Referral management is an increasingly important part of managing the patient experience and coordinating care within a clinically integrated network (CIN). Yet, often times, referral workflows and trends are poorly documented and misunderstood.
Our organization, Fibroblast, a patient referral management solution company, conducted a survey of over one hundred physicians across thirty specialties to quantify how their referral processes work and how they affect providing care. Our data revealed three major conclusions:
Patients do not follow-up
Our data revealed that approximately 33% of patients do not follow-up with the specialist to whom they are referred. That's worse than the adherence rate for most prescription medications![i] Put another way, only two out of every three patients actually receive the care that they need when a referral is made. This gap in adherence results in higher acuity cases, poor patient outcomes, and millions of dollars of cost to healthcare organizations annually. In an increasingly risk-based environment, providers cannot afford this gap in care.
What's more, we also found that 40% of patients that follow through with a referral never follow-up with the referring physician after the care is initially provided. Providers know that an episode of care is not complete when a patient leaves the clinic. Updating a patient's medical record with consultation notes, labs, and test results is crucial to a complete episode of care. Simply put, patients don't always have the same priorities. This closed loop is particularly important when a patient sees a provider outside of a CIN, because the referring provider can be left without critical information and patients are left with an incomplete medical record.
Referral networks are incomplete
Providers make referrals as a necessary part of everyday patient care – sometimes dozens of referrals a week. Depending on the provider and their specialty, our study found a wide range of referral volume. One theme was consistent, however: referral networks are incomplete. A substantial portion of referrals – 43% – are made to providers that a referring physician does not know well. Moreover, 17% of referrals are made to providers that a referring physician has never met.
Relationships are the foundation of building patient trust and providing excellent care. That relationship extends to a provider's referral network. But that network can never encompass every specialty and subspecialty, and a physician could never be expected to personally know each provider. Relationships and expertise will always be the backbone of outstanding care, but referrals cannot be made on solely personal, subjective relationships. Referral decisions should be made with the individual patient in mind. Matching a specialist should also take into account objective patient characteristics, like insurance coverage, location, and cost.
Referral workflow technology needs improvement
Of all the providers we surveyed, a staggering 92% responded that they could improve their referral management practices. Referrals are an integral part of managing an episode of care and ensuring high-quality outcomes. Poor referral practices and dated technology should never be the cause of adverse patient outcomes. If 92% of providers insisted they needed improved sterilization processes, you can bet organizations would take steps to correct them!
Today's typical workflow for referrals is messy and incomplete, at best. Patients all-too-easily slip through the cracks. And can you blame office staff members when they're given fax machines–the best technology 1972 has to offer–to manage referrals? Our respondents indicated that over 50% of the current referral process is redundant and repetitive. In today's environment of electronic medical records and CINs, no staff member should ever have to use dated technologies to process a referral again. And in the age of smart phones, email, and predictive analytics software solutions, every patient deserves to be part of the referral conversation in real-time.
In summary, our survey of physicians confirmed that today's methods of referral management leave three clear opportunities for improvement. First, patients and providers must close the referral loop and ensure coordination of care. Second, providers should refer their patients based on both their professional recommendations and the objective characteristics of individual patients. Third, current referral workflow processes are outdated, inefficient, and costly for both staff and patients. Improvements to the referral workflow can benefit all stakeholders involved.
As CEO, Scott leads Fibroblast's strategy, business development, sales, and customer success efforts, among other things. Scott is deeply committed to Fibroblast's mission of ensuring that no patient falls through a crack in the healthcare system, and he is passionate about healthcare innovation and reform. Prior to co-founding Fibroblast, Scott was a senior commercial litigation associate with an AmLaw 100 law firm, serving as trial counsel for Fortune 100 companies and national financial service firms in state and federal courts and before the SEC, NYSE, and FINRA. Scott also served as a Managing Director of a premiere Chicago-based legal search and consultancy firm. Scott graduated from Washington University School of Law, after receiving a BA from the University of Illinois. Scott has also studied at the University of Chicago's Booth School of Business.
The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.