It is a well understood fact that most healthcare systems are functioning in silos as they evolved that way over the past few decades. However, with modern technology it should not have to continue going down that track, particularly where it tends to reduce efficiencies, raise costs and yield poorer patient care outcomes. According to the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality (AHRQ), coordinated care among healthcare system (specialty care, hospitals, home health care, and community services and supports) is important as it offers greater access to services (with shorter waiting times for urgent needs and enhanced in-person hours).
As Patients move between various care settings, many of these ills can be cured by simply using technology. This problem with having disparate healthcare systems that do not communicate effectively, or at all, with one another clearly shows up in the patient referral process that runs between physician offices in much of the world today. Physicians spend 20% of their time on non-clinical paperwork as per the 2014 Survey of America’s Physicians by the Physician’s Foundation. This further exacerbates the problem.
All this is in great part due to the referral process’ dependence on the old world practices and tools of phone calls, paper letters, faxes, and an over reliance on the patient himself having to do some of the work needed to make it happen, including calling up physicians to secure appointments and carrying big, fat files of records detailing past medications, lab reports and other documents. All these do not just add labor and costs to the process. They sometimes even stall it completely. That is why so many referrals are not completed.
Hey CFO—Don’t leave money on the table!
Indeed, all these issues show up in our research, which tells us that:
- One in 6 referrals never make it to the destined specialist
- Almost 70 percent of specialists do not receive patient’s information prior to their visit
- Physician practices regularly lose 65 percent of the referrals
Now, think of the impact on the revenue of physician practices if these factors were reversed. A 10 to 20 percent leakage prevention results in a concomitant revenue increase of up to 47 percent. And then consider these facts: employed physicians typically equal the largest investment by a hospital, and more than 100 million referrals each year go through issues such as the above. When extrapolated, to the case of Accountable Care Organizations (ACOs)—a small increase in referral rates can lead to a huge surge in their bottom lines. So just imagine the whopping productivity increase and additional revenue if all the referrals were completed as intended!
Referral Management mandated by Meaningful Use Stage 2 (MU2)
Fortunately, we are not alone in seeing value in fixing the patient referral management problem. Among the federal government’s Medicare and Medicaid EHR Incentive Program Meaningful Use Stage 2 (MU2) requirements are those that underscore the need for a robust technology-based referral management solution across the continuum of care.
Specifically, these come under criteria for attestation to MU2 Core Measure 15, which relates to Summary of Care and includes requirements for Eligible Providers (EPs) to provide a summary of care record and ensure at least 10 percent of all such referrals are done electronically.
Why then are CIOs guilty of inaction?
CIOs of most healthcare provider organisations are usually guilty of underestimating the impact of such referral revenue leakages, and this partly happens because of the fires that they have to fight daily in other areas. However, a small investment of time in analyzing the relevant metrics would immediately provide a business case.
Most healthcare software vendors will be happy help build this case too. CIOs would do well now to look at referral management, not as a passive need arising out of MU2 attestation, but rather as an active revenue contributor to their enterprise objectives. If they presented an investment in referral management technology from a revenue angle, they would find the CFO and the CEO more than willing supporters of their cause. An investment such as this is a slam dunk for most provider organizations.
As for the kind of solution they need, it would have to be one that minimizes the administrative tasks that have to be performed- by all parties including the physicians, their staff, and the patients–within the patient referral process, but that maximizes the amount and currency of necessary information communicated between physician practices.
Technology has given us the means to do this. We now build online platforms that house entire communities of physician practices in a web of constant information exchange and communication. Each offering physician practices ways to exchange records, notes and other important patient information and schedule appointments. Each offering physician practices visibility into the movement of their patients–including whether they make their referred appointments, and whether they complete the Loop by returning after receiving treatment by their specialists–and 360-degree views into the condition and recovery of patients, so they can administer comprehensive care. And each giving patients nothing to do, only requiring them to just show up for their appointments!
That is the solution that makes for healthier patients and also healthier operating budgets for physician practices.
-By Karthik Tirupathi
The author is the CEO of Napier Healthcare, a leading provider of Cloud-based referral management Loop technology that is revolutionizing the way physicians seek, secure and retain referrals.