Is Your Health System’s Referral Network Leaking Patients and Revenue?
A key objective for an integrated health system is to keep provider referrals within the system. Many of the financial, patient outcome, and quality assumptions about a health system depend upon keeping the system, well, “integrated.” Most health systems in the U.S. do a good job putting together the right mix of clinical capabilities, medical staff specialists, technology and equipment, branding, physical locations, and back-office business processes such as managed care contracting and revenue cycle. But one area that routinely gets neglected is making sure it is easy, from an operational perspective, to make referrals among providers.
Systems need to do a better job defining and managing what we call the “Order Cycle.” The order cycle comprises all the operational activities that must function well from the perspective of providers and patients for a physician order to make its way through the system smoothly. Some of the key weigh stations for an “order” are:
(i) initiating the order in the physician’s office;
(ii) transmitting that order to an appropriate ancillary provider (e.g., a diagnostic testing location);
(iii) making sure the order has all required details in areas like patient demographics and insurance information, diagnostic notes to help facilitate the insurance pre-authorization, correct details about the requested test (has the right test been ordered?), care deadlines, and physician office preferences on topics such as final report delivery. There are many communications and handoffs that must be managed without mistakes for an order to be managed efficiently, without errors, and to close the loop so that all key parties get what they need and are satisfied with the experience. This process often breaks down in integrated health systems, causing care delays, inferior outcomes, patient and physician dissatisfaction, and lost business (e.g., leakage).
Proper management of the order cycle can address these problems. Care can be improved, waste can be eliminated, and financial performance can be greatly enhanced. It is vital that an integrated health system have a plan to manage the order cycle. Systems must identify and track every step in the process the way FedEx tracks a package (“when did the order get on the truck to go out for delivery?”). Managing the order cycle enables a system to know where every order stands in the process at all times. Key constituencies such as referring physicians, clinical managers, system executives, payors, and patients can have a transparent view into each case along the referral pathway. If a glitch or barrier develops, that can be quickly identified and addressed. Service standards can be set and improved upon (e.g., how long after an order is initiated does it take to contact and schedule the patient?). Needless, wasted phone calls and follow ups can be eliminated. Consistency, trust, and reliability can be developed among all players in the health system. When they have a choice, providers will turn to the more reliable, transparent, glitch-free process when referring patients for needed care. Do you know where things stand with all orders in your health system?
If not, it may be advantageous to work with an outside resource with expertise in identifying improvement and growth opportunities within your order cycle. Centauri Health Solutions has developed a comprehensive program which utilizes its proprietary PatientTracker+ tracking system, to help community health systems manage the order cycle, improve service levels to referring physicians and patients, stem leakage, and grow revenue. In partnership with your staff, we can help you create a truly integrated system of care.
Doug Wetmore
Senior Vice President, Referral Management & Analytics
Centauri Health Solutions, Inc