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Ten Ways In Which HealthViewX Solution Can Fix Your Referral Management

Referral Management Process in healthcare

Patient Referral Management in healthcare plays a vital role in treating patients. The physician or the PCP identifies the need for a referral and sends it to the most relevant imaging center or specialty practice. A typical patient referral process goes through the following steps,

Referral Initiation – The referring physician usually a PCP identifies the need for a referral and initiates medical referrals. A need for a referral arises when the patient needs advanced treatment or diagnosis that cannot be provided by a PCP.
Insurance Pre-authorization – If the patient has an insurance coverage, the referring physician has to validate the same. The physician must do this to find the imaging center/specialist care practice comes under the patient’s insurance coverage. Most of the PCPs do this manually. It is a time-consuming process wherein the PCP has to wait for the insurance company to respond.
Finding the right provider – Depending on the treatment required, insurance coverage and patient’s convenience, the physician will narrow down the search and find the right receiving provider for the referral. Dr.Miller is a primary care physician. A patient visits his clinic complaining of chest pain. After the initial diagnosis, the physician refers him to a specialist for better treatment. The referring physician looks for the best cardiologist in the city. Considering the patient’s and specialist’s comfort, the referring physician initiates the referral. This the more complicated than the insurance pre-authorization step as it takes more time and effort of the PCP.
Sending out the referral – After finding the right provider, the referring physician shares the patient information and the diagnosis details with the receiving provider. The referral is sent via phone, fax, email, etc depending on the source, the receiving provider is comfortable in getting the referrals from. Most referrals are sent via fax. The PCP has to fill out a form and fax it to the receiving provider. This process takes a lot of manual effort as faxes and forms are tedious to work with.
Following up with the referral – After the receiving provider receives the referral, the specialist may communicate with the referring physician for missing information. Most of the time, the PCP may not be available to the specialist for queries. This slows down the referral process as the specialist cannot proceed with the referral. The specialist who is also a busy doctor may not have the time to update the referring physician regarding the referral. This affects the referring provider as he cannot close the referral loop or get a feedback from the patient or receiving provider.

The referral process is quite demanding for the physicians. Communicating and giving timely updates is not easy with the current workflow. Considering the complexity of referral networks, an effective Referral Management Software is the need of the hour.

How can HealthViewX help in solving such challenges?

To sum up, these challenges cause a bad experience for the patients and providers. These challenges can be addressed by the unique features of HealthViewX.

Simple referral forms – The patient demographics and diagnosis required are already in the application. The referral coordinator can create the referral through a simple three-step form.
Insurance pre-authorization process – HealthViewX automates the insurance pre-authorization process. This reduces the manual effort of the referral coordinators.
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.
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.
Timeline View – 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.
HIPAA compliance – The solution is HIPAA compliant and offers secure data exchange. It supports almost all formats of files and keeps the patient documents safe.
Referral and timeline view reports – The health provider can generate the timeline view and referral analytics data as a report in any form.
Referral loop 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.
New Referral Channels – HealthViewX supports two channels of referrals, Desktop Direct and Type-enabled pdf for sending referrals. This reduces the time and effort the physician spends in filling in forms and sending faxes. The best part is that it does not require the referring provider to use our system.

HealthViewX Patient Referral Management solution smooths the referral process and fixes most of the challenges in a referral management system. Do you want to know more about HealthViewX Patient Referral Management solution? Schedule a demo with us.

Does A Referral Management Software Really Enhance The Patient Experience?

When patients need advanced treatment or additional diagnosis that cannot be given within the practice, they are referred to a specialist/imaging center. The process of managing all the patient referrals that are received or sent is called patient referral management. There are many challenges faced by the patients in the referral process.

Challenges faced by patients

Let us review a typical referral process including the challenges faced by the patients.

Patient visits the PCP – Andrews met with an accident recently. He met his PCP, Dr. John the next day as he was experiencing pain in his knee joints. After examining him, Dr.John wanted him to consult an orthopedic. The doctor then initiated the referral.
PCP initiates the referral – John created a referral in his EMR. He did not have time to do the insurance pre-authorization so he left it to Andrews. He then found an orthopedic and gave him referral information verbally. Now when he met the specialist, Andrews had to again elaborate his condition and problems to him. This increased the efforts he took to meet a specialist. It did no go well with Andrews as he was already in pain.
Patient Disorientation – John had instructed Andrews about the specialist he should visit, tests he should take and how to explain his condition. Andrews found these instructions too complicated to comprehend. He left the clinic with lots of confusions and doubts.
Patient visits the specialist – Andrews then called the specialist a number of times. The first two times, the line was engaged. Finally, when he got through, all appointments were booked for the day. to confirm his appointment. He had to wait for 24 hours in pain to meet the specialist. He spent another two hours in coordinating with the insurance company. At last, He met the orthopedic after long hours of waiting in pain. He got treated but was not happy with the waiting time and negative experience. He did not get back to the PCP to share referral updates and plans to visit some other PCP next time.

Challenges faced by the physicians

What factors stop Dr.John from giving the best patient experience to Andrews?

Insurance Pre-authorization – John runs a practice where he treats many patients in a day. He has not adopted a referral management software. So he has to do the insurance pre-authorization for his patients. It is time-consuming and tedious.
Finding the right specialist/imaging center – The clinic has no effective approach for finding the right specialist/imaging center. The chances of missing out on a good specialist/imaging center are high as it is done manually as they are not updated regularly.
No referral updates – John is not up-to-date with the progress of the referrals which makes referral loop closure impossible.

The lack of a systematic referral workflow increased the manual effort and makes it tedious to follow-up with patients and receive referral updates.

HealthViewX Patient Referral Management System

Considering the challenges faced by the patients, an automated Healthcare Patient Referral Management System is the need of the hour. Electronic healthcare referral management system helps healthcare organizations in the seamless processing of the referral process.

Let us review the same instance with HealthViewX Referral Management solution in place,

Patient visits the PCP – Andrews met with an accident recently. He met his PCP, Dr. John the next day as he was having pain in his leg. After examining him, Dr.John wanted him to consult an orthopedic. The doctor then initiated the referral.
PCP initiates the referral – John created a referral in HealthViewX system. HealthViewX does the insurance pre-authorization automatically in the background. With the help of the “Intelligent Smart Search” feature, he found an orthopedic. After giving the necessary information, John created the referral. The specialist got notified of the referral and all referral information were easily accessible by him.
Patient Disorientation – Andrews left the clinic with clear information about the specialist and appointment details. There was no need for him to call up the specialist for appointment as everything is automated. The patient will be notified about the appointment and tests to be taken.
Patient visits the specialist – Andrews met the orthopedic soon after the appointment was fixed. He got the best treatment and was satisfied with the referral process.

If you were Dr.John, would you not want Andrews to have a better experience? By using referral management software, you can ensure that Andrews’ knee pain heals while he also develops a positive opinion about your practice. Using a referral management software, you as a PCP can retain patients like Andrews in your network.

HealthViewX Patient Referral Management Solution features

Insurance Pre-authorization – HealthViewX solution supports automated insurance pre-authorization that reduces the manual work of the referral coordinators.
Intelligent Provider Match – The solution supports an “Intelligent Provider Match” Feature that helps in finding the right specialist/imaging center easily.
Seamless communication – HealthViewX solution has an inbuilt audio calling and messaging application which is secure and enables faster communication
HIPAA compliant data security – The solution is HIPAA-compliant and offers secure data exchange. It supports almost all formats of files and keeps the patient documents safe.
Referral history – The timeline view provides the history and current status of the referral. A status helps in knowing the referral progress.
Referral loop closure – Referral updates are hard to miss that makes it easier to close the referral loops on time.

HealthViewX Patient Referral Management application solves most of the challenges faced by the patients and PCPs. This increases patient satisfaction and revenue. To know more about HealthViewX solution, schedule a demo with us. Our patient referral management experts will guide you through our HIPAA-compliant solution.

How can Federally Qualified Health Centers Ensure The Progress Of Patient Referrals?

Federally Qualified Health Centers are community-based health care providers that receive funds from the HRSA Health Center Program to provide primary care services in underserved areas. They must meet a stringent set of requirements, including providing care on a sliding fee scale based on ability to pay and operating under a governing board that includes patients.

The scope of services of a Federally Qualified Health Center

Basic Health Services
- Health services related to family medicine, internal medicine, pediatrics, obstetrics, or gynecology that are furnished by physicians and where appropriate, physician assistants, nurse practitioners, and nurse midwives;
- Diagnostic laboratory and radiologic services;
- Preventive health services
- Emergency medical services
- Pharmaceutical services as may be appropriate for particular centers
Referrals to providers of medical services and other health-related services;
Patient case management services (including counseling, referral, and follow-up services) and other services designed to assist health center patients in establishing eligibility for and gaining access to Federal, State, and local programs that provide or financially support the provision of medical, social, educational, or other related services;
Services that enable individuals to use the services of the health center (including outreach and transportation services and, if a substantial number of the individuals in the population served by a center are of limited English-speaking ability, the services of appropriate personnel fluent in the language spoken by a predominant number of such individuals);
Education of patients and the general population served by the health center regarding the availability and proper use of health services
Telehealth/Remote long-distance health services
- The CARES Act that has been established in response to the COVID-19 pandemic authorizes FQHCs to provide telehealth services
- This act removes the previously existing barriers that restricted the scale of services that physicians and practitioners could exchange to patients remotely
- Price has been set at $92 for claims with the code G2025

Patient Referral Program in a Federally Qualified Health Center

Federally Qualified Health Centers constitute Primary Care Providers (PCP) who serve the underserved population. FQHCs are high outbound referral setups i.e they send out numerous referrals. A patient visits the clinic when he/she is suffering from an illness. Depending on the severity, the physician might refer the patient to an imaging center for further diagnosis or a specialist practice for advanced treatments.

An FQHC is recommended to have a dedicated referral coordination team to send out referrals and ensure effective referral coordination. With the help of the patient demographics and diagnosis details, the referral coordinator reviews the insurance prior authorization and finds the right imaging center or specialty practice for the patient. Following that, the coordinator creates a referral that includes the details of patient demographics and the required diagnosis. Finally, the referral is sent to the relevant imaging center or specialty practice.

Challenges faced

The referral creation involves tedious manual work due to the following reasons.

Finding the right specialist/imaging center – Due to the increasing amount of imaging centers and specialists, 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. It is also less likely for an FQHC to have the updated list of imaging centers and specialty practices.
Time Spent – As referrals are handled manually, a referring coordinator spends approximately half-an-hour to one-hour for creating a referral and even more time in following up.
No Updates – After a referral is sent, both the referring and the receiving providers may not be updated on the referral progress. In other words, the specialist/imaging center and the patient fail to update the clinic on the progress of the referral resulting in open referral loops.

Why are referral updates important to a Federally Qualified Health Center?

The patient’s well being – The primary role of a physician is to check on his/her patients’ health. Therefore, it is essential for a provider to know the status of the referral, the appointment, the patient’s condition, or illness.
Referral loop closure– Open referrals are a result of the referring provider not being updated on the referral’s progress. The ultimate aim of a referral process is to give the patient better treatment. Closing a referral loop is very important because it indicates that the patient was taken care of.
Data Analytics – PCPs require 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.
Referring to the right person – Depending on the progress of the referral and the patient’s feedback, the physician can get to know how good or bad the referral process has been. This will help the physician in knowing what step to take next.
Schedule follow-up appointments – After the referral is done, the physician has to schedule an appointment for the patient. For eg: If the physician is referring his patient to an imaging for X-ray, the physician must be notified once the test is done so that he can schedule an appointment and give treatment to his patient depending on the results. Structured appointments scheduled in a well-managed referral system is a constant source of new patient revenue.

Monitor your referral pipeline better with the HealthViewX solution

The major problem with an FQHC not getting updates is that everything is manual. A software solution can solve this problem quite easily. HealthViewX Patient Referral Management solution enables a referral in three simple steps thus providing a successful referral program. After the referral is created, it can be tracked with the 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 allow providers to be updated on the progress of the referral. This helps providers simplify the referral process and close 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.

Reference

(source:http://ldh.la.gov/index.cfm/page/797)

How To Control Patient Referral Leakage In Your Referral Network?

Health providers in a health system need patients to run their practice profitably. Be it a hospital, health network or private practice, healthcare providers rely on incoming referrals from other health providers and entities. Referrals generate revenue and improve patient retention rate. Providers tend to refer patients to specialists within the same hospital or health network. This is to retain them in the same hospital. A provider should consider factors such as personal relationships, quality outcomes, proximity, insurance coverage and patient preference before referring a patient. When a provider fails to consider these, patient referral leakage is bound to happen.

Patient Referral Leakage

Patient Referral Leakage happens when healthcare providers refer patients out-of-network. Accordingly, patient leakage is sometimes known as network leakage or referral leakage. The following definitions will help in better understanding of patient leakage,

In-Network – In-network refers to medical care within a network of doctors, hospitals, and other health providers who have a contract with a health insurance company. Inside the network, patients seek medical care only from those providers who are under the terms of the health insurance. In-network care is cheaper due to discounted rates that a health insurance company has negotiated ahead of time with the various health networks.
Out-of-Network – Out-of-network refers to patients looking to get medical care outside their current health network. This means that the patients seek care from out-of-network providers who cover their health insurance. Health providers refer patients seeking advanced treatment out-of-network. This is the main reason for patient leakage.

Why does patient referral leakage happen?

Sometimes patient referral leakage is unavoidable. When patients need medical care that is unavailable in their network, the health provider must understand the patient’s needs. The health provider must refer the patient to a specialist or an imaging center depending on the need.

However, there are occasions where in-network providers may refer patients to out-of-network providers on purpose.

Provider’s Repute – Sometimes, a health provider may refer their patients out-of-network to another provider who is more reputable in that specialty. This could be because the current health network has not employed a reputable specialist. The provider must make sure that a patient gets the best treatment possible.
Unaware of Providers in their network – Health providers who have just joined a health network or are a part joint ventures, acquisitions do not know all their specialists. This causes confusion and the health providers refer the patient out-of-network. When a health system fails to make it easy for health providers to refer within the network, patient leakage is inevitable.
Patient’s Choice – When certain treatment or care is not available within a network then it is up to the provider to refer the patient out-of-network. The health provider may recommend a next best course of treatment and the provider to consult for advanced treatment. Patients do tend to take the provider’s advice but it is up to the patient. This is why certain amounts of patient leakage will always exist. If the patient decides to move out of the practice due to unavoidable reasons then referral leakage becomes inevitable.

Why should it be curbed?

Patient’s Benefit – The patient may need immediate care and attention. So processing and closing it at the earliest will be the best for the patient. Patient leakage leads to open patient referral loop which will affect the patient’s health.
Patient’s Experience – A patient moves out-of-network due to many reasons. Primarily it is because the patient is not satisfied with the medical care provided in the current health system. Patient’s bad experience has a direct effect on hospital’s revenue, the number of incoming referrals, patient crowd, etc. In order to give efficient care to the patients, a health system must prevent patient leakage.
Missed Revenue and Reimbursement opportunities – The main problem with patient leakage is the missed revenue opportunities for health systems. These organizations miss out on reimbursement for medical services that they had provided earlier when patient leakage occurs. This applies to healthcare systems that adopt value-based care or payment models such as accountable care organizations (ACOs).
Failed relationships with healthcare providers and patients – Patient leakage results in failed relationships with healthcare providers and patients. Many health systems have spent resources on building clinical alignment with their referral network. Unfortunately, when patients go out of the system providers lose their trusted receiving providers.

How to tackle Patient Referral Leakage?

Employing right providers – Organizations can cut down patient leakage by employing respected, experienced, and well-regarded providers that they. This will cut down the number of patients who voluntarily go out-of-network. This is because they will find the right provider in their network.
Clear communication between physicians and patients – Clear communication between providers and patients is key to creating a positive patient experience and engagement. A health system can decide to give patients control of their own health by implementing an e-consult software. It should allow patients to schedule their own appointments, talk to providers online, order prescriptions, etc.
Being transparent in all aspects – The health system must be transparent about prices and pricing structure with the patients. Healthcare providers should give upfront estimates of costs and detailed end-of-care financial statements. Quality metrics is the other part that health networks must make readily available to the patients. It includes patient outcomes, patient satisfaction scores, physician reviews, etc. Ease of use and timely access to best care are crucial aspects of the patient experience. In a health system, it is important for a patient to receive medical care easily and in a timely manner.

How can HealthViewX Referral Management solution help?

Information Technology is transforming healthcare to a great extent. Patient referral leakage never happens with the help of a software application like HealthViewX. HealthViewX Patient Referral Management solution simplifies the referral process by the following steps,

Referral Initiation – The patient demographics and diagnosis required are already in the application. The referral coordinator can create the referral through a simple three-step form which includes health insurance pre-authorization, finding the right receiving provider with the help of “smart search”, etc. 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.
Referral status and timeline view – 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.
Referral and timeline view reports – The health provider can generate the timeline view and referral analytics data as a report in any form.
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.

HealthViewX Patient Referral Management solution smooths the referral process and reduces the burden of the referring and the receiving ends. Referral Management software cuts down patient referral leakage to a considerable number. Do you want to know more about HealthViewX Patient Referral Management solution? Schedule a demo with us.

Seven Mistakes To Be Avoided In A Patient Referral Network

Referral Networks of healthcare play a crucial role in determining the hospital’s income, patient stability, and information security. It is essential for a practice to build a strong referral network of health providers from the beginning. It requires a strong provider base to strengthen a patient referral network. Once the practice establishes a patient referral network, they have to maintain it. There are few mistakes that every practice makes and are not aware of how they lose their referrals. The following are few mistakes that can affect patient referral networks,

Ignoring Patient Satisfaction – Patient satisfaction is the determining factor of a hospital’s repute. During the referral process, the patients interact with the receiving physician. So patient experience of the referral has a direct impact on the hospital’s patient referral network. In many cases, the physicians are unaware of how the referral process impacts the patient. When the receiving physician finds the referral information incomplete, the physician will make the patient repeat the diagnosis. This affects the patient’s experience. The patient will also not like to bridge the gap between the referring and the receiving physicians. When the patient is dissatisfied, he/she leaves the practice resulting in patient leakage. A Referral Management software that can easily communicate between the referring and receiving physicians will improve the patient’s experience. Surveys and feedback forms keep the practice informed of the patient’s experience. The physicians must handle patients better and make them feel good during the referral process.
Partnering with bad network physicians – Having health partners with bad repute in a patient referral network is the biggest mistake. If the practice is not selective in choosing the physicians, it is bound to witness worst patient experiences. The practice should not sign any physician just because they have good credentials. Even a good physician may not meet the referral requirements. The hospital must take time to analyze the physician and study the provider’s network before signing them. Choosing good health partners is a strategic decision and should make it considering the future well-being of the practice. If the practice is looking for a long-term partnership then should find a stable health partner. In the age of technology, the practice must choose a physician who complies with the EHR/ Referral Management software used. EHR or Referral Management software compatibility issues greatly influence patient referral networks.
Poor communication – Communication is everything in a referral process. It lays the foundation for patient’s experience. As a part of medical care rules, hospitals should have protocol norms for communicating with patients. The practice should train their staff and should check the same regularly. This will make sure that when the practice refers their patients out, all the essential information moves along with them. This will give the patients better understanding of what to expect and what their responsibilities are. The practice must make sure to spend quality time with the patients for their doubts and queries. Patients expect the physicians to communicate smoothly and flawlessly. Living up to the expectations of the patients make the practice run smoothly.
Neglecting measurements – Staying aware of general patient satisfaction may not be enough. The practice must adopt more formal methods of evaluating the health of the network. The practice can get a high-level view of what’s going on through surveys, feedbacks, software etc. These tools can be used to get patient opinions, evaluate the smoothness and timeliness of transitions. It can also say how well the practice has established patient expectations around referrals and how well they’re being met. Surveys can be anything as simple as a form of feedback options integrated into the patient portal solution. The practice must make sure that the surveys cover topics like coordination, access, and quality of care along with appointment experience. Measurement at this level may require a dedicated staff member, or at the very least, making the required duties a formal part of an employee’s job description. Once the practice has a clear picture of what’s going on, it’s time to improve. The practice can use the information gained to highlight specific areas of improvement. It improves future training and protocol standards.
Neglecting long-term growth – The practice should have a solid business strategy. The American Academy Of Orthopedic Surgeons proposed a ten step process. It helps doctors in having a strategic approach towards the growth of the practice. The process involves market evaluations, budget creation, strategic plans development, marketing plan, new reimbursement model preparation, etc. Business development is the backbone of a strong patient referral network. Once the practice establishes a patient referral network, they must begin adding more doctors and professionals with whom they are comfortable. This will optimize the processes and standards already in place.
Careless about security breaches – One of the few downsides of a well-connected patient referral network is increased exposure to data breaches. Since 2009, 15 million patients’ Personal Health Information has been exposed. A practice should protect their patients’ valuable information. Hiring a professional to audit the practice’s internet breach can help. Audits detect unauthorized access to patient information, curb inappropriate accesses and track misuse of PHI. A practice can consider partnering with other network members. It cuts down the cost of bringing in outside consultants and solutions. The practice must keep all personnel properly trained on HIPAA guidelines.
Using outdated technology – The increase in the number of referrals on a daily basis makes it very tedious and difficult for the existing process and system to manage them. The most commonly used system of referrals being fax and this method of sending / receiving referrals is time-consuming and prone to errors. Communication with the PCP’s and the patients on follow-ups and sharing of the results is a cumbersome process which impacts the overall satisfaction of the both. Considering the complexity of referral system, an effective Referral Management Software is the need of the hour.

HealthViewX Referral Management solution features

HealthViewX Patient Referral Management solution has features that best suit a hospitals’ Referral Management System.

Seamless communication – HealthViewX solution has an audio calling and messaging features. It enables secure and faster communication among the referring physicians, receiving physicians and patients.
HIPAA compliant data security – The solution is HIPAA-compliant and offers secure data exchange. It supports almost all formats of files that can b sent and received during any time of referral process. It also keeps the patient documents safe.
Referral history – The timeline view provides the history and current status of the referral. A status helps in knowing how far the referral has progressed. It acts as a channel of communication between referring and receiving physicians.
Data Analytics – A comprehensive dashboard helps to track the number of referrals in the queue and shows the number of referrals in different statuses. This helps in knowing how fast the referrals are getting closed.
Report Consolidation – The data regarding the referrals and timeline view can be printed as a report anytime in pdf/excel form.
Invariant referral process – HealthViewX Patient Referral Management solution can integrate with EMR/EHR and can write data of referral into any system if required. It is almost zero deviation from the current workflow a practice is using.

With HealthViewX Patient Referral Management solution in place, physicians never make a mistake in the referral process. Managing a referral life cycle is very easy. A 30-minute demo with our team will help you know how effective our solution is in tracking and managing the referral process. To know more schedule a demo with us.

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

Community Healthcare Centers and what do they do

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

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

Patient Referral Management in Community Clinics

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

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

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

The gap between the community healthcare and specialty care

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

From a referring provider’s perspective, the referral coordinator receives and processes many referrals every day. After sending out a referral, it is very difficult to follow-up with it manually. There are no effective and secure means of communication between the referring and the receiving providers. If the receiving provider or the patient fails to update the progress of a referral to the referring provider, he/she will never get to know what happened with the referral. Closing the referral loop becomes nearly impossible in this case.

From a receiving provider’s perspective, the referral he/she receives may contain incomplete information. Without vital details, processing the referral will be difficult. The source of referral are many but there is no single interface to manage it all. Missing out on referrals is common. There is no way of getting a consolidated data on the number of referrals missed and the number processed. Patient referral leakage becomes imminent if the referrals remain unprocessed for a long time.

From a patient’s perspective, he/she is referred to take tests in an imaging center and then meet a specialist to continue with the treatment. If the patient has to communicate back and forth between the referring and the receiving providers for incomplete information, history of illness, etc, it annoys the patient. It is frustrating for the patient to communicate between the two ends.

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

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

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.