Strong Referral Network Integrity Requires Continuum-Wide Communication and Data Sharing

This article was authored by Will O’Connor, MD, the chief medical information officer of TigerConnect.

Millions of patients are referred for specialized services each year, but as many as 45% will never make it to the referred-to clinic or hospital.¹ Missed referrals and other appointments account for more than $150 billion in lost revenue and wasted time for healthcare organizations² and costs nearly $1 million per year per employed physician.³

A major driver behind these skipped patient referrals is lack of coordination and follow-up. For example, the patient is handed a phone number and instructed to schedule an appointment with the recommended provider. In some referral cases, the healthcare organization will schedule the appointment on behalf of the patient at the point of care; however, this is often without confirming or sharing crucial background about why the patient was referred.

These common scenarios raise significant risks that the patient will either forget or skip the appointment, visit another provider, or the referred-to provider will not know why the patient is at the practice. These circumstances negatively impact financial performance, care quality, and patient experience. Utilizing mobile-driven clinical communication and collaboration workflows, however, offer a more efficient pathway to stronger network management and care continuity.

The impact of missed referral appointments

Missed appointments have far-reaching impacts beyond lost revenue for the organization. Poor continuity of care is associated with more preventable hospitalizations, complications of chronic illness, and higher costs per episode of inpatient care.⁴

If the patient self-refers to a non-preferred provider, the healthcare organization risks a patient receiving lower quality or unnecessary care, which can decrease payment under certain value-based care programs. When the referred-to provider is unaware of why the patient is in the office, it leads to potential confusion, wasted care or errors, and a less positive patient experience.

Avoiding such consequences requires a strong referral network management plan. The foundation of that plan is continuum-wide clinical communication and collaboration utilizing the physician’s favorite communication device: the smartphone. The mobile device is not only essential for notification but also for securely sharing clinical data to support safe and effective decision making and care continuity. While some physicians turn to smartphones for noncompliant SMS texting—even with the patient’s best interest in mind—the use of a secure communication network reduces the exposure of physicians communicating in an illegal manner via SMS.

Four tips to prevent network infidelity

The following are 4 ways healthcare organizations can strengthen their referral network management while communicating more efficiently throughout the continuum:

1. Prioritize patient education. Every patient should leave the hospital or physician’s office understanding why he or she is being referred to a specialist. This small time investment will pay dividends later in the continuum through appointment completion and adherence to the treatment plan. Organizations should adjust discharge procedures to ensure patients comprehend their care plan and next steps, especially when referrals are involved.

2. Make the connection. The previous statistics show that it is clearly not enough to hand patients a phone number and hope they follow through with scheduling. Organizations need to schedule the appointment for patient, or at the very least, contact the specialist securely and safely through their mobile device and ensure the physician’s front office staff is expecting the patient’s call. Providing the patient’s phone number is helpful so the specialist’s office staff can reach out if they have not heard from the patient within a day or 2.

3. Track and follow up. Research studies revealed another alarming trend in this area: after a referral was made, physicians were often unclear about who would be responsible for which aspects of the patient’s care plan.⁵ A well-defined process for tracking and following up on referrals will prevent patients from getting lost in the system.

As the physician who receives the referral, he or she can support better continuity of care by sharing data and images from the referral appointment with the originating physicians. For example, a cardiothoracic surgeon takes an intraoperative photo of the patient’s heart and sends it to the referring cardiologist and primary care physician along with notes confirming a diagnosis. This form of collaboration is more efficient and meaningful to the referring physicians than a follow-up phone call or fax that may occur days later. It is also the kind of collegial support that encourages further referral opportunities down the road.

4. Provide effective tools. Today’s most advanced clinical communication and collaboration technology makes it exceedingly simple for physicians to connect in this way with each other directly over a secure mobile platform. Extensive built-in directories enable clinicians to find colleagues by name or by role. Sending a quick text message to a specialist in the presence of the patient not only provides pertinent information for the consult, but also serves to communicate clearly to the patient that this appointment should be a priority.

Communication beyond notification

Ensuring the referred physician or organization is alerted of the incoming referral is important, but beyond just notification, using a clinical communication and collaboration platform delivers patient background and context all efficiently shared through a mobile device. This alleviates the referred-to physician from follow-up steps, such as checking a fax machine or electronic health record for the additional information.

References:

1. Office of Massachusetts Attorney General. “Examination of Health Care Cost Trends and Cost Drivers” June 22, 2011. Accessed July 20, 2018. https://www.mass.gov/files/documents/2016/08/uy/2011-hcctd-full.pdf.

2. Sviokla J, Schroeder B, Weakland T. “How Behavioral Economics Can Help Cure the Health Care Crisis. Harvard Business Review. March 1, 2010. Accessed July 23, 2018. https://hbr.org/2010/03/how-behavioral-economics-can-h.

3. refferalMD. “30 Healthcare Statistics That Keep Hospital Executives Up At Night.” Blog. August 30, 2018. Accessed July 23, 2018. https://getreferralmd.com/2016/08/30-healthcare-statistics-keep-hospital-executives-night/.

4. Song Z, Sequist TD, Barnett ML. “Patient Referrals—a Linchpin for Accountable Care.” Journal of the American Medical Association. August 13, 2014. https://jamanetwork.com/journals/jama/article-abstract/1886863.

5. Mehrotra A, Forrest C, Yin C. “Dropping the Baton: Specialty Referrals in the United States.” The Milbank Quarterly, March 2011. Accessed July 23, 2018.

Engaging the referred-to physician early can also involve front-office staff in patient communication and preparation. Mobile communication tools and mobile-driven workflows ensure stronger referral network management, improved continuity of care, and a better patient experience.