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Streamline Your Patient Referral Workflow With HealthViewX Patient Referral Management Solution

Most healthcare providers are aware that referrals are critical, high-quality, and high-value demand generation channel. Did you know?

More than one-third of all patients seen are referred
Additionally, over 46% of faxed referrals never result in a patient visit
An estimated 50% of referring physicians never know if their patient was actually seen

But there are some mistakes every provider makes which can affect the revenue and the referral process to a great extent.

Common mistakes in healthcare referral programs

1. User Interface Design – Referral programs should be so simple to use that the physicians refer their patients without facing any issue. There are many constraints physicians face while initiating referrals. Some constraints include,

Sending referrals to receiving providers in the preferred channel
Poor website structure with little information about referrals
Handling paper-based forms of various templates for sending referrals

These confusions cause a bitter experience to the referring physicians. The chances of PCPs referring to such specialists are less. This will lead to the failure of the referral program.

2. Complicated referral process – A referral program should not impede the existing workflow. It should not require extensive hours for a person or group to manage the referral program. One of the major problems faced by referring physicians is that they have to manage multiple systems or software for initiating a referral. For eg: A referral coordinator must take the patient information from the EMR/EHR and then create a referral through fax, website or direct message. This complicates the process for the referring physicians.

3. Finding the right specialist/imaging center – The number of imaging centers and specialist practices is increasing day-by-day. The referring physician does not have the list of all such imaging centers and specialty practices. The chances of missing out on a good receiving provider are high. With a manual process in place, it takes a lot of time and effort for the referral coordinator to narrow down the referral coordinator’s search and find the right one.

4. Time- consuming referral process – As the referrals are handled manually, a referring coordinator spends about half-an-hour to one-hour for a creating referral on an average and even more time in following up the same.

5. No system to give referral updates – After a referral is sent, both the referring and the receiving providers so not have easy access to updates. The referring and the receiving providers lose track of the referrals as it is difficult to coordinate manually for such referral updates. This results in open referral loops.

Monitor your patient referrals better with the HealthViewX solution

Referring physicians can address the referral workflow challenges and achieve a streamlined referral pipeline with the help of a software solution. HealthViewX Patient Referral Management solution enables creating a referral in three simple steps thus providing a successful referral program. After the referral is created, it can be tracked with help of the status. Both the referring and receiving providers will be notified of the appointments, test results, treatment recommendations, etc. HealthViewX can integrate with EMR/EHR and can also coordinate between the referring and the receiving sides. Any referral has a timeline view which is common to both the receiving and the referring providers. In the timeline view, history of the referral can be seen for eg: notes related to the patient’s health, previous status of the referral, etc. Documents attachment and status change can also be done at any time of the referral process. HealthViewX Patient Referral Management solution can always keep you updated on the progress of the referral thus simplifying the referral process and helps in closing the referral loop.

HealthViewX Patient Referral Management solution helps the referring provider to track the referral progress. Schedule a demo with us and our patient referral management experts will guide you through our HIPAA compliant solution.

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
their 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 refer now 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.

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3160594/

Attract And Retain Patients Within Your Network In Seven Simple Steps

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

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

It is through Patient Value Journey.

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

The Patient Value Journey

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

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

1) Attaining Patient Awareness

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

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

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

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

2) Patient Engagement

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

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

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

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

3) Patient Subscription

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

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

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

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

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

4) Conversion

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

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

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

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

5) Achieving Diagnosis and Treatment

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

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

6) Ascension

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

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

7) Advocacy

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

Patients can share positive feedback with the world by:

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

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

Making the Patient Value Journey Work For You

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

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

Using technology to solve patient-related problems

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

References

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

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

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

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

How valuable is a Patient Referral Management Software To Primary Care Physicians?

When PCPs send a referral to a specialist, they expect that specialists will let them know when their patients received care. Many times it doesn’t happen as expected. The hospital may be too busy to share information. In other cases, the hospital may have faxed a notification to a patient’s primary care physician (PCP). But, for one reason or another like coordination issues, busy schedule, the physician practice may never have received it.

There are many such problems as the above PCPs deal with every day. Let us read through a few in detail.

Insurance pre-authorization – The time a PCP invests on the process of insurance pre-authorization is more. Waiting for the insurance to respond is neither good for the PCP, not the patient.
Finding the right specialist/imaging center – The number of imaging centers and specialist practices is increasing day-by-day. It takes a lot of time and effort for the referral coordinator to narrow down the referral coordinator’s search and find the right one.
Time Spent – As the referrals are handled manually, a referring coordinator spends about half-an-hour to one-hour for a creating referral on an average and even more time in following up the same.
No Updates – After a referral is sent, both the referring and the receiving providers get busy. It is not possible for both of them to be updated on the referral progress. So the specialist/imaging center and the patient fail to update the clinic on the progress of the referral. This results in open referral loops.

Manage your patient referrals better with the HealthViewX solution

Fortunately, many PCPs are realizing the need for a better way to process and manage referrals securely. This is when they feel an automated Patient Referral Management System can help.

HealthViewX Patient Referral Management solution enables creating a referral in three simple steps thus providing a successful referral program. After the referral is created, it can be tracked with help of the status. Both the referring and receiving providers will be notified of the appointments, test results, treatment recommendations, etc. HealthViewX can integrate with EMR/EHR and can also coordinate between the referring and the receiving sides. Any referral has a timeline view which is common to both the receiving and the referring providers. In the timeline view, history of the referral can be seen for eg: notes related to the patient’s health, previous status of the referral, etc. Documents attachment and status change can also be done at any time of the referral process. HealthViewX Patient Referral Management solution can always keep you updated on the progress of the referral thus simplifying the referral process and helps in closing the referral loop.

How has HealthViewX added value to PCPs’ patient referral problems?

1) Automating the insurance pre-authorization process

HealthViewX platform has a payer management module that maintains and manages

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

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

prior authorization submission
status checks coupled
fax integration

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

2) Intelligent Provider Match

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

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

HealthViewX Patient Referral Management solution helps the PCPs in handling and managing their referrals. Are you a PCP 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.

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

What is Patient Referral Management?

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

Challenges faced by FQHCs

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

1. No single system for Referral Coordinators

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

2. Cumbersome Insurance Pre-Authorization

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

3. Specialist & Patient Referral Communication

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

4. Referral loop closure

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

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

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

HealthViewX is the Next-Generation Patient Referral Management Solution

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

2. Payer-specific prior authorization process automation

HealthViewX platform has a payer management module that maintains and manages

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

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

prior authorization submission
status checks coupled
fax integration

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

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

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

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

HealthViewX clearly understands the specialists’ referral preferences by,

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

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

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

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

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

Chronic Care Management Services In Federally Qualified Health Centers

What are FQHCs?

Federally Qualified Health Centers (FQHCs) in the United States are non-profit entities 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. FQHC is a dominant model for providing integrated primary care and public health services to low-income and underserved population. There are two types of FQHCs, one receives federal funding under Section 330 of Public Health Service Act and the other meets all requirements applicable to federally funded health centers and is supported through state and local grants. 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

What is Chronic Care Management?

The CMS introduced the Chronic Care Management program in 2015. It insisted care coordinators give 20 minutes of monthly non-face-to-face care management services for beneficiaries with two or more chronic conditions. It helps in managing their conditions, risk factors, medication adherence, and coordination of care with other providers. In order to claim CCM reimbursements, the practices must offer

24/7 access to care management services
a platform for direct patient-practitioner communication
ability to manage transitions between providers and settings

Chronic Care Management in FQHCs

It is not mandatory for FQHCs to furnish Chronic Care Management services for their patients. These services can be given in addition to any routine care coordination services already furnished as a part of the patient’s visit to FQHC. Though it is not mandatory for them to give CCM services, they can bill for the same if the CCM requirements are met.

The CCM billing for FQHCs is a little different though. For CCM services furnished between January 1, 2016, and December 31, 2017, FQHC can bill the under the CPT code 99490. Payment is based on the Physician Fee Schedule (PFS) national average non-facility payment rate for CPT code 99490. FQHC claims submitted using CPT code 99490 for services on or after January 1, 2018, will be denied.

For CCM services furnished on or after January 1, 2018, FQHCs can bill CCM services under the general care management HCPCS code, G0511. CMS has set the payment annually at the average of three national non-facility PFS payment rate for CPT codes 99490, 99487 and 99484.

It is important to note that the 2018 payment of HCPCS code G0511 is $62.28. It is high compared to the reimbursement of $42, CMS gives to practices other than FQHCs under the 99490 CPT code.

Why should FQHCs give CCM services to their patients?

Increased reimbursements – FQHCs receive grants for treating their patients. When they provide Chronic Care Management services to their patients, they get more grants from CMS. This increases the revenue for FQHCs.
Improved patient satisfaction – Chronic Care Management services establish a long-term connection with patients. The patients can reach out to the physicians at any time in need. This improves patient experience and the FQHC will see more patients coming into their hospital.

HealthViewX Chronic Care Management Software, the best fit for FQHCs

FQHCs are reluctant in giving CCM services to their patients as it is a laborious task. With increasing CCM requirements from CMS, FQHCs are worried about taking up the Chronic Care Management program. This is when an electronic healthcare product can come to play. HealthViewX Chronic Care Management solution has features that solve most of the problems faced by FQHCs.

Inbuilt audio, video calling and messaging features – HealthViewX Chronic Care Management solution has inbuilt video and audio calling features. It helps in giving Chronic Care Management services to their patients. Secure messaging is also available through which the physicians and the patients can communicate.
Automated call log feature – After a patient call, care plan creation or any action related to Chronic Care Management services, call logs are added to the patient. It reduces the physician’s manual effort is logging the call logs.
Preventive Care plans – HealthViewX solution supports care plans for the Chronic Care Management service for a patient. The physician can create a care plan depending on the patient’s health report. It helps in monitoring the patient’s vitals.
Chronic Care Management Analytics – Dashboards with intuitive charts and tables give complete analytics of the Chronic Care Management services. It provides a clear picture of the revenue perspective.
Consolidated Report – The physician can generate a consolidated report of the Chronic Care Management services given for a particular period. This makes it easy for the billing practitioner for getting the Medicare reimbursements.
HIPAA compliance – HealthViewX Chronic Care Management is HIPAA compliant. It facilitates secure data exchange. Our solution manages all patient-related documents securely.

HealthViewX Chronic Care Management solution is on par with the current requirements of the CCM program by the CMS. It helps FQHCs to set up a CCM program with the least investment. To know more about our Chronic Care Management solution, schedule a demo with us.

Improving Patient Referral Management Workflow Between Federally Qualified Health Centers & Specialists Clinics/Imaging Centers

Federally Qualified Health Centers and what do they do

A Federally Qualified Health Center (FQHC) is a community-based organization that provides comprehensive primary care and preventive care, including health, oral, and mental health/substance abuse services to persons of all ages, regardless of their ability to pay or health insurance status. Thus, they are a critical component of the health care safety net. FQHCs are called Community/Migrant Health Centers (C/MHC), Community Health Centers (CHC), and 330 Funded Clinics. FQHCs are automatically designated as health professional shortage facilities. a non-profitable, consumer-directed healthcare organization. FQHC serves the underserved, underinsured and uninsured people, and provides them with access to high quality and preventive medical health care. FQHCs were originally meant to provide comprehensive health services to the medically underserved to reduce the patient load on hospital emergency rooms.

FQHCs include community health centers, migrant health centers, health care for the homeless health centers, public housing primary care centers, and health center program “look-alikes.” They also include outpatient health programs or facilities operated by a tribe or tribal organization or by an urban Indian organization. FQHCs are paid based on the FQHC Prospective Payment System (PPS) for medically-necessary primary health services and qualified preventive health services furnished by an FQHC practitioner.

Their mission has changed since their founding. Their mission now is to enhance primary care services in underserved urban and rural communities

Patient Referral Management in Federally Qualified Health Centers

Federally Qualified 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. Federally Qualified Health Centers do not have the facilities for giving specialized treatments or for taking advanced tests. So, when a patient requires any specialist medical attention, the PCP refers him/her to the most suitable imaging center or specialty practice.

Federally Qualified Health Centers 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 Federally Qualified Health Center and specialty care

A referral process may become inefficient and ineffective if the Federally Qualified Health Centers 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, the physician refers him/her 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 Federally Qualified Health Centers and Specialist Clinics/ Imaging Centers

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.
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.
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.
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.
Any tool that can give prompt reminders on the appointments, follow-ups to both the patient and the receiving providers can help.
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.
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.