THE OUTDATED REFERRAL PROCESS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 This outdated system for making referrals is inefficient and costly.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.