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Top 6 Reasons Why You Need A Referral Management System Even Though You Have An EMR/EHR

When an organization considers purchasing a patient Referral Management System (RMS), one of the first points management considers is whether or not its existing EMR/EHR can provide the missing functionality with an add-on, or perhaps already does but is not being used.

In general, use cases that are exclusive to employed healthcare providers working within the provider system will favor using an EMR alone. However, once an organization wants to do complex tiering of its networks and/or work with provider resources outside its organization, a Referral Management System becomes critical. 

Below, we provide the top 6 reasons a Referral Management System is a necessary tool for a healthcare system in addition to an EHR/EMR.

6. Referral Management Systems Enable Healthy Provider Network Utilization

A healthy referral network should be able to distribute referrals evenly among comparable resources in a given geography. It is essential to maintain active participation among all the providers in the network. Often a favored specialist at the top of the list keeps getting more and more referrals at the expense of others who might be just as qualified. An effective Referral Management System can provide load-balancing algorithms so that referrals are distributed evenly among comparable providers.

5. Referral Management Systems Provide End-to-End Patient Referral Tracking

Part of the clinical opportunity for referral management stems from the fact that referrals typically occur when there is a change of diagnosis or an escalation in care. As such, a referral is often the first indication that a patient will likely trigger significant downstream consumption. A well-implemented patient referral solution enables an organization to track patients in real-time and better guide patients towards high-quality low-cost care settings. Further, the system needs to encourage specialist staff to report appointment attendance or noncompliance, as well as return clinical notes to primary care offices for better patient care and better patient outcomes.

4. Referral Management Systems Facilitate Real-Time Referral Reporting

The ability to report highly granular referral analytics that illustrates referral patterns is essential for any Referral Management System. Organizations taking on risk as well as organizations optimizing referral patterns need to stay vigilant about network performance and network adequacy. Referral analytics should help organizations identify particular areas of concern as well as provide reporting that impacts referral patterns and facilitates change. Furthermore, robust Referral management software should be able to provide this data within the application itself as well as have the ability to export this data in any suitable format. 

3. Referral Management Systems Create Dynamic Referral List Based on Location

Many organizations must be able to manage referrals across large geographic areas. Indeed, the Service Level Agreements (SLAs) that many provider organizations enter into with payers as part of risk-sharing arrangements have network requirements that dictate how far away a specialist referral can be for a patient. A patient referral management solution can store the SLAs from the different payers, and then generate a geo-specific list of referral resources that can be based on the primary care provider’s location or the patient’s home.

2. Referral Management Systems Create Dynamic Referral Lists Based on Payer Selection or Plan Design

Referral networks tend to have networks within the network, where different payers or insurance plans have preferences or rules where patients can go for care. A referral management solution can generate a referral list for each patient based on the plan each patient carries.

1. Referral Management Systems Connect Healthcare Clinics Across Different EMRs

Once an organization wants to manage referrals across networks (e.g. among affiliates), chances are high that many offices will be using different EMRs. An effective referral management solution will be able to provide workflow and integration solutions that can work across multiple different EMR/EHR vendors and networks. 

How has HealthViewX added value to referring physicians’ patient referral problems?

1) Automating the insurance pre-authorization process 

HealthViewX platform has a payer management module that maintains and manages 

  • Different payer details
  • Modes of prior authorization
  • Direct authorization procedures
  • Payer forms 
  • Online portal links
  • With this information already present, it provides the referral coordinator with the capability to automate 
  • Prior authorization submission
  • Status checks coupled 
  • Fax integration

It simplifies the process of insurance pre-authorization. The referral coordinator need not waste time on the process anymore.

2) Intelligent Provider Match 

Our “Smart Search” feature makes it easy for the referring provider in finding the right provider. It has smart filters and search options that help in narrowing down the specialist based on the requirements.

3) Establishing best practices

After using our HealthViewX Patient Referral Management System, physicians were automatically alerted to

  • Appointments
  • Referral status
  • Patient diagnostic reports
  • Referral completion 

As a result, we can cut down on miscommunications and bridge the gaps between the specialist and the physician community. The system also assembles a patient encounter record from the EMR/EHR and pushes it directly to the physician.

4) Forming a close-knit of trusted referral receiving centers

Our system helps in strengthening ties with the medical community. From a history referral experiences the PCPs can from a close-knit of referral receiving providers. Physicians can now refer patients to hospitals they can rely on. 

HealthViewX Patient Referral Management solution helps the referring physicians in handling and managing their referrals. Are you an inbound referral heavy practice looking for an end-to-end referral management solution? Schedule a demo with us. Our patient referral management experts will guide you through our HIPAA compliant solution.

How Can Automated Referral Workflows Increase Patient Satisfaction?

Today’s healthcare model demands that services be centered around patients. This model faces additional challenges when care needs to be coordinated among multiple providers. Between 1999 and 2009, the number of primary care visits resulting in referral has increased by 159%. 

Problems with the existing referral workflow

Research strongly indicates that referring physicians need to improve the quality of information they provide to consulting physicians. When surveyed, 63% of PCPs and 35% of specialists report dissatisfaction with the current referral process because,

  • Paper referrals often do not provide adequate information
  • Consult reports are not delivered in a timely manner
  • Many referrals do not even include transmission of information, either to or from specialists

Consequently, PCPs are always not aware if a patient has seen a specialist. To add to this, up to 80% of ACO clinicians report the lack of interoperability among data systems is the greatest challenge. It happens particularly when they are attempting to locate information from out-of-network providers. Physicians consistently indicate that improvements are needed in the referral system to optimize patient care.

Why are automated workflows important?

Did you know? Among all patient referrals from PCP to the specialist, it is estimated that only half as many patients show up for their specialty care appointment. Furthermore, “self-referral” patients who see specialists without a recommendation from a PCP are associated with higher patient dissatisfaction and poorer continuity of care with the primary care doctor. A study states that 70% of specialists rate the referral information they receive from Primary Care Providers as fair or poor. 

In a patient-centric healthcare environment, patient satisfaction is the major concern of many practices. An automated referral workflow provides a way for physicians to ensure that patients are getting the care they need when they need it. As PCPs refer more patients to specialists each year, coordinated care and automated referral workflow become an urgent issue for both independent and hospital-based practices.

How can an Electronic Referral System help?

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.

Impacts of implementing an electronic referral management system

After the implementation of an electronic referral system, providers have observed, 

  • Enhanced direct communication between PCPs and specialists regarding their mutual patients
  • Better appointment tracking
  • Improved access to specialty care
  • Increased consult report compliance and follow-up

In addition, referral systems appeal to front-office staff because of its intuitive user interface and human-centered design. When providers can easily access needed information, they’re empowered to deliver better care.

Benefits of automating the referral workflow

  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.

 

Reference

3 Ways Through Which A Practice Can Enhance Patient Experience And Improve Patient Engagement

Patient experience is not just about the quality of care measurements and outcomes. Today, there are about 10 aspects that define the patient experience, and each one has its own impact to attract and retain patients within the network.

Patient experience and engagement can be defined by the following aspects,

  1. Meeting with a doctor
  2. Wait time
  3. Billing
  4. Scheduling appointments
  5. Appointment follow-up
  6. Staff interactions
  7. Pharmacy
  8. Online reviews
  9. Social media
  10. Website

Let us explore a few tips that will enhance the patient experience, improve patient engagement, drive better outcomes and keep staff engaged. We know patients actively involved in their health tend to have better outcomes, report higher overall satisfaction, and experience lower health-related costs.

Enhancing and transforming the patient experience and providing first-rate, patient-centered care revolves around the consistent development of processes to meet patients’ expectations and needs. Understanding patients’ preferences and priorities will allow practices to identify and optimize opportunities to increase comfort and reduce suffering which will ultimately strengthen the patient-provider relationship.

Let us first define exactly what patient engagement is and break down top-level strategies that practices can use to stay connected with their patients outside traditional clinic walls.

What is the difference between patient engagement and patient experience?

The patient experience is influenced by the perception of the care they received. Ultimately, patient experience represents the overall satisfaction of their personal experience with the practice, which, more often than not, is beyond control.  

Patient engagement, however, relates to the way a patient mobilizes their healthcare experience. What actions do they take that allow them to take an active role in their healthcare? What tools, technologies, and programs are available to encourage patients, caregivers, and families to play a more engaged role in administering their long-term health and wellness?

To improve patient engagement, a practice must recognize that engaging with patients is a triangular synergy between the physician, the patient, and the practice. It is about encouraging interaction between patients and providing meaningful opportunities for your patients to engage in the ways they know and are comfortable with.

1) Keeping patients engaged after they leave

Patient engagement is no rocket science. Patients want any practice to be accessible. They desire simple ways to schedule appointments, and perhaps most important of all, they want transparent and straightforward billing.

Technology has its purpose, but nothing can substitute for genuine interpersonal communication. Compassion and empathy are not something patients can get from AI or an app; they are, however, things the practice and their staff can use to promote greater engagement.

If a practice has the latest technological gadgets, it doesn’t mean that they can check patient engagement off your to-do list. Improving patient engagement is about that personal touch, human connection, feeling like taking an active role in managing healthcare delivery.

Therefore, how can a practice engage their patients? The answer lies in the space between a doctor’s visit and the following chapter in a patient’s care.

Patients have climbed on the digital bandwagon and ready for technological engagement. Patients already interact daily with different technologies, so practice should consider employing those to boost engagement. Here are some ideas that will work:

  1. Smartwatch health data monitoring
  2. Real-time educational opportunities through the website or Alexa-like devices
  3. Push notifications to remind patients to exercise, pick up their prescriptions, or invite them to special events or seminars

To impact patient experience, satisfaction, and engagement, it will be critical to concentrate on the tiny adjustments within the practice’s workflow that will have a significant impact on the patient.

2) Leverage Artificial Intelligence

Three-quarters of aging households are expected to adopt voice-assisted technology by 2020 making artificial intelligence (AI) the tech frontrunner to enhance patient engagement.

Not inconceivable is the presence of an Alexa like Bluetooth speaker running through exam rooms, performing like closed-loop HIPAA-compliant systems. Patients would be able to ask questions related to their file and diagnosis, change the TV channel or dim the lighting in the room.

Virtual reality (VR) can also drive patient engagement. Some hospitals in California are employing VR to show patients how specific brain surgeries will be performed, thus elevating patient satisfaction scores as well as reimbursements. There’s a real possibility of home care and wound care with patient and provider interacting one-on-one from different locations is just around the corner.

3) Remember who you are talking to

The language also has a great impact on patient engagement. Instead of focusing on “adherence and compliance,” the practice should try to discern the underlying social or environmental factors hindering a patient from complying with medical recommendations.

Why is a particular patient unable to comply? A practice must take the time to connect with and understand their patients. They need to have conversations, put themselves in their patients’ shoes, and then find methods to boost patient engagement and enhance overall patient satisfaction.  

Roughly 40 million U.S. adults read at a junior high school level. However, most healthcare directions are written in much more complex language (usually in tiny fonts) which cause confusion and increase non-compliance, particularly among aging populations. To fully engage patients, practices must make sure they can comprehend the instructions we’re giving them.

What does it all mean?

At the end of the day, an engaged patient has superior outcomes, reduced costs of care, and greater satisfaction overall. The more a practice develops a culture beyond the clinical atmosphere to one that connects both patient and provider through a digital culture of wellness, communication and personalization, the more the patients and the practice will benefit.

Patients demand experiences be more custom to them, and one of the best ways to deliver is to keep them engaged outside of the office, leverage technology and utilize the proper language to drive your points and treatment plans home.

Relevance and use of patient referral management software to FQHCs and large enterprise hospitals

Money inflow is very important for medical practices. Without a constant source of revenue, medical practices cannot pay bills, pay employees or take care of patients. Importance of revenue is no different for Federally Qualified Health Centers, Community Clinics, Large Enterprise, and Specialty Hospitals. One way to ensure constant revenue is by retaining patients within the hospital network and providing optimal patient care. To do this efficiently, hospitals use patient referral management software.

Role of FQHCs:

FQHCs play an important role in supporting their community and providing care services to the underserved. Due to this, they may experience financial issues at uncertain times. When budgetary resources are strained, it is critical for an FQHC to

  • Operate with maximum operational efficiency
  • Preserve financial security
  • Maintain staffing levels to continue operations

Inefficient and improper business processes will lead to patient dissatisfaction which will result in patients leaving the practice. FQHCs must concentrate on

  • Maximizing their business and staff efficiency
  • Minimizing financial risks

The relevance of patient referral management software to FQHCs

It is important for FQHCs to take good care of their patients. Factors such as waiting time, improper schedules, referring to the wrong provider, etc create patient dissatisfaction. Using referral management software, providers can access patient health records, schedule appointments and choose providers based on diagnosis and preferences. FQHCs can reduce patient-show rates, decrease referral leakage and also improve patient satisfaction.

FQHCs traditionally prefer working with EMR/EHR systems because they are comfortable with it. An EHR/EMR system has many advantages but when it is complemented with a Referral Management software practices can experience many more benefits.

The relevance of patient referral management software to Enterprise Hospitals

The following challenges in the patient referral workflow are common in enterprise hospitals across the USA.

  • Limited provider information – Physicians do not have information about the providers within their network. This is to blame for unnecessary out of network referrals. Providers who refer out of network could avoid at least one-third of these if they had access to more robust information about providers in their networks. Even when physicians have access to their health system’s provider directories, they are not using the directories because they don’t have the level of information that is needed.
  • Inadequate referral information – Even when physicians refer their patients out-of-network, the chances of a successful referral are less. This is because many providers who receive referrals rate referral information as poor. Without referral information, receiving providers cannot treat their patients effectively.
  • Inefficient patient appointment scheduling – For providers who schedule an appointment for the patient, they prefer doing it through the phone to shared electronic health records system. When heavy use of the phone occurs, it is difficult for providers to see capacity in their network to book the next available appointment. So they bypass the network and book the appointment before the patient leaves the office.

For FQHCs and Enterprise Hospitals, additional investment in a patient referral solution is recommended for the following reasons:

  1. Outbound and Inbound Referrals – HealthViewX Referral Management Solution can integrate with both the receiving and referring end. For inbound referrals, it helps in channelizing various sources into one single queue. In the case of outbound referrals, it facilitates integration with the existing system to read the patient data and send out referrals.
  2. Referral Timeline – In HealthViewX Referral Management System, any referral has a timeline, to capture and notify the progress of the referral to all the stakeholders. A referral will be mapped to a status which helps in tracking it better. With this, the providers can always be aware of how the referral is progressing.
  3. Workflow and Task Management – A workflow can be defined by how the referral flow must be(business rules). Tasks can be created to manage referrals by assigning it to the respective person.
  4. Improved communication – HealthViewX Referral Management Solution supports messaging and calling features for the referring and receiving providers to stay connected.
  5. Data Management – The solution is HIPAA compliant and enables secure data exchange of all patient-related documents.
  6. Seamless Integration – The solution can seamlessly integrate with any EMR/EHR/RIS or Third Party application thus providing minimal disruption in the existing referral flow.
  7. Referral History Consolidation – The consolidated data regarding the referrals and the referral history of any patient can be printed as a hard copy at any time in pdf/excel.
  8. Smart Search – HealthViewX Referral Management solution has a smart search facility that helps in finding the right provider for the treatment required.
  9. Referral Data Analytics – Referral data-centric dashboard gives complete data regarding the number of referrals flowing out, the number of referrals in various status, patient follow-ups, etc.

HealthViewX Patient Referral Management solution smooths the referral process and solves most of the inbound and outbound referral challenges for Large Enterprise Hospitals. Do you want to know more about HealthViewX HIPAA compliant Patient Referral Management solution? Schedule a demo with us.

FQHC Statistics – Growth, Region, Performance and Revenue – Federally Qualified Health Centers across the USA

What are Federally Qualified Health Centers (FQHCs)?

Federally Qualified Health Centers (FQHCs) in the United States are non-profit entities that are composed of clinical care providers, who operate at comprehensive federal standards. FQHCs were originally intended to provide the medically underserved population with quality care to minimize patient load in hospital emergency rooms.

According to Medicare and Medicaid statutes, FQHCs receive federal funding under Section 330 of the Public Health Service (PHS) Act to provide comprehensive primary care services to uninsured and underinsured populations thus ensuring that comprehensive care is available to all, regardless of income or insurance status. Medicare pays FQHCs based on the FQHC Prospective Payment System (PPS) for medically necessary primary health services and qualified preventive health services given by an FQHC practitioner.

To receive federal funding, FQHCs must meet the following requirements:

  • Be located in a federally designated medically underserved area (MUA) or serve medically underserved populations (MUP)
  • Provide comprehensive primary care
  • Adjust charges for health services on a sliding fee schedule according to patient income
  • Be governed by a community board of which a majority of members are patients at the FQHC

The Growth of FQHCs

In the early 1960s, there were only 8 health centers in the U.S. Ever since then, the numbers have increased exponentially. By 2001, there were 748 health centers at 4,128 service sites around the nation, serving approximately 10 million individuals.

Federal funding for health centers has increased from $750 million in 1996 to $2.2 billion in 2010. Federal support has increased tremendously over the last 10 years. In 2011, there were 1,128 health centers providing care to more than 8,000 rural and urban delivery sites in the U.S. and territories. Today, there are 1,400 organizations with 11,200 facilities serving about 25 million individuals every year.

The above chart shows the growth of health centers from its inception in 1980 till 2020. The chart also shows the exponential increase in the number of patients served over the years.

FQHCs in various regions across the U.S

State State Code Number of FQHCs
California CA 178
Texas TX 73
New York NY 70
Florida FL 48
Ohio OH 47
Illinois IL 45
Pennsylvania PA 44
North Carolina NC 40
Michigan MI 39
Massachusetts MA 39
Georgia GA 35
Louisiana LA 36
Oregon OR 33
West Virginia WV 31
Tennessee TN 30
Alaska AK 28
Missouri MO 28
Washington WA 27
Virginia VA 26
Indiana IN 25
Kentucky KY 23
New Jersey NJ 23
South Carolina SC 23
Arizona AZ 21
Mississippi MS 21
Colorado CO 21
Oklahoma OK 20
Maine ME 20
Kansas KA 18
Maryland MD 17
Montana MT 17
New Mexico NM 17
Wisconsin WI 18
Connecticut CT 17
Minnesota MN 16
Alabama AL 15
Hawaii HI 14
Iowa IA 14
Idaho ID 14
Puerto Rico PR 14
Utah UT 13
Arkansas AR 12
New Hampshire NH 11
Vermont VT 11
District of Columbia WDC 8
Rhode Island RI 8
Nebraska NE 7
Nevada NV 7
Wyoming WY 6
South Dakota SD 5
North Dakota ND 4
Delaware DE 3
Virgin Islands VI 3
Guam GU 2
Northern Mariana Islands MP 2

Performance of FQHCs

Figure 2 - Health Centers Perform Better on Ambulatory Care Quality Measures than Private Practice Physicians

Figure 2 – Health Centers Perform Better on Ambulatory Care Quality Measures than Private Practice Physicians

The above chart shows how health centers have outperformed private practice physicians in every aspect of service.

Figure 3 - Health Centers Provide More Preventive Services than Other Primary Care Providers

Figure 3 – Health Centers Provide More Preventive Services than Other Primary Care Providers

The above chart shows a comparison between health centers and other providers based on the number of patient visits for various ailments.

Figure 4 - Health Center Patients Are More Satisfied with the Overall Care Received Compared with Low Income Patients Nationally

Figure 4 – Health Center Patients Are More Satisfied with the Overall Care Received Compared with Low Income Patients Nationally

The above chart shows the level of satisfaction of low-income patients. Health center patients have a huge level of satisfaction as compared to other low-income patients nationally.

Financing and Reimbursements for FQHCs

FQHCs are required by law to provide services to all people, regardless of ability to pay. The uninsured are charged for services on a board-approved sliding-fee scale, which is based on a patient’s family income and size.

FQHCs are financed through various methods. These include a mix of Medicaid and Medicare reimbursements (with different payment methodologies), direct patient revenue, other third-party payers (private insurers), state funding, local funding, philanthropic organizations, and grant funding from the Bureau of Primary Health Care (BPHC) of HRSA of the U.S. Department of Health and Human Services (HHS).

The above chart shows the revenue distribution of FQHCs based on payer source (2018).

FQHC Revenue across all regions in the U.S (approx. 2018)

Source:
George Washington University analysis of the Health Resources and Services Administration’s Uniform Data System. Special Data Request, September 2019.

Location Medicaid Medicare Private Insurance Self-Pay Federal Section 330 Grants Other Grants and Contracts Other Total
United States $12,958,743,457 $2,260,247,981 $3,048,512,406 $1,248,741,884 $4,829,287,467 $3,336,624,219 $1,007,447,180 $28,689,604,594
Alabama $52,785,795 $17,803,287 $17,114,860 $12,744,350 $83,625,546 $13,471,556 $4,344,085 $201,889,479
Alaska $102,348,854 $18,671,815 $37,698,230 $6,477,465 $67,692,068 $119,544,705 $2,756,393 $355,189,530
Arizona $337,972,854 $47,634,000 $71,949,881 $23,395,361 $83,428,217 $41,485,739 $5,472,766 $611,338,818
Arkansas $62,148,511 $24,046,228 $30,622,521 $12,429,111 $54,555,352 $9,120,521 $1,735,385 $194,657,629
California $3,704,343,504 $411,514,109 $291,192,054 $148,976,225 $658,760,061 $615,047,232 $334,581,140 $6,164,414,325
Colorado $319,775,816 $39,134,784 $48,657,089 $30,779,398 $106,101,957 $95,942,011 $20,709,084 $661,100,139
Connecticut $228,434,332 $32,127,164 $26,544,878 $11,568,619 $59,696,129 $50,791,682 $10,598,421 $419,761,225
Delaware $11,773,644 $1,479,685 $2,463,464 $4,386,233 $13,557,989 $5,219,063 $470,309 $39,350,387
District of Columbia $160,105,430 $22,175,379 $32,105,709 $5,512,030 $27,476,019 $31,943,055 $7,236,844 $286,554,466
Florida $391,497,340 $60,674,510 $209,954,679 $81,714,253 $236,911,216 $193,834,424 $17,832,728 $1,192,419,150
Georgia $66,177,853 $48,142,417 $57,295,748 $30,758,262 $117,787,006 $28,848,026 $9,877,675 $358,886,987
Hawaii $107,408,992 $15,806,563 $17,253,126 $5,783,071 $31,398,131 $32,520,603 $3,907,118 $214,077,604
Idaho $45,572,373 $21,289,644 $50,122,229 $22,535,206 $45,993,298 $25,577,164 $3,267,335 $214,357,249
Illinois $455,197,448 $56,238,990 $131,100,822 $64,116,380 $201,027,383 $137,469,419 $29,398,121 $1,074,548,563
Indiana $200,004,374 $20,647,447 $30,284,051 $18,433,251 $75,547,860 $28,756,217 $30,759,622 $404,432,822
Iowa $83,853,103 $13,542,737 $23,553,367 $12,655,645 $38,528,294 $19,319,034 $1,624,245 $193,076,425
Kansas $37,808,462 $19,789,301 $26,840,099 $15,221,728 $44,761,541 $16,668,896 $4,665,564 $165,755,591
Kentucky $176,573,940 $46,631,367 $68,598,016 $24,819,874 $80,881,354 $6,773,516 $6,597,845 $410,875,912
Louisiana $146,815,697 $31,043,111 $59,995,751 $11,587,230 $100,474,957 $30,961,276 $4,441,509 $385,319,531
Maine $41,882,541 $35,423,228 $47,436,524 $12,099,407 $43,787,648 $11,360,335 $6,280,495 $198,270,178
Maryland $150,688,381 $29,260,626 $73,964,146 $13,146,680 $57,449,364 $35,657,860 $21,090,583 $381,257,640
Massachusetts $362,280,706 $103,012,238 $165,134,454 $27,248,100 $128,238,080 $258,007,270 $160,820,426 $1,204,741,274
Michigan $314,285,715 $68,214,766 $79,638,020 $28,291,497 $127,807,919 $44,375,118 $9,855,849 $672,468,884
Minnesota $75,452,268 $12,577,519 $16,837,190 $11,935,453 $42,977,632 $29,987,097 $4,128,981 $193,896,140
Mississippi $32,037,428 $18,436,338 $22,813,575 $21,440,111 $74,626,865 $14,886,816 $1,657,237 $185,898,370
Missouri $255,311,813 $26,546,831 $59,184,521 $28,003,100 $110,804,809 $33,834,797 $10,235,337 $523,921,208
Montana $34,073,242 $12,203,723 $17,685,163 $7,521,912 $42,126,575 $10,185,208 $6,307,871 $130,103,694
Nebraska $19,899,828 $1,982,820 $13,342,672 $7,991,555 $22,106,057 $22,906,355 $1,933,464 $90,162,751
Nevada $33,773,688 $11,166,606 $12,531,690 $3,172,460 $21,069,529 $15,948,721 $706,509 $98,369,203
New Hampshire $21,695,854 $17,132,960 $22,653,425 $5,099,829 $24,039,213 $11,899,812 $2,725,189 $105,246,282
New Jersey $158,938,887 $11,758,143 $14,145,131 $21,606,309 $81,666,571 $69,281,662 $5,982,249 $363,378,952
New Mexico $132,429,129 $26,364,684 $24,132,532 $15,923,683 $76,523,082 $57,190,428 $4,530,396 $337,093,934
New York $1,461,356,192 $201,623,297 $250,926,163 $50,171,017 $269,626,284 $385,124,022 $91,523,863 $2,710,350,838
North Carolina $90,190,949 $59,012,065 $65,516,943 $50,837,624 $133,899,942 $40,248,341 $26,574,283 $466,280,147
North Dakota $11,640,795 $3,863,326 $9,419,592 $4,474,860 $10,746,019 $908,251 $1,001,661 $42,054,504
Ohio $261,827,729 $51,042,970 $58,596,828 $25,007,037 $146,210,064 $41,839,517 $21,051,011 $605,575,156
Oklahoma $58,934,312 $20,089,581 $28,480,968 $19,992,107 $58,679,531 $10,582,038 $2,883,612 $199,642,149
Oregon $394,118,738 $51,503,384 $31,974,615 $15,310,703 $91,700,505 $91,028,195 $7,602,558 $683,238,698
Pennsylvania $315,531,242 $68,519,997 $104,374,387 $17,072,987 $128,243,325 $37,490,171 $10,326,309 $681,558,418
Rhode Island $109,670,334 $15,761,096 $19,797,174 $5,830,348 $28,040,434 $14,890,907 $4,960,361 $198,950,654
South Carolina $95,328,346 $89,583,350 $103,316,045 $25,145,381 $89,314,251 $31,444,029 $18,322,528 $452,453,930
South Dakota $11,514,028 $4,903,220 $10,207,221 $6,525,886 $17,900,812 $3,435,235 $1,231,547 $55,717,949
Tennessee $80,779,671 $26,920,974 $41,375,639 $15,091,806 $87,348,642 $31,856,403 $3,747,729 $287,120,864
Texas $405,350,935 $68,050,313 $170,985,325 $92,159,958 $258,162,160 $309,998,557 $26,687,781 $1,331,395,029
Utah $29,700,875 $11,520,256 $16,681,038 $13,794,751 $39,878,950 $24,880,704 $3,574,692 $140,031,266
Vermont $47,210,527 $31,973,872 $34,695,192 $23,137,643 $23,463,366 $7,348,657 $8,511,984 $176,341,241
Virginia $54,549,880 $39,744,588 $42,438,653 $26,005,991 $85,805,735 $20,677,091 $4,357,021 $273,578,959
Washington $769,937,162 $89,428,910 $129,151,433 $58,320,292 $139,027,744 $94,896,347 $14,596,022 $1,295,357,910
West Virginia $116,781,516 $57,847,408 $83,808,357 $28,402,025 $68,591,429 $16,910,711 $12,143,151 $384,484,597
Wisconsin $149,327,704 $8,202,250 $27,257,452 $10,451,845 $45,790,614 $27,262,928 $7,630,433 $275,923,226
Wyoming $6,918,264 $4,226,082 $5,490,411 $3,411,365 $7,478,734 $1,763,502 $477,559 $29,765,917
American Samoa $786,753 $0 $0 $0 $3,082,370 $0 $0 $3,869,123
Federated States of Micronesia $0 $0 $24,112 $84,319 $3,186,592 $0 $0 $3,295,023
Guam $2,451,828 $53,941 $17,002 $132,489 $2,173,874 $2,330,520 $137,227 $7,296,881
Marshall Islands $0 $0 $0 $31,865 $1,061,772 $1,086,917 $0 $2,180,554
Northern Mariana Islands $98,987 $641 $7,161 $11,185 $677,559 $0 $122,655 $918,188
Palau $0 $0 $259,006 $1,461,345 $940,810 $50,000 $0 $2,711,161
Puerto Rico $153,566,707 $33,237,486 $10,276,689 $7,922,019 $103,150,074 $16,880,374 $3,452,418 $328,485,767
U.S. Virgin Islands $7,822,181 $665,954 $589,383 $581,248 $3,678,153 $4,875,184 $0 $18,212,103

Definitions:
*Medicaid*: also includes the Children’s Health Insurance Program (CHIP), family planning programs, and state-funded coverage programs.

*Private Insurance*: includes employer-sponsored insurance and insurance purchased in the individual market (including the Marketplaces).

*Federal Section 330 Grants*: grants provided by the Health Services Resources Administration, Bureau of Primary Health Care under Section 330 of the Public Health Service Act.

*Other Grants and Contracts*: includes federal grants other than Section 330 grants, grants from state and local governments and private foundations, payments from state and local indigent care programs, and contracts.

*Other*: includes non-patient related revenue, such as fundraising, interest income, rent from tentants, etc.

Future of FQHCs

FQHCs have had significant growth in the past decades. The statistical data indicates that FQHCs have the potential to serve more patients by improving the quality of care. To provide quality care and improve patient experience, FQHCs must invest in the right technology like HealthViewX Care Orchestration Platform which provides the best solutions for the major challenges faced by the health centers.

Reference:

  1. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/fqhcfactsheet.pdf
  2. Kaiser Commission on Medicaid and the Uninsured (data from the National Association of Community Health Centers and the Uniform Data System (UDS) of the Health Resources and Services Administration (HRSA).
  3. Goldman, LE et al. Federally Qualified Health Centers and Private Practice Performance on Ambulatory Care Measures. American Journal of Preventive Medicine. 2012. 43(2):142-149. *Fontil et al. Management of Hypertension in Primary Care Safety-Net Clinics in the United States: A Comparison of Community Health Centers and Private Physicians’ Offices. Health Services Research. April 2017. 52:2.
  4. 2015 Uniform Data System. Bureau of Primary Health Care, HRSA, DHHS. National Center for Health Statistics. NCHS Data Brief. No. 220. November 2015. Hypertension Prevalence and Control Among Adults: United States, 2011 – 2014. National Committee for Quality Assurance. Comprehensive Diabetes Care, The State of Healthcare Quality (2016).
  5. Shi L, Tsai J, Higgins PC, Lebrun La. (2009). Racial/ethnic and socioeconomic disparities in access to care and quality of care for US health center patients compared with non-health center patients. J Ambul Care Manage 32(4): 342 – 50. Shi L, Leburn L, Tsai J and Zhu J. (2010). Characteristics of Ambulatory Care Patients and Services: A Comparison of Community Health Centers and Physicians’ Offices J Health Care for Poor and Underserved 21 (4): 1169-83. Hing E, Hooker RS, Ashman JJ. (2010). Primary Health Care in Community Health Centers and Comparison with Office-Based Practice. J Community Health. 2011 Jun; 36(3): 406 – 13.
  6. Shi L, Lebrun-Harris LA, Daly CA, et al. Reducing Disparities in Access to Primary Care and Patient Satisfaction with Care: The Role of Health Centers. Journal of Health Care for the Poor and Underserved. 2013; 24(1):56-66.
  7. George Washington University analysis of the Health Resources and Services Administration’s Uniform Data System. Special Data Request, March 2018.
  8. Community Health Center Revenues by Payer Source.

How Can Large Enterprise Hospitals Overcome The Challenges In Patient Referral Workflow?

Did you know? There are about 8000+ large enterprise hospitals in U.S. Recently, Becker’s Hospital Review released the list of top 50 large health systems. How is a hospital classified as a large enterprise hospital?

Hospitals which have typically 500 or more beds are categorized as Large Enterprise Hospitals. They are capable of serving the broader needs of the community. Some larger hospitals offer a combination of acute and long-term care services while also providing research opportunities in some cases and accommodating a variety of specializations.

Considering the huge number of patients in such hospitals, the referral numbers are also high. So such large health systems face challenges such as operational inefficiency, patient dissatisfaction, care discoordination and missed referral updates in their referral process. Let us go through the patient referral workflow in detail to understand their challenges better.

Patient Referral 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. In the workflow explained below, Mark is the patient who visits his PCP, Dr.James.

  1. 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.
  2. Dr.James does the insurance pre-authorization – The PCP does the insurance prior 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.
  3. Dr.James has difficulty finding the right specialist – The 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.
  4. 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.
  5. 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.
  6. 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 of Patient Referral Workflow in Large Enterprise Hospitals

  1. Handling multiple EMR/EHRs – Large Enterprise Hospitals and Health Systems that are formed as part of mergers and/or acquisitions tend to handle multiple EMRs. EMR interoperability is their greatest challenge.
  2. Finding the right specialist – A Large Enterprise Hospital has huge number of specialists. PCPs are not aware of specialists who were newly added or who came within their network as a result of mergers or acquisitions. So many times PCPs tend to refer their patients out of their network in spite of having the right provider within the network.
  3. Patient no-show rates – When patients miss/forget or do not show up for appointments, it results in revenue loss for the hospital. Patients miss appointments due to various reasons like no reminders, waiting time, better specialist within the locality, reputation of the receiving provider, etc.
  4. Referral leakage – Did you know? Referral leakage for any health system can average anywhere from 55-65%! Patient leakage or referral leakage occurs more in an out-of-network referral than in an in-network referral. There could be many factors such as reputation of a provider, lack of knowledge or insight and patient’s choice that lead to patient leakage.
  5. Patient dissatisfaction – Large enterprise hospitals should keep in track of the number of patients moving out of their network. An alarming 25 to 50% of referring physicians do not know whether their patients see the specialist! Patients become dissatisfied with the treatment when specialists or PCPs do not follow-up with them regularly.
  6. 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.

HealthViewX Patient Referral Management Features for Large Enterprise Hospitals

  • Multi-channel referral consolidation – The HealthViewX solution can capture fax, phone, email, online form referrals or any other referrals in a single interface. It makes it easy to monitor and manage all channels of referrals in a single queue.
  • Intelligent Provider Match – The HealthViewX “Smart Search” feature makes it easy for the referring provider in finding the right provider. It has smart filters and search options that help in narrowing down the specialist based on the requirements. This saves a lot of time for the referring provider.
  • Insurance pre-authorization process – HealthViewX automates the insurance pre-authorization process. The provider need not coordinate with the insurance company for prior authorization. The HealthViewX solution will do it for them. This reduces the manual effort of the referral coordinators.
  • 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.
  • Timeline View to track referrals – With the help of a referral status, the referring provider can get to know what stage the referral is. A timeline view shows a history of stages through which the referral has progressed. The chances of a referring provider missing out on referral updates are very less.
  • Referral closure and feedback – The referring provider can close the referral when it gets completed. The receiving provider and the patient can give a feedback on the referral process to the referring provider. Thus the referring provider can make it easy for the other the next time.
  • Referral Analytics – Helps in tracking the number of referrals and gives complete information about the referrals processed, missed, scheduled etc with the help of a Referral Data-centric Dashboard.

HealthViewX Patient Referral Management solution smooths the referral process and solves most of the inbound and outbound referral challenges for Large Enterprise Hospitals. Do you want to know more about HealthViewX HIPAA compliant Patient Referral Management solution? Schedule a demo with us.

 

Reference

https://www.beckershospitalreview.com/lists/50-largest-hospitals-in-america.html

https://www.mass.gov/files/documents/2016/08/uy/2011-hcctd-full.pdf

https://www.beckershospitalreview.com/lists/52-great-health-systems-to-know-2018.html