authorization process. The first one is the api-based method. Through this, we retrieve information regarding the forms and communicate information back and forth between the FQHC and the insurance company. The second one is the form automation method.  Through this, we get all payer-specific form, fill in the necessary information and send it to the insurance company via efax
  3. To and fro Communication – At any time of the referral process, the PCP and the center can communicate with the help of the inbuilt secure messaging and voice call applications. By this, the physicians can get referral updates easily.

Useful HealthViewX Patient Referral Management Solution features

Leading FQHC in California has chosen HealthViewX due to the industry-leading patient referral management features. FQHCs across USA can benefit from Referral Management Software depending on their patient referral workflow,

  • Intelligent Provider Match
  • HIPAA compliant data security
  • Referral history
  • Referral loop closure

HealthViewX Patient Referral Management software has provided the best use cases for the major challenges faced by the FQHC. Are you a Federally Qualified Health Center missing out on your referral updates? Schedule a demo with us to know more about our solution.

How Can An Open Patient Referral Loop Hamper Your Network?

The increasing complexity of patient referrals in healthcare

Patient referrals are increasing in number every day. Health Systems and Hospitals which send out numerous medical referrals find it difficult to track and close a patient referral loop on time. What factors prevent the referral coordinators, operations managers, physicians or care providers from closing the patients’ referral loops?

  1. Prior Authorization – The referral coordinator does the insurance pre-authorization for the patient referrals in healthcare. Considering that one out of every three patients is referred to a specialist, it is difficult to do prior authorization. This makes patient referral system time-consuming and affects referral loop closure.
  2. Finding the right specialist/imaging center – The referring provider must choose the right specialist or imaging center that will suit the patient best. He/She should send the referral to a reliable provider who will give the best care and give regular updates. The referring provider must also consider a provider who covers the patient’s insurance before initiating the referral. If the referring provider fails to do this, open patient referral loop becomes imminent.
  3. No updates on the referral progress – The receiving provider fails to update the progress of the referral. 25% to 50% of referring physicians do not know if their patients actually visit the specialist or imaging center. As many patient referrals are initiated on a daily basis, tracking it manually is difficult for the referring provider. This ultimately results in open patient referral loop.
  4. Inadequate referral information – The receiving providers usually have a tough time processing referrals with incomplete information. 70% of the specialists rate the patient referral information from the referring providers as poor. This affects the patient referral lifecycle.
  5. Outdated referral workflow – The current referral workflow is outdated. The providers find it difficult to cope up with the increasing patient referrals in healthcare. On an average, a referring provider spends half an hour to one hour per referral and even more time in following up. Outdated referral technology affects the referral loop closure.

Close a referral loop in healthcare with the HealthViewX Patient Referral System

Information Technology enables patient referral workflow automation. HealthViewX Patient Referral Management System simplifies the process and closes the referral loop on time.

  1. The Primary Care Provider (PCP) identifies the need for a referral and initiates the same through the EHR system.
  2. The referral coordination team then validates the referral and does the insurance pre-authorization with the help of HealthViewX solution.
  3. The Intelligent Provider Smart Search feature of HealthViewX Patient Referral Management System helps in finding the right specialist or imaging center easily.
  4. The referral coordination team then sends the referral with the necessary documents to the relevant specialist or imaging center through the HealthViewX platform.
  5. The receiving provider gets notified about the referral and can schedule appointments with the patient.
  6. The patient and the receiving provider get reminders of the appointments thus reducing no-show rates.
  7. The referring provider is also notified about the status of the referral and how it is progressing. HealthViewX timeline view makes tracking and managing the referral lifecycle easier.
  8. HealthViewX tracks and sends reminders to the receiving provider to update the diagnosis, treatment recommendations, care plans in the referral.
  9. HealthViewX makes it easy for the referring provider by automatically updating this information back to the EHR system.
  10. Thus the HealthViewX solution closes the referral loop on time and helps in easy monitoring of the same.

Features and Functionalities

  • Referral workflow automation reduces the time and manual effort spent on a referral. Thus HealthViewX solution improves the efficiency of the process.
  • Patient coordination framework achieved through the patient application that helps in managing appointments and log data for the care plans prescribed by the provider.
  • Automated insurance pre-authorization reduces the work of the referral coordination team and makes the process simple.
  • Intelligent Provider Search feature helps in finding the right specialist or imaging center in no time.
  • Referral timeline view and communication enables easy flow of information between the referring and the receiving ends.
  • Scheduler integration gives timely reminders and notifications to the patients and the providers about appointments, lab tests, etc.
  • Referral insights and analytics gives the PCPs 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.

Benefits of closing the patient referral loop in the healthcare industry

  1. Increased Medicare reimbursements –  Medicare considers closing medical referral loop as a benchmark for giving reimbursements. Closed medical referral loops increase the opportunities for Medicare reimbursements for referral marketing.
  2. Streamline referral management – With HealthViewX Patient Referral System in place, the referral workflow is automated and streamlined.
  3. Improved patient care – Reduced waiting time gives patient satisfaction thereby improving the care quality.
  4. Increased productivity – Reduced operational time improves the efficiency of the patient referral system.

HealthViewX Patient Referral Management application helps in closing the referral loop and increases the revenue for the practice. To know more about HealthViewX solution, schedule a demo with us. Our patient referral management experts will guide you through our HIPAA-compliant solution.

 

Top 7 Measures That Can Help In Boosting A Hospital’s Revenue

Hospitals in the USA play a vital role in the healthcare industry. But in today’s economy hospitals in USA are facing a serious financial crisis despite the various revenue sources. This is due to the increase in the number of uninsured people seeking medical services, lower reimbursement rates from the Center for Medicare and Medicaid Services (CMS), staff shortage, etc. Many hospitals are facing bankruptcy and some are eventually shutting down.

Why are hospitals in the USA facing economic recession?

The following are the few reasons why hospitals are facing financial difficulties

  1. Lower reimbursement rates – Financial burden on the hospitals have increased due to the falling reimbursement rates from the CMS. According to the study done by the American Health Association, there is a steady decrease in the reimbursement rates for Medicare and Medicaid services. When the cost incurred on the service is more than the reimbursement received, the hospital suffers a huge loss. Hospitals in the USA received only 87 cents for every dollar spent on Medicare patients in 2016.  Hospitals in the USA received only 88 cents for every dollar spent on Medicaid patients in 2016. In 2016, 66% of hospitals received less Medicare payments, while 61% of hospitals received less Medicaid payments. With the increase in the aging population, Medicare and Medicaid services will become a financial burden for the hospitals.
  2. Increasing the number of uninsured and older people – The increasing number of uninsured and older people implies that many hospital services will go unpaid affecting their medical billing cycle. This increases the hospitals’ debt, as the state and federal laws insist on providing care for all regardless of their financial ability affecting the overall healthcare revenue cycle. In addition to the increasing number of the uninsured population, people are living longer. Therefore, they need more care and longer hospital stays.
  3. Rising cost of hospital equipment – Hospitals must have updated equipment to retain their patients. When hospitals change to new technology they incur significant cost on the equipment and on training their staff in operating the new device. There is no more long hospital stay because of the technological advancements. This affects the medical billing revenue cycle. Also, there is an increase in labor costs due to the acute shortage of registered nurses.

Top seven approaches to maximize profitability

Industry experts say that the key to maximizing a hospital’s profit is to cut down the costs and increase the reimbursements. Following are the top seven practices that a hospital can take up amid the poor economic conditions.

  • Cut down staffing costs by data-driven decisions
  • Cut down costs by managing vendors
  • Involve physicians in cost-cutting efforts
  • Partnering with other organizations
  • Partnering with local physicians
  • Attracting new physicians
  • Changing the quality of service

Let us look into each of them in detail.

  1. Cut down staffing costs by data-driven decisions – Labor is the biggest cost for hospitals. It is important for the hospitals to have the right headcount in their facilities. Hospitals can employ staff on a part-time or hourly basis. This is called “flexible staffing”. The hospitals can adjust the staff strength based on the patient census data. The hospital management must also monitor the efficiency of the staff. They can review the average hours spent on a case and compare it with the benchmark value. The hospital must communicate about the efficient staffing benchmark throughout the organization. The hospital management must collaborate with the physicians, nurse practitioners, etc to meet the expectations. Hospitals must not have a blanket approach to layoffs. The hospital management must take a close look at their business before laying off employees.
  2. Cut down costs by managing vendors – Hospitals can cut down supply costs by working with vendors. This will improve contracts and encourage physicians to take fiscally responsible supply decisions. The hospital management should not shy away from approaching vendors for discounts. Hospitals must have only the required number of vendors. The hospitals can also ask the vendors to submit purchase orders for equipment or implants that were not included in the written agreement with the facility.
  3. Involve physicians in cost-cutting efforts –  Hospitals should encourage physicians to keep a watch over the supply costs and other activities, such as unnecessary tests and inefficient treatments that may drive up the hospital costs. The hospital must support the use of products from vendors that are cost-effective but still of high quality, especially in areas such as orthopedic implants, which can be considerably costly for hospitals. In addition, experts say the use of protocol-based care can cut down costs associated with unnecessary tests or treatments.
  4. Partnering with other organizations – During tough economic times, some hospitals can outsource or partner with other organizations for certain services, such as food and laundry services, clinical services, etc. By outsourcing certain services to more efficient providers, hospitals can share the savings with the service provider. However, hospitals must be sure to select truly efficient providers. Often, hospitals outsource services such as laundry, food and nutrition, information technology or human resources as they do not have the capital to invest in these. Some hospitals have also begun to outsource clinical services such as emergency room staffing, anesthesiology, etc to become more efficient.
  5. Partnering with local physicians –  Hospitals can join hands with local physicians and surgery center management companies to offer outpatient services. This reduces competition and also improves the hospital’s revenue cycle management.
  6. Attracting new physicians  – Identifying and attracting new physicians to bring cases to the hospital is another way to increase profits. Physician-owned hospitals can bring in more physicians as partners, while other types of facilities can recruit new physicians who are willing to visit patients at their hospitals.
  7. Changing the quality of service – Hospitals can change or increase the quality of services they offer to be able to compete in the market.  For instance, a hospital can invest money to develop their cardiac or cancer treatment centers which will attract more patients from different areas.  New programs and treatment centers will also influence more doctors and nurses to join their hospitals. This may cost a lot but it has the potential to bring in higher profits because specialized care cost more money and attracts more patients who otherwise cannot receive this care in other hospitals.

Hospitals that focus on enacting these best practices are likely to see improvements in their profitability. Hospitals can also benefit from using today’s economic conditions as an opportunity to improve their overarching approach to business, creating a more sustainable organization in the future. Schedule a demo with us to know more!

Bridging The Gap Between Community Health Center & Specialists Clinics/Imaging Centers

Community Healthcare Centers and what do they do

A Community Healthcare Center (CHC) is a non-profitable, consumer-directed healthcare organization. CHC serves the underserved, underinsured and uninsured people, and provides them with access to high quality and preventive medical health care. Since 1965 Community Health Systems have provided comprehensive health and wellness support services to more than 22 million Americans, who otherwise would not have had access to quality care.

Community Healthcare Network receives funds through federal and local grants and payments from patients and insurance companies. CHCs must compete once every three years for federal grant funding and use these federal grant dollars to help patients pay for their healthcare costs.  

Patient Referral Management in Community Clinics

Community Health Centers comprises of PCPs who offer primary health care services and related services to residents of a defined geographic area that is medically underserved. Many patients visit a PCP in a day. Community Health Centers do not have the facilities for giving specialized treatments or for taking advanced tests. So, when a patient requires any of these, the PCP refers him/her to the most suitable imaging center or specialty practice.

Community Health Systems mostly refer their patients out of the network. The referral workflow from the perspective of a referring provider is as follows.

  • The PCP sends the referral through the EHR/EMR to the referral coordination team.
  • The referral coördinator will study the patient demographics and understand the required diagnosis.
  • The team coordinates for insurance preauthorization to cover the medical expenses for the required treatment/services.
  • Based on these, the referral coordinator will find the right specialist or imaging center for further diagnosis.
  • After finding the right specialist or imaging center, the patient details are sent out as a referral.
  • Community Health Systems sends referrals through various sources like phone, fax, email, etc.
  • The referral coordinator chooses the source depending on the receiving provider’s convenience.

The gap between the community healthcare and specialty care

A referral process may become inefficient and ineffective if the community health systems and the specialty clinics/imaging centers fail to communicate. When there is no proper communication from the specialty centers/imaging centers the community healthcare network finds it difficult to understand the progress of the referral. Let us see it from different perspectives to understand why there is a communication gap.      

  • From a referring provider’s perspective, the referral coordinator receives and processes many referrals every day. After sending out a referral, it is very difficult to follow-up with it manually. There are no effective and secure means of communication between the referring and the receiving providers. If the receiving provider or the patient fails to update the progress of a referral to the referring provider, he/she will never get to know what happened with the referral. Closing the referral loop becomes nearly impossible in this case.
  • From a receiving provider’s perspective, the referral he/she receives may contain incomplete information. Without vital details, processing the referral will be difficult. The source of referral are many but there is no single interface to manage it all. Missing out on referrals is common. There is no way of getting a consolidated data on the number of referrals missed and the number processed. Patient referral leakage becomes imminent if the referrals remain unprocessed for a long time.
  • From a patient’s perspective, he/she is referred to take tests in an imaging center and then meet a specialist to continue with the treatment. If the patient has to communicate back and forth between the referring and the receiving providers for incomplete information, history of illness, etc, it annoys the patient. It is frustrating for the patient to communicate between the two ends.

Referrals become incomplete, inefficient and ineffective when the participants fail to communicate and share timely information.

Guidelines to bridge the gap between Community Health Systems and Specialist Clinics/ Imaging Centers

  1. The referring provider must understand the reason for the referral. The referring provider should also make the patient understand why a referral is necessary and what the patient can expect from the referral visit. Give time for questions and encourage the patient to clarify their doubts during the referral appointment.
  2. When the referral coordinator does the insurance pre-authorization, he/she must make sure that the receiving provider covers the insurance policy of the patient. This will keep the patient better informed of how much the service will cost.
  3. It is better for the referral coordinator to contact the specialist directly. He/She can give information about the patient’s current situation, as well as other medical records, test results, and documents to avoid duplication of effort.
  4. Both the sides have to agree on the urgency of the referral and discuss the duration of the process, frequency of referral updates and the mode of communication.
  5. Any tool that can give prompt reminders on the appointments, follow-ups to both the patient and the receiving providers can help.
  6. After the referral reports arrive, the provider must check the results and recommendations. If the referring provider cannot understand the specialist’s evaluation, he should contact the specialist to understand the diagnosis better.
  7. Referral is an important part of patient care but the patients are not obligated to follow-up with the specialist. If the referral isn’t completed, the referring provider must talk to the patient during the next visit to find out why. Documenting this can help in directing future referrals to the right specialist or imaging center.

HealthViewX Patient Referral Management solution communicates effectively between the referring and the receiving ends. The timeline view and referral status help in tracking the referral. Prompt reminders will never let you miss an appointment or follow-up. To know our solution better, schedule a demo with us.

How Not to Share Patient Information For Referral

The medical referral process is an important part of ambulatory care in the US. Medical referrals have a direct connection to patient health outcome and the provider’s revenue flow. Patient-specific information and the need to keep it safe is even more important.
To protect patient information from falling into the wrong hands, healthcare providers use various procedures and processes to ensure maximum security but when it comes to referral workflow there are no standard procedures nor any secure technology to ensure information safety.

Gigabytes of patient records are compromised each year because providers do not have processes, the required technology or is unaware of HIPAA regulations. Here is how not to share patient information during referral.

Email Is Not What You Think It Is:

Many providers rely on emails to send and receive patient information instantly. Emails are easy and a lot faster than faxes but the problem with emails is that the files sent through with emails are generally un-encrypted when transmitted or when saved leaving patient information sensitive to theft. Using emails to share patient-related data is against HIPAA compliant and according to HIPAA, the provider is held responsible for any breach.

Beware Of Faxes:

Faxes are the most common format to send and receive patient information between practices. Regular faxes are affected by the problem of encryption; since these files are not encrypted, this information could be accessed by an individual with access to phone lines and basic knowledge of the system. Faxes are slow and time-consuming and do not support all type of file formats. Received faxes are usually kept in the machine for some time exposing patient information to unauthorized people. Faxes leave a paper trail of patient information which will practically result in making EMR/EHR systems useless.

Triplicate Form:

Although triplicate forms sound straightforward, practically triplicate forms transfer the process of referring a patient from provider to patient or patient’s skin. The patient is left with the challenge of coordinating between physician offices – calling referral coordinators, faxing files to specialists’ office. Often a patient will have to request an appointment with multiple specialists which means sending sensitive patient information to specialists office who may not be taking care of the patient at all.

Sharing patient information is crucial in the medical referral process, but the systems that the healthcare providers use are incompetent to do a fast transfer of patient file and transfer it securely to authorized providers.
Hospitals need to establish clear-cut procedures in case of sharing patient information. Such a procedure should be able to track the flow of patient data and establish standard norms and practices to minimize the possibilities of compromising data.