Effective Referral Management To Improve Care Coordination

Holistic care involves the delivery of healthcare services at many levels. It not only includes primary care by a general physician but also the focused intervention by a specialist. Typically, a patient is referred by his primary care physician to enable him to see the specialist. However, the transition, most of the time, is not as smooth as it should be.

And why is that?

It is because referring a patient to a specialist is just the first step. Seamless transition of a patient from one healthcare setting into another requires concerted efforts, involving well-planned referral management, preferably by a Referral Coordinator, aka Care Coordinator. This care coordination involves:

• Transferring medical notes to the specialist
• Following-up with the patient to ensure he/she completes the referral
• Follow-up by the patient for his/her referral appointment
• Receiving the medical note from the specialist and ensuring that the primary care physician (PCP) has the same information at hand
• Integrating the medical information with the existing treatment plan to have everybody involved in the care on the same page 

Barring when the patient follows-up with the specialist, every step at the backend involves diligence to ensure referral completion and that all the relevant information is received at both ends. And when the facility is not able to provide efficient referral management, either of the following occurs:

• Delayed appointment to the specialist,
• A no-show from the patient, a phenomenon known as referral leakage,
• Overall patient dissatisfaction, especially when the patient completes the referral but the PCP does not receive the necessary information

What’s lost with a lost referral?

• Lost time: The physician could have offered care to someone else at that particular time of the visit
• Lost revenue: Loss of cash flow that the facilities and physicians, at both ends, could have made with value-based care.
• Lost care: On missing multiple appointments, the patient can lose its chance to receive specialized care from a specialist.
• Lost provider satisfaction: With each missing referral appointment, the burden on PCP increases to offer such treatment that he otherwise would not provide, resulting in low quality of healthcare or no intervention at all.

If so much is at stake, then why Referral Leakage occurs?

Good question! Studies show that a hospital loses an astounding 55-65% of revenue due to referral leakage. As high as 40% of the patients do not show up for their scheduled appointments. Following are some issues that make the patient not follow-up with the specialist for its referral appointment:

• Referring the patient to a facility that is far away from its place
• Scheduling the visit without considering the patient’s preference of date and time
• Not informing the patient on time about the appointment when it is finally scheduled
• Not sending a reminder to the patient about the appointment a day or two before the visit
• A little or no information with physicians or general staff to match the right specialist with a referral
• Poor communication around the patient’s financial responsibility

A dedicated Care Coordinator for effective Referral Management

Referral coordinators are trained professionals that help physicians by coordinating referral appointments by scheduling appointments, sending reminders, and providing patients with information about their scheduled visits. Better coordination between referring physicians and specialists increases patient satisfaction with the received healthcare service. A referral coordinator validates all the information with the referring provider and then chooses the right specialist using the Referral Management System (RMS).

The referral is then submitted to the specialist with the necessary documents. The referral coordinator coordinates with the specialist for appointments. Using highly advanced RMS tools, the care coordinator is able to send automatic notifications and reminders to the patient and the specialist through the preferred mode of communication.

Once the appointment is complete, he ensures to receive referral updates or outcomes from the specialist, and then feeds in the information into the EHR, sharing it with the primary healthcare provider.

Appointing a Referral Coordinator has the following benefits:

• Reduced patient “no-show” rate
• Eliminate referral leakage
• Improved operational efficiency
• Patient and PCP satisfaction
• Enhance revenue generation
• Streamlined referral Lifecycle Management.

Referral Coordination going Digital with Electronic RMS

Studies indicate that the referral-to-appointment ratio climbs from approximately 60% to more than 90% by implementing a digital, accountable transition of care. The state-of-the-art RMS systems create a mechanism whereby specialists can reach out to patients, and increase the likelihood of an appointment being scheduled.

Digital connection enhances transparency, creating accountability on both sides. With the advent of EMRs generating digital medical records, it makes all the more sense that the referral information should also be transmitted in a digital manner wherein specialists can have instant access to the files.

Value-based care is taking the center stage in the healthcare industry. It is high time that primary care providers and specialists bridge the gap in their communication. This is where an electronic referral management system comes into play.

The Positive Impact on Care Coordination

1. Introducing a collaborative design connecting PCPs with specialists on a single uniform network
2. Enabling primary care facilities to optimize their practices’ reimbursements by exceeding patients’ expectations, thus improving healthcare quality
3. Offering a secured, quick, and reliable network to transmit necessary information between PCP and specialist
4. Providing PCPs the enhanced visibility to track referrals and know what’s going on with the patient between visits
5. Empowering primary care team to guide its patients to a specialist who will provide the best care at the best price
6. Decreased waiting times for face-to-face specialty clinic visits
7. Streamlined workflow with easier follow-ups and automatic closing of the loop on all the completed referrals

Offering Robust Referral Management Services

ScribeEMR has hired highly qualified Referral Coordinators, who track every bit of relevant information regarding the referrals set up by the primary care provider, work with insurance companies to share essential patient information and secure authorizations, and ensure that the patient presents to the referral appointment.

Necessary information is conveyed to the patients to help them make critical care decisions regarding their referral appointment, thereby resolving any issues that may arise before the visit.

ScribeEMR provides its Referral coordinators with powerful Referral Management tools, enabling them to keep track of their patient referrals throughout the care continuum.