Tag Archives: hospital

Revenue lost due to patient leakage in hospitals and health systems

The last few years have been a tumultuous time for hospitals and health systems due to the high patient leakage rate. Even today, patient leakage is a key concern and remains an unsolved challenge in many of the health systems. Health systems are losing more than 20% revenue due to inefficient organizational referral processes, as a result, patients are opting to different care providers for their care needs. Identifying the gaps or latitude to go out of the system, and sealing this, is the basic step that health systems need to take in solving patient leakage challenge.

What are the main causes of patient leakage?

Here are some reasons why patient leakage happens

–          Referring physicians refer patients to out-of-network providers

–          Patients move out of the care network due to poor care coordination

–          Unavailability of a specialist within the care network

Patient Leakage and its consequences

Though in most hospitals patient leakage is contributing to significant revenue loss, this loss is ignored, and not given much importance. Health systems and hospitals need to consider this leakage extremely important. Non-coordinated or fragmented care is one of the main reasons for patient leakage. The point is to emphasize on some damaging consequences patient leakage can bring on care quality and patient health outcomes.

Understanding the actual causes of this leakage and taking tangible steps to address this challenge is vital. It is the responsibility of the health system to track and manage patient referrals in a better way with a solution for tracking leakages and referrals. Otherwise, it can damage the health system’s reputation, undermine its brand value, and even jeopardize its competitive edge.

Challenges in processes that cause patient leakage

Streamlining different processes for different aspects is required for better overall operational efficiency. One such process that needs attention to arrest leakage is the patient referral process. Health systems need to adapt to solutions that will help seal this leakage. HealthViewX helps referral coordinators in health systems to manage patient referral efficiently and improve care, performance, compliance, and reduce leakage.

The current referral process lacks certain mechanisms to make this process effective.  Hospitals and health systems need a referral solution in addition to an EMR to solve their referral challenges especially referral leakage.

An ideal referral solution for hospitals should have the following features

  • Multi-channel referral consolidation

Health systems have multiple access points for patients and chances are that health systems may miss following-up with some referrals. The solution needs to consolidate referrals from multiple sources like fax, email, phone calls, online forms, etc. It should integrate well to bring all of these referrals into one single queue and ensure not a single referral is missed.


  • Secure exchange of information

A HIPAA compliant solution that supports the secure exchange of sensitive patient information among the care providers involved in patient care is a must. The provider should be able to attach documents securely at any time for one another’s reference.


  • Patient referral history

Both the referring physician and the receiving provider should have access to the entire referral history. All required information right from the time a referral is initiated and consequent diagnosis reports, referral status, etc. should be available at any point of care.


  • Scheduler Integration

Patient convenience is one of the most important factors in providing care. Scheduling appointments as per patient convenience and automated reminders for both patient and provider about the appointment is mandatory.


  • Dashboard and referral insights

The solution has to give complete data of the referrals flowing into the health system. The number of referrals processed, number missed and many more as per the requirement of the health system. These data analytics should give the practice a clear picture of how referrals are handled and where the leakage is happening.  

Speak to HealthViewX solution experts to understand more about HealthViewX Referral Solution features that will help solve some of the challenges in the patient referral process and increase revenue through effective tracking. Schedule a demo today!

The Role of Referral Management in Value-Based Health Care

What is Value-Based Care?

Value-Based Care is a care delivery model in which healthcare providers are paid based on the health outcomes of the patient. Value-based is a quality-based care model that drives “better health for all” and benefits the community, providers, and payers as a whole. Value-based care helps healthcare providers by helping patients improve their health and reduce the prevalence of chronic illness. This care model is a potential swap for fee-for-service reimbursement based on quality. The providers are paid based on the health outcomes of the patients and are rewarded for helping patients’ improve their health. The ultimate goal of value-based care is to optimize the care for the patient population.

What are the benefits of Value-Based Care?

For Patients – Reduced cost and better health outcomes

For Providers – Better patient satisfaction and improved care efficiencies

For Payers – Stronger control on costs and lowered risk

For Community – Reduced spend on healthcare and improved overall wellbeing

What is a Patient Referral Management Solution?

Patient Referral Management Solution is a patient referral tracking tool for end-to-end referral communication and management. The solution is designed for healthcare organizations to enable them to provide better care with a well-orchestrated customizable workflow. Its primary goal is to enhance and streamline interaction among all care providers involved in patient care for better patient outcomes.  

Role of Patient Referral Management Solution in Value-Based Care

Right from small to large, healthcare providers face a lot of challenges in their referral process. Poor communication and referral workflow among providers lead to diminished care quality and patient experience. Lack of timeliness of the information and inadequate patient information or reports all contribute to poor care continuity, patient dissatisfaction, and poor health outcomes.

A well-orchestrated and automated patient referral solution has the potential to transform referral workflows and help providers improve their patient health outcomes. It helps provide value-based care through better care coordination throughout the care journey. A referral management solution can help improve efficiency, reduce time spent on redundant tasks, cut down on overhead costs, reduce referral processing time thus helps both providers and patients. Streamlined workflows lead to better patient outcomes.  The prime objective of the solution is to improve patient-physician interaction and provide value-based care for better patient outcomes.

Why is Referral Management crucial for Healthcare Providers? 

Referral Management is very crucial for healthcare providers to track and manage referrals, and ensure better patient outcomes. Referral management is essential when

  • referring and receiving providers have different EMRs/EHRs
  • healthcare providers are coordinating between in-network and out-of-network providers
  • health systems are looking to improve patient health outcomes and reduce no-show rates
  • providers want to increase revenue and reduce operational cost
  • health systems want to focus on quality care by using value-based care models 

A major challenge in the current referral process is that most EMRs are not equipped enough to handle the end-to-end referral process. A referral management solution helps healthcare providers to track and manage their end-to-end referral process with complete transparency. The solution helps streamline workflow, reduce clinical errors/delays, cut down the processing time by automating multiple touchpoints, and obtain strategic data/facts for informed decision-making. The prime objective of the solution is to enhance communication among healthcare providers involved in patient care.

By leveraging technology the healthcare industry can provide value-based care for their patients and better patient experience. An end-to-end patient referral tracking ensures timely care, improves care coordination and better outcomes. HealthViewX referral management solution is designed to suit any practice, customized to meet user requirements, and enables data-driven decision support, and provides real-time insights of patient-reported data to promote better care delivery. Schedule a demo today to understand more about our HIPAA Compliant SaaS-based referral solution from our experts. 

Referral Management Solution Is The Need Of The Hour For Large Hospitals

With the ever-evolving healthcare setting and exponential developments in health IT,  many choices need to be made by hospitals/health systems to provide their patients’ with quality care. Health systems are struggling to manage their clinical, operational and monetary challenges. Most importantly, it is necessary to orchestrate care teams’ workflow movements to be able to demonstrate meaningful use. This is the key to improving patient care and the ability to make better-informed decisions. A lot of providers are already adapting to smarter and new healthcare technologies to shape the future of healthcare.

Factors like sustainability, patient-centricity, care delivery, HIPAA compliance, digital health technology, etc. should be kept in mind before choosing any IT solution. Referral Management Solution is one such solution that is the need of the hour and it has to be chosen with utmost importance. Moving from volume-based to value-based care model will require building a solution to manage higher patient referral volumes, to ensure patients’ receive care within their referral network, track referrals, close referral loops, study dashboards and analytics for meaningful use, etc.  

There are a lot of benefits a referral management solution can bring to referring physicians, patients and receiving physicians: that includes, improved operational efficiency, reduced referral leakage, increased referral loop closures, increased revenue and patient satisfaction.

There are several other reasons why a referral management solution is required to manage patient referrals. Hospitals face numerous challenges in their referral process such as operational inefficiency, improper communication among providers, lack of coordination, missed referral loop closures, increased no-show rates, time consumption, etc.

Below are some alarming stats that show the need for a referral solution for hospitals

  • 46% of faxed referrals never result in a scheduled appointment.
  • 55% of specialist visits are unnecessary.
  • There is an annual leaked income of $900k per physician employed.
  • 50% of referring physicians do not know whether their patients actually see the specialist.

In addition, hospitals participate in passive referral management:

  1. Physician informs the patient about the need to see a specialist.
  2. Referral coordinators may not reach out to the patient to get an update to see if the patient had visited the specialist.
  3. Follow-up or update from the customer is completed only during the next visit.

Active referral management enables both provider and patient-driven processes to be managed by referral coordinators. It ensures maximum efficiency, finds the right provider for the patient, identifies referral patterns, improves stakeholder communication, reduces referral leakage, decreases lead time, improves completion rates, ensures closure of the referral loop and satisfaction of the patient.

Pitfalls in choosing the right Referral Management Solution:

Even though there are different referral management software with an array of features in the market, it often becomes frustrating to choose the right solution for your hospital. So before zeroing in on the solution, a detailed analysis of your current challenges in the patient referral process has to be carried out. Later mapping to the required features of the solution will be the best choice.

Health Systems need an end-to-end interoperable referral solution to track their patient referrals throughout the process until the referral loop closure. The solution should streamline and enable seamless communication among all stakeholders’ involved in-patient care.

Some of the benefits you can see when using patient referral software are

For the providers:

  • Reduce referral leakage and improved operational efficiency
  • Seamless communication
  • Multi-channel integration
  • Manage and track referrals
  • Meaningful engagement
  • Effective diagnosis and treatment

For the patients:

  • Prompt diagnosis
  • Save time and money
  • Better outcome

HealthViewX Referral Management Solution was created with the potential to solve all the challenges faced by enterprise hospitals in their referral process.

HealthViewX Referral Management Solution helps to send and receive referrals securely and seamlessly, provide quick access to patient data, fix appointments, send notifications and alerts, and share information throughout to ensure closure of referral loop. A 30-minute demo with our team will help you know how effective our solution can track and manage the referral life cycle. To know more schedule a demo with us.

How To Identify An Under-performing Referral System And Make Improvements For The Same?

For many health systems, referral leakage may equate to millions of dollars in foregone revenue. Every patient who seeks care elsewhere is a lost revenue opportunity now and potentially into the future. Thus it is important for health systems to increasingly focus on minimizing referral leakage while managing referrals. The following are the symptoms of an underperforming referral system which have a negative impact on referral leakage,

  • Disability to identify in-network or aligned providers.
  • Inept or unclear information on what patient types or conditions a provider treats.
  • Limited or no ability to measure the referral management team performance or financial outcomes.
  • Ineffective prioritization and workload management.
  • Increased authorization-related denials and write-offs.
  • Too much reliance on paper-based or manual communication and tracking systems.
  • Increased patient referral leakage due to complicated, cumbersome, or unclear referral processes.

Analyzing your organizations’ opportunity for improvement

The ability to make significant improvements in referral processing efficiency and patient retention depends on the following factors,

  • Degree of process standardization
  • Organization’s accountability
  • Underlying infrastructure
  • Organization of staff
  • Technological capabilities

Accountability and standardization of the process

There is a huge communication gap between the referring provider and receiving provider offices which makes the process inconsistent. Organizations often fail to standardize the process by defining who is responsible for

  • Obtaining prior authorizations
  • Locating a specialist with good access who will treat the patient’s condition
  • Gathering relevant medical records
  • Contacting the patient to schedule the appointment

Organizations with strong referral management programs have developed a consistent and standardized workflow that clearly delineates responsibilities by role. Achieving this level of efficiency requires that operational and clinical leadership collaborate to design and develop policies, procedures, standards, and workflows to support strong referral management practices.

Technology Systems and Capabilities

Despite having a thoughtful and disciplined approach to monitoring and managing referrals, technology systems are often unable to facilitate best practice workflows or deliver the performance data necessary to effectively manage the end-to-end process. Therefore, the following processes have been happening manually,

  • Tracking authorization status
  • Monitoring scheduled appointments
  • Calculating referral conversion rates, staff productivity, and downstream revenue

Furthermore, the inability to share information electronically among providers necessitates increased use of paper-based and faxing processes. Without the proper supporting technologies, there is increased processing effort and workload, risk of lost or inaccurate data, and, most importantly, the potential to delay patient care.

The following are the technological capabilities needed to support the best practice referral, management team,

  • Identifies providers in the referral system
  • Matches patients with the ideal scheduling providers
  • Prompts follow-up when appointments are not scheduled or care is not received
  • Facilitates the transfer of post-visit documentation between providers
  • Supports detailed reporting to manage performance

Close your referral loops 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.
  • The Intelligent Provider Search feature helps in finding the right specialist or imaging center in no time.
  • Referral timeline view and communication enables an easy flow of information between the referring and the receiving ends.
  • Scheduler integration gives timely reminders and notifications to the patients and 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.

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

How Can Referral Inbound-Heavy Practices Profit From Patient Referrals?

Why are patient referrals important?

Patient referrals are excellent sources of revenue for health systems. Why is it necessary to have referrals flowing into your network? When a practice receives more referrals, it means patients will visit that practice. It has a positive impact on your revenue. When patients regularly visit a practice, the practice always stays active in the healthcare industry. But inbound-heavy referral practices can use technology to take care of their patient referrals.

What are the challenges faced by a referral inbound-heavy practice?

  • 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. It is difficult to track and manage such a high volume of referrals. Varied sources of referral make it difficult to get a comprehensive data about the referrals flowing in. The chances of missing out on a referral are high.
  • Time-consuming process – On an average, referral inbound-heavy practices receive 1000 plus referrals every day. Handling all of them manually is a time-consuming process. The practice is aware of how many were processed and how many need immediate attention.
  • Limited referral information – Many referrals have less or no information required to process them. It makes it difficult for the referral coordinator to proceed with the diagnosis. It takes a lot of time for a practice to contact the referring provider for information or clarifications.
  • Appointment scheduling and patient no-show rates – After receiving the referral, the practice 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 a practice to track.

How can an Electronic Patient Referral Management help referral-inbound heavy practices?

The current referral management is no way close to the increasing demands of the referral process. It provides no option for communicating between the referring and the receiving ends. Relying on EHR/EMR/RIS for managing referrals makes it a costly affair and does not fulfill the current requirements. Electronic Referral Management has been creating buzz for some time.

Inbound patient referral management challenges can be resolved to improve operational efficiency, reduce inbound patient referral leakage and close the loop of patient referrals. A patient referral management software must have the following benefits,

  • Consolidating the referral channels – The system must handle referrals from email, fax, phone, referral slips and direct visits. The software must consolidate referrals from all sources into a single queue from where it can be processed.
  • Data security – The software must manage all sensitive patient-related data securely.
  • Data Analytics – Complete analytics of the referrals flowing in, processed, missed etc. Patient referral system should give a clear picture of how efficient the practice is in handling inbound referrals.
  • Referral history – The history must be common to both the referring physician and receiving specialist/imaging center. The progress of the patient referral from the time of referral initiation and subsequent diagnosis should contain patient diagnostic reports, referral status to ensure there is no missing information.
  • Integration with scheduler – This will help in scheduling appointments for the patients. Also, the system should send automated reminders to patients and physicians about the appointments.
  • HIPAA Compliant – This will enable secure data exchange of patient sensitive documents.

HealthViewX Patient Referral Management Solution features

  • Single Referral Workflow Queue Consolidation – It collects Fax, Phone, Email, Website referrals and manages them in a single interface. This helps in managing them better.
  • Timeline View – Both the center and the PCP can view the timeline data of the patient in which the referral history is present. The provider can attach documents at any time for one another’s reference.
  • 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.
  • 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.
  • Referral Data Consolidation – It has options for printing the consolidated data about the referrals and the referral history of any patient as a hard copy at any time in pdf/excel.
  • Secure Data Management – HealthViewX Patient Referral Management is HIPAA compliant. It manages all patient-related documents securely. It helps in secure exchange of data.
  • Referral Analytics – Helps in tracking the number of referrals and gives complete information about the number processed, missed, scheduled etc with the help of a Referral Data-centric Dashboard.

HealthViewX Patient Referral Management solution helps practices in managing their referral network and increasing their revenue. Are you a referral inbound-heavy practice looking to track your inbound referrals very effectively? To know about HealthViewX Patient Referral Management System in detail schedule a demo with our team.