Without referring providers, many healthcare facilities would find themselves with numerous empty beds and idle medical experts, rapidly on the way to financial decline. Fortunately, referring providers do exist, and the cooperation between primary care providers and hospital facilities can provide the best possible healthcare for patients with serious or chronic medical conditions.
On the other hand, when referring communications are ineffective, patient and business outcomes can be far from optimal. Consider some of these scenarios:
- A referring physician provides a diagnosis, but it is ignored or not received by the hospital. The patient undergoes unnecessary duplicate tests at added cost to the patient and the facility.
- Triage resources are tied up in assessing and deciding what to do with referred patients, causing delays in placement for those patients as well as all others waiting for triage. Patient placement is sub-optimized from a cost perspective as well compared to the better utilization of beds that is possible when earlier referral data is use.
- Treatment information and prognosis is not conveyed back to the primary care physician and the recommended post-release care is not provided. The patient might experience drug-drug interaction, relapse of the original health issue, or aggravated problems.
- Value-based payment, including lack of insurance payment in the case of poor patient outcomes, becomes a blame game between referring provider and healthcare facility when communications are ineffective.
What are the options for referral communications?
Among the objectives of referral communications are ensuring that patient information is conveyed securely, minimizing the possibility of errors, and keeping costs and delays low. Think about some ways communication could be completed:
- Face-to-face communications – In the old days of Marcus Welby, M.D., the doctor often walked to the nearby hospital to deliver his patient to a specialist or surgeon, conveying information and compassion and staying through a procedure to greet the patient with a favorable outcome. Sheer patient volume makes this impossible on a regular basis today, although regular hospital rounds can be a valuable part of primary care or specialist practice to stay engaged with the hospital team and specific patients.
- Provider communications via the patient – Few referring providers would trust their patients to communicate critical information to the next provider, simply because most patients don’t have the medical literacy to do this effectively. Patients are often sent away with paperwork to take with them to the hospital admissions area, although this can be easily lost, especially with a time lapse before admission. It’s worth thinking creatively about what technology can do in this area. Just as retailers are looking at how to personalize in-store shopping experiences by linking to an app on a customer’s smartphone, patients could carry all their personal health information in an app on their phones, with secure Airdrop capabilities to and from healthcare providers at both ends of the referring process.
- Telephone – Communicating by phone adds interactivity and tone of voice (a critical part of messaging) to communications between providers, but it needs to be supplemented with written materials for a complete and retained patient picture. In addition, given busy schedules on both ends, trying to connect often becomes a frustrating game of telephone tag.
- Email/text/fax – This broad umbrella covers the most common means of communicating between providers currently, with the caveat that appropriate safeguards must be in place following the HIPAA Privacy Rule.
- Shared records and communication system – Effective use of electronic health records (EHRs) within a network can be a powerful tool for a smooth and successful patient transfer. Current test results, medical history, and readable physician comments are at the fingertips of the referring and receiving healthcare professional. Enhanced programming can provide information on drug interactions, recommended vaccines and tests, and data charts. Search capabilities add value beyond simple communications.
The key is virtual integration
Ideally, a patient receives integrated care from a team of physicians, therapists, nurses, and other providers. All team members have up-to-date information on conditions and changes. There is continuity of care from the start of treatment to the end. This can be supported within a facility with good intradepartmental communications.
However, when referring providers are separated by miles, time, cultures, and systems from other healthcare facilities, additional measures are needed. Some of the best practices of virtual integration can help address gaps so that the patient sees a unified team and a cohesive and effective treatment plan no matter where he or she is being treated.
Just as manufacturing organizations find ways to optimize communications with internal and external suppliers and customers, healthcare facilities need to optimize communications with in-network and out-of-network “suppliers,” i.e. referring providers.
How do you start?
Simply because of separation by geography and area of focus, primary care providers and hospitals often function as separate entities, even if they are in the same network or overall healthcare system. It’s important to get away from “silo” thinking and shift to “flow” operations. Think of the patient as a product receiving value-added care as he or she progresses from one healthcare provider to the next. How can that process flow as smoothly as possible?
That question logically leads to using concepts of lean and value stream mapping to understand the process (current state) and determine how to make improvements (future state).
To start, convene a group of representatives from several types of referring providers and specialists and the treatment facility. Often when customers and suppliers work together to discuss the existing points of interaction they identify immediate opportunities to eliminate problems and make enhancements simply because each entity didn’t know what the other needed. Each team may have optimized what they were doing from an internal perspective even if it was sub-optimal for the product, or in this case, the patient.
The outputs from this type of working team are likely to include flowcharts of critical operations, roles and responsibilities on referring and receiving ends (both feed-forward and feedback to and from the hospital), a living database of contact information, service level agreements, metrics for success, and a plan for ongoing review.
That’s a very brief overview of steps to improve referring provider communications. To understand how well your facility currently operates in this area, contact EON for an assessment and discussion of path forward.