Private practices generally have a concern about how patient referral management systems work, and the related organizational components.
What is referral management?
Referral management is the process of monitoring, coordinating, directing, and controlling referrals. It varies according to the nature of a practice, encompassing a wide range of functions. In healthcare, referral systems may send a referral to specialty care or receive a referral from primary care. In addition to analyzing referral data, it includes:
Communicating referral updates to healthcare providers
Referral process feedback
Referral loop closure
How does referral management systems work?
It depends on the practice. When a client needs services that is outside of the scope of work within a practice, they are referred from generalist to specialist care. In healthcare, the PCP (Primary Care Physician) identifies the need for the referral and places a request with the referral coordination team. The referral coordinator does the insurance pre-authorization and identifies the right specialist for the referral. Then, the referral coordinator sends the referral. The specialist validates the referral information and coordinates with the referring physician for missing information. The specialist schedules an appointment and delivers care to client. The specialist must give timely updates to the referring clinician. After referral has been completed, the clinician closes the referral loop.
What are the medico-legal risks in referral management?
Some of the possible risks include:
Referral orders getting lost in the process
Delays in client being seen by specialists
Clients being seen by an inappropriate specialists
Referrals being returned to the practice when it is needed
Whether referral management may breach confidentiality
Why opt for referral management technology?
Currently, the process for referral management is too manual and requires a lot of time, energy, and effort. Technology helps automate processes. It also makes the following much easier:
Finding the right receiving providers
Client care coordination and communication
Referral updates to referring clinicians
Whom does referral management systems benefit?
Referral management systems automate manual processes that traditionally have cost time, money, and effort. Benefits to stakeholders involved include the following:
Referring clinicians - Referring clinicians identify need for referral and initiates the same. A technology enhancement would reduce the processing time of referrals, saving costs, time and effort for referring clinicians.
Referral coordinators - Referring coordinators complete the insurance pre-authorization and locate the appropriate specialist. Since referral coordinators manage multiple technologies, a technology enhancement to their system can help easing the process.
Receiving providers - Specialists struggle with managing referrals from various channels and fail to communicate effectively with clients and referring clinicians. A technology enhancement can automate process by channelizing referrals into a single queue and improves communication in EHR systems.
Patients - A technology upgrade can help clients by reducing efforts in communicating between referring and receiving providers. It enhances client care experiences by reducing care fragmentation.
What type of organizations or companies can use a referral management system?
Technology can help organizations and companies who send and receive referrals. Referral management technology is used by community clinics and federally qualified health centers (FQHCs). They use EHRs to track and manage patient data. Specialty clinics use technology to receive and manage referrals and client appointments efficiently. Larger enterprise hospitals send and receive referrals. They use technology to track how many referrals are flowing in and out of their networks.
Does referral management systems help with addressing inbound and outbound referrals?
Inbound referrals are referrals received in a practice and outbound referrals are sent to a practice. Technology can help automate the process of sending and receiving referrals. Both inbound and outbound heavy practices can benefit for technology updates to their practice's EHR/EMR systems.
How would my practice implement a referral management system upgrade?
Technology must identify paint points or issue areas in current workflow states and attempt to develop solutions to address these challenges. Before implementation, a practice would need to consider the following:
Understanding your practice's challenges and what they would need to solve
Studying the practice's current workflow completely
Propose a solution that could fit within an existing workflow
Implement a solution without disrupting the existing systems in place
For a referral management solution to be implemented, the above recommendations would need to be executed for easy implementation.