18th Dec
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My Holiday Wish–Fixing the Referral Process to Prevent and Beat Colon Cancer

By Dr. Andrew Albert, CMO

One in 20 people will get colon cancer.  It’s the second most common cause of death in men and third most common cause of death in women.

Colon cancer arises from small polyps that generally take up to 10 years go grow. Ten years, that’s quite a long time. Some patients have few polyps and others have many. Unfortunately, colon cancer requires just one polyp to rear cancer’s ugly head. I would venture a guess that most of my patients–90% or more–have one polyp after the age of 50. Guidelines by the American Gastroenterology Association suggest Colonoscopy for all patients over 50 (some before then). There are multiple options provided patients to prevent colon cancer; none as effective as Colonoscopy. A Colonoscopy takes 30 minutes of procedure time. Unfortunately, studies have shown (over the past 5 to 10 years) that 30-40% of patients proceed with Colonoscopy. The remainder fails to comply—the one in 20 to get colon cancer.

Why Aren’t More Patients Following Up and Getting Colonoscopies?

Why is this case? What causes such a discrepancy? Polyps and lack of treatment equals colon cancer. Isn’t this intuitive? Fear, apprehension, and angst about the procedure affect compliance with recommendations for screening. At times, patient may exhibit denial. “There is nothing wrong with my health, I feel perfectly fine”. As a physician, these words send waves of anxiety through me. Aside from walking the patient to the gastroenterology suite, there are few options in addressing these barriers. These barriers know no socioeconomic or cultural boundary.

The Patient Referral Process is Broken

What about physicians? With the development of shared risk, there is greater attention paid to the referral process; more significant focus on “measures” and “outcomes.” Referrals to gastroenterologists have increased significantly. Approximately 69% of primary care physicians (PCPs) report they send specialists patients’ medical history and reason for consultation at time of referral, though only 35% of specialists report that they receive such information. Moreover, nearly 81% of specialists claim to send notifications about test results back to referring PCPs, though only 62% of PCPs report receiving such information. Ultimately, only 50% of referrals actually lead to a completed appointment and most referring physicians have no idea whether their patient was seen in the first place.

Unfortunately, it’s because of ineffective scheduling. The referral process is broken. Hospital systems across the nation describe an “abyss,” a chasm between the referring and receiving physicians’ offices. The boundaries of this abyss can often be measured in feet not necessarily miles. The issue is so simple and clear. Walking across the hall or driving the few blocks from one office to another can present a challenge. Patients get lost and it’s out job to help them find their way.

There are numerous additional issues with completing colonoscopy. A multivariate analysis from the Journal of General Internal Medicine identifies barriers including those of female sex, younger age, and insurance type. Patients also perceive colonoscopies as being painful and have concerns about modesty and bowel preparation. As a result, adherence to colonoscopy is low. Ultimately, better communication with patients and resolution of barriers will increase compliance. Making the process of scheduling easier will decrease the impact of such barriers.

This past year, I had the unfortunate experience of diagnosing three colon cancers on the same day. Three women presented to the gastroenterology lab. These lovely and relatively young women were 60, 62, 65 years of age. All three came in for screening colonoscopy. None of them had symptoms. All were found to have colon cancer; a situation that could have been avoided.

Colon cancer is preventable beatable and treatable. Imagine looking at the warm, kind, anticipatory faces of those patients. Then imagine your patient’s smile disappear as you inform them they have cancer. Continue to imagine that pit in your stomach when you realize that if they presented sooner, these conversations would never have taken place.

Thinking about the situation, everyone is affected by this outcome. Aside from the obvious consideration of the patient, one also needs to consider the family, the primary care provider, and the insurance carrier. How could we let this happen!? Colon cancer is “preventable” and all I can think about is how we could have done better for our patient. With all our knowledge, what could we have done differently?

Let’s Start Fixing the Referral Process by Automating it

The referral process is broken and we can no longer rely on patients to make the right decisions with their care, even if informed.  We, as providers, need to take responsibility for safety and outcomes. We need to do better for our patients. It’s time to focus on processes at hand and improve healthcare with each attributed life. We need to address these barriers head-on.

An automated referral management platform eliminates patients “falling through the cracks.” The referring doctor or the doctor’s staff would be able to refer at the point of care and schedule the referral, increasing the likelihood that patients will follow through with the procedure. We have seen this with plastic surgery and weight loss referrals in particular. An automated referral management platform would help ensure timely diagnosis and treatment for patients, decreasing the subjectivity of the process overall. Does one really choose to have a colonoscopy? No. Will patients follow through if their physician facilitates the process? Absolutely.

Since the referring doctor schedules the required appointment before the patient leaves the office, the referring doctor can ensure that the specialist within the appropriate time frame will see the patient.  Manually tracking referrals is not only difficult and time-consuming, but it also draws health care staff away from other critical tasks. An automated referral management platform takes care of this problem by allowing providers in the referral chain to see whether patients attended their appointments.  The coordination of care would no longer be an issue. Such technology would further advance the referral process by sending automated appointment reminders via email or text messages, further promoting patient attendance.

Fibroblast facilitates patient care, improves outcomes, improve safety and quality for healthcare systems. The benefit is clear. It’s time to take the next step!

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11th Nov
Posted By

How Improving the Radiology Referral Process Can Improve Patient Care, Patient Experience, and Reduce Health Care Costs in the Long Run.

This following is a guest post by Dr. Sanket Shah, a Resident Physician in Diagnostic Radiology.

Imaging is an integral part of a patients care.  Radiology is a key diagnostic tool for many diseases while also playing an important role in monitoring treatment and predicting outcome.  Despite the rapid technological advancement in diagnostic imaging, access to this valuable tool often falls through the cracks related to poor imaging referral management.   When choosing a specialist or procedure (including imaging centers), patients rely heavily on their doctor to make the referral that is in the patient’s best interest as outlined in this survey carried out by the Center for Studying Health System Change.  However, it seems that more can be done at the point of care to improve this process.

 

Often, patients go to see their primary care doctor in the ambulatory setting with an ailment, for which an imaging test is ordered.  For example, a family member recently fell during the Chicago Marathon due to the large crowds at the beginning of the race and injured his elbow.  A day after the race he went to see his primary care doctor.  When I asked him what his doctor said about his elbow, he told me he received a prescription for an elbow X-ray.   As a resident physician in radiology, I was excited to review his radiograph with him only to be disappointed to find out he had not yet gotten his x-ray (almost 2 weeks later).  On top of that, it took him about an hour to find his prescription (see below), which was buried in other important household paperwork, when I asked to see it.

Imagining Referral

 

 

 

 

 

 

 

 

 

The puzzled look on his face when asked where he was going to get the elbow x-ray taken only made my frustrations with the process grow even more.  I spent a few minutes that night looking on the health organization’s website his doctor is affiliated with, where there is a list of preferred in-network imaging centers.  He was essentially expected to set up his own appointment and bring his paper referral with him to the appointment in order for the appointment to be accepted.  As his elbow was still visibly swollen 2 weeks later, I urged him to get the X-ray taken as soon as possible. If he indeed has a fracture (which I suspect he may), the process has already delayed his care.

 

Beyond the point of care, there are also gaps in physician communication which often cause a delay in patients care.   I can share a recent example which involved a patient getting an X-ray for a sports related injury.  The x-ray demonstrated a fracture in a location which also indicated ligament damage, which was correctly reported by the radiologist.  The ordering physician was late to follow up on the imaging results probably assuming the radiologist or patient would inform him of any abnormality requiring follow-up.  The patient assumed his doctor would have notified him if anything was wrong, and the radiologist assumed the ordering physician would have followed up with the final report or the patient.  This ultimately resulted in delayed care for the patient which rendered him outside of the time window necessary to successfully repair the torn ligament.  Who is at fault?  Is it the individuals or the process? Many providers often do request imaging reports be faxed to their offices once the radiology report becomes available, which often do not go through for many various reasons including a high volume environment.  As a result, imaging findings that are deemed “non-urgent” often fall by the wayside.  With the tools available today, such a process gap should be avoidable and studies have showed that using a referral tool within an EMR can improve physician communication.

 

Although many larger healthcare organizations are implementing such tools to improve requests for imaging, lab tests, and specialist referrals in the era of accountable care and meaningful use, many smaller organizations and stand alone doctors’ offices still lag behind the curve.  One big hurdle in the system today seems to be the lack of interoperability between large EMR vendors which often limits a physician’s ability to exchange patient information as stated in this recent New York Times article.

 

As imaging plays a pivotal role in a patients care, it is important for both providers and imaging centers to develop better methods to manage their patients imaging referrals.   If providers were capable of processing an imaging request at the point of care before a patient leaves the primary care doctors office, it can make an immediate impact on a patients care, as it makes them much more likely to follow through with their appointment.   This would also create a healthier relationship and improve communication between imaging specialists and their referring physicians, which is right in line with the American College of Radiology Imaging 3.0 Campaign.   With the patient’s best interests in mind, there is much room for improvement in increasing speed to schedule (in-turn decreasing turn-around time), driving patients to centers in-network, while also improving an imaging centers referral capture rate.  It’s time to utilize technologies that make it easier for patients to get the care they need and for doctors to share information and communicate with each other better to enhance patient care.

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25th Apr
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AUTOMATE THE REFERRAL PROCESS TO REDUCE MALPRACTICE RISK EXPOSURE

Problems with patient referral management are a major concern for healthcare providers everywhere, and if they aren’t, they should be. One of the major problems doctors have with referring patients is out-of-network patient leakage. However, there’s something worse at stake. When the referral system doesn’t work as it should, doctors and their patients are at serious risk. Doctors face the potential for malpractice suits and patients face an increased risk of health complications or even death.

The following is what too frequently happens in a referral situation: A patient shows up with a medical concern that warrants the review of a specialist or a doctor notes health matters of concern during an office visit. The doctor gives the patient a referral on a piece of paper and the patient leaves the office with instructions to call and schedule an appointment. Either the patient fails to make an appointment to see the specialist in a timely manner or the patient loses the paper altogether. Sometimes the patient does make the appointment, but he waits far too long to actually see the specialist. In all of these cases, the patient doesn’t get the timely diagnosis and follow-up care he needs.

Such issues with referrals can lead to a missed or delayed diagnosis, and in the case of serious diseases and conditions like cancer or heart disease, that may cost the patient her life. As for the doctor in question, he or she may be slapped with a malpractice lawsuit, accused of failure to diagnosis or delay in treating the patient. In such cases, handing the patient a piece of paper with a referral on it simply isn’t good enough.

BETTER REFERRAL MANAGEMENT TO REDUCE MALPRACTICE RISK

Providers and medical malpractice insurance carriers would be well advised to consider an automated referral management system designed to eliminate the risks outlined above and reduce patient leakage.   Here’s how such a system can help:

Lost or Forgotten Referrals: An automated referral management platform would eliminate the chance that a patient fails to follow up with a specialist. The referring doctor or the doctor’s staff would be able view a list of in-network specialists while the patient is at the point of care and schedule the referral appointment with the specialist seamlessly and in real time. This helps increase the chance that the patient will follow through with seeing a specialist and provides documentation that the referring doctor provided the appropriate referral.

Delayed Treatment: An automated referral management platform would help ensure timely diagnosis and treatment for patients. Since the referring doctor schedules the required appointment before the patient leaves the office, the referring doctor can ensure that the specialist within the appropriate time frame will see the patient.

Poor Patient Care Follow-Up: Another major issue with patient referrals is follow-up care. How can doctors determine whether patients kept their appointments and received appropriate care? Manual tracking is not only difficult and time-consuming, but it also draws health care staff away from other critical tasks. An automated referral management platform takes care of this problem by allowing providers in the referral chain to see whether patients attended their appointments, as well as the outcome of the visit and any recommended follow-up care.  This technology would further advance the referral process by sending automated appointment reminders via email or text messages, further promoting patient attendance.

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10th Apr
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PREVENTING PATIENT LEAKAGE WITH AN AUTOMATED REFERRAL PROCESS

THE OUTDATED REFERRAL PROCESS

Most physicians still rely on a manual, ad-hoc, paper-based system for making patient referrals to specialists. This outdated system for making referrals is inefficient and costly. Paper-based referrals lead to rates of patient leakage to out-of-network providers that are above 20%. This leakage not only wastes millions of dollars in lost revenue – it creates serious administrative inefficiencies and increased costs in terms of lost revenue.

One of the most glaring inefficiencies is the improvised manner in which the patient referral process is handled under the paper-based system. Staff members spend valuable time faxing referrals, sitting on phone calls with specialists and following up with patients. In many cases, patients are given paper copies of referrals that they themselves are then expected to hand-deliver to specialists. Without any means for healthcare providers to know where patients are in the referral chain, patients can easily fall through the cracks. And because referrals only occur in one direction there is no room for communication between physicians and specialist regarding patient care. This kind of inefficiency directly contributes to lower patient satisfaction with the entire process, and results in patients disengaging completely from care.

Additionally, providers do not have a clear picture of the referral patterns of the physicians in their networks. Providers cannot determine whether or how often referrals result in out of network patient leakage. This limits their ability to develop a complete understanding of key performance metrics and determine where there is patient loss. Analysis of performance metrics is done in a makeshift manner that does not have complete data, which results in an inability to comprehensively recognize trends and respond to them effectively.

THE SOLUTION: AN ELECTRONIC REFERRAL SYSTEM

Providers need to develop methods to manage referrals so that they can maximize patient retention and reduce patient leakage. The first and most important step in developing better referral management is tracking patient referrals so that providers can get a better understanding of how many are happening out of network. Effective patient retention relies first and foremost on having data on where out-of-network patient leakage is occurring. An electronic referrals system can provide this.

The second aspect of developing better referral management is to streamline the system so that physicians can quickly send in-network referral requests and receive status notifications as visits are scheduled and patients are seen. With a streamlined, electronic system, physicians can have access to specialist visit results as soon as they are available. This quickly and efficiently facilitates communication between physicians and specialists. Patients can be included in the referral process with text messages and email alerts, which enable them to receive better care and lead to higher follow up rates. And administrators can receive data on referral patterns in real time, allowing them to direct referrals to in-network specialists who deliver the best care at the lowest cost.

A final additional factor of better referral management is to reduce malpractice risk. Not only does an electronic referral system streamline the process and pick up the gaps; it also has a built in system to flag lack of follow up and even complaints by patients, as well as potentially catch errors or high risk procedures that may need to be looked into or followed up on. This feature allows for catching cases of medical malpractice early on, thereby reducing medical malpractice claim exposure overall.

An electronic referrals system is the single most efficient way to minimize out-of-network patient leakage and improve the entire referrals process. Equipping providers with tools they can use to optimize their referral networks and improve patient retention is vital to building a sustainable, efficient healthcare system that can best serve patient needs and minimize administrative costs. And creating a transparent, clear referral chain, in which all healthcare providers know where each patient is at all times, is crucial to doing this successfully.

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01th Apr
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  • Network & Referral Leakage Imagery

PATIENT LEAKAGE EFFECT ON ACO

Accountable care organizations (ACOs)–groups of doctors, hospitals, and other medical care providers–have a trio of goals: to provide high-quality care, to coordinate efficient care for patients, and to reduce healthcare costs. Patient leakage can represent a major impediment to reaching these goals. While it is only one factor that can affect the success of an ACO, it is an important one.

WHAT IS PATIENT LEAKAGE?

Out-of-network patient leakage, also sometimes called network leakage or referral leakage, occurs when patients are referred to healthcare providers outside the ACO. Sometimes this is unavoidable, such as when a patient needs emergency care while traveling far outside the reach of the network or when the only specialist or after-hours provider available isn’t part of the ACO. However, too often, patient leakage occurs because an in-network provider actually refers a patient to a provider outside the network.

WHAT IS THE IMPACT OF OUT-OF-NETWORK LEAKAGE?

When patients seek care from out-of-network providers, they are essentially buying into un-managed care. The out-of-network provider has not committed to the quality standards, procedures, and cost management that in-network providers have. This means a few different things. First, the ACO no longer has control over ensuring that the patient gets the high-quality, efficient care he or she needs, and second, coordinating care among in-service and out-of-network providers can prove difficult and time-consuming. Third, the fees the employer, insurance company and/or patient has to pay may be much higher than the fees set by the ACO. Additionally, when fewer patients depend on the services of ACO providers, that translates into less revenue for the ACO.

SHARED SAVINGS: WHY IS IT IMPORTANT?

One of the primary goals of an ACO is to improve care, efficiency, and value for patients. By working together, an ACO’s care providers can often achieve this goal while also reducing operational costs. Thanks to the reduced costs, there are savings, which can be distributed among ACO members and the parties responsible for paying for care. A high level of network leakage threatens not only the goal of reducing costs but also this shared savings.

Sources:

Will Your Accountable Care Organization Succeed?
The Strategy Many ACOs Call the Secret to MSSP Success
Everything You need to Know About Accountable Care Organizations

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01th Apr
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HELPING PATIENTS MAKE CONNECTIONS HELPS EVERYONE

By Dr. Andrew Albert, Chief Medical Officer and Cofounder of Fibroblast

Here’s what frustrates me about healthcare. As doctors, we try to give our patients the best possible care. They come to us with their ailments, aches, and concerns, and they come to us for routine check-ups that sometimes result in less than routine discoveries. When they’re in the office, we help our patients as best we can, and we recommend further treatments or consultations, if necessary. But once patients leave our office, they’re on their own.

I’m sure I’m not alone when I say I wish I could do more.  That’s why I’m happy to see a change in the way doctors are interacting with patients, and that making connections for them between ourselves and other physicians has become much easier.

MAKING CONNECTIONS

For example, an increasing number of doctors have started communicating with patients via social media and text messaging. In fact, 67% of doctors say they use a social media platform for professional reasons, according to a survey of 4,000 physicians by QuantiaMD.

Patients certainly appreciate this accessibility: A 2012 PwC Health Research Institute report found that 61% of patients trust information posted by physicians on social media, and 41% of patients would be willing to share information with doctors on social media.

KEEPING PATIENTS IN NETWORK

Taking things a step further, we as physicians now have the power to make even stronger connections between our patients and care providers, and between ourselves and other doctors in our own networks.

I’m talking about new tools like Fibroblast, which makes scheduling appointments as easy as a couple of clicks. If we need to refer a patient to another doctor, we don’t have to stop at a suggestion, or a name and contact information. We can set up the appointment before the patient walks out the door.

We can direct our patients to another health care provider in our own network, thus preventing patient leakage and lost revenue. Since so much of our record-keeping has moved online (55% of U.S. doctors have embraced some type of electronic health record system, according to a study conducted by the U.S. Centers for Disease Control and Prevention’s National Center for Health Statistics), patient information can be shared — not duplicated — and the patient can get better care.

BUILDING BETTER RELATIONSHIPS

Doing all we can to assist our patients with scheduling follow-up appointments ensures that they will see someone we trust, and that they’ll do so soon.  Facilitating this connection helps all involved, and helps build longer-term relationships that keep everyone healthier.

 

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01th Apr
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WHY LEAVE PATIENT CARE TO CHANCE?

By Dr. Andrew Albert, Chief Medical Officer and Cofounder of Fibroblast

A recent article in the Hyde Park Herald caught my eye.

It discussed how Dr. David Meltzer, a University of Chicago hospitalist and economist, is trying to reduce the number of hospital visits by people who aren’t getting the right kind of care from their primary care physicians. But even better, he and his colleagues are going to work together to “reduce the number of hospital and emergency room visits, decrease the number of unnecessary tests, improve patient health and satisfaction, and reduce the cost on the health care system.”

How will he do this? By coordinating these patients’ treatment across a network of doctors, instead of leaving things to chance.

Meltzer appreciates, like I do, the value of keeping things in the family. That is, of going beyond a suggestion of further treatment to making a referral that includes the scheduling of appointments with the colleagues and partners we trust. Doctors’ working together like this improves the care of all patients, not just those most in need of treatment, which is the subgroup that Meltzer’s partners will be focusing on.

When patients’ care is unguided, and strong referrals are not part of the treatment process, a patient can end up in the hospital unnecessarily or in the care of another physician who is unfamiliar with the situation. There can be a breakdown in communication, a chance of a misdiagnosis, and that can lead to a mistrust in the doctors they see. Not to mention, resistance to care over the long term is increased.

Just as important: Uncoordinated medical care increases costs for the hospital and other medical facilities (not to mention the patients themselves), and takes money away from the physicians who can do the best, most relevant service for their patients.

Meltzer has the right idea, and it’s up to doctors like him not just to work together, but to utilize technologies (like Fibroblast) that make it easier for patients to get the care they need and for doctors to share information and communicate with each other better.

“The key here is there is value in a strong doctor-patient relationship,” Meltzer told the Herald. “We believe where there is a strong and stable relationship, there is more trust.” With more trust, there is a greater chance that patients will receive the care they need.

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01th Apr
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  • Network & Referral Leakage Imagery

TURNING PHYSICIANS INTO HUBS FOR PATIENT CARE

By Dr. Andrew Albert, Chief Medical Officer and Cofounder of Fibroblast

Doctors and hospitals need to stop thinking of themselves as just a stop on a patient’s journey to wellness. Instead, I propose that they see themselves as the hub of a patient’s care.

We want what’s best for our patients, and we also need to make a living. As much it may be good for the bottom line when patients return and think they need further care, there can be consequences. Earlier this month, the federal government started to penalize hospitals for readmitting patients too soon after they were discharged. Among its reasons for doing this was the fact that Medicare alone pays $17.4 billion a year for unnecessary return visits.

It doesn’t have to be that way.

At Denver Health, the hospital works closely with a network of neighborhood clinics that are all linked by a computerized record and scheduling system.

When a patient needs continued care, the hospital can let one of the clinics know that a patient is coming, and can help that patient get a priority appointment.

That prevents them from having to be readmitted to the hospital — reducing revenue in the short-term, perhaps, but keeping the patient (and the billable hours) in the network over the long term. Also: The patient’s records are easily shared, meaning the care they receive will be nearly seamless.

That’s a model for how healthcare should be: Doctors and hospitals working together in a mutually beneficial system that provides patients with the best possible care and rewards the physicians as well. It turns doctors into the point person for their patients, not just as the referral source, but an enabler of scheduling (using a tool like Fibroblast) so patients will be seen as quickly as is necessary by a trusted medical professional.

As more and more healthcare systems go online, the possibility of this kind of collaboration and shared responsibility increases. I look forward to the day when we’re all a part of a Network like Denver Health’s and we’re keeping patients — and revenue — where we want them.

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