When patients have been referred to see a specialist, it is essential that they have access to quality healthcare and can be seen in a timely manner due to most referrals being needed for a change in diagnosis or second opinion. Like anything in healthcare, there are a lot of moving parts that can impact the lines of communication and can make essential administrative tasks harder to complete correctly. Referral management is no different. With referrals, within the private and public sector, being such an important aspect of the financial well-being of those healthcare systems, streamlining the process and making it a collaborative effort for all involved is essential.
Having a secure referral management program in place can alleviate common disruptions in the process, such as network issues, patients not meeting certain criteria or medical claims not being billed correctly or even paid. Inefficient scheduling, patient tracking, and billing can quickly cause a massive loss in revenue for providers if not corrected since referrals for care happen regularly for both private and public healthcare sectors. Those who are seeking medical care also suffer because the inefficient process can cause stress and a poor healthcare experience.
COVID-19 Impacted the Referral Process
When COVID-19 emerged in early 2020, it forced the healthcare industry into uncharted territory in almost every respect. Despite the virus being responsible for a vast amount of innovation as healthcare systems navigate new regulations and patient outcomes, the referral process saw a noticeable decrease in completion rates in the spring. The combination of social distancing, stress of the unknown, and self-isolation to reduce the spread of the virus are a few reasons why many patients did not complete or put their specialized care on hold. However, with the expanding coverage for Telehealth appointments and the easing of certain restrictions, the referral process has picked back up and patients are once again seeking specialized medical treatment.
Signs of a Inefficient Referral Management Program
When a customized referral workflow is implemented, it not only streamlines critical administrative processes for those providing, receiving and billing for the medical care, but patients and their families can feel more engaged and have a better overall healthcare experience during their treatment.
When there is not an efficient referral management process established, it can result in a massive gap in a patient’s treatment and revenue loss for those providing treatment.
Here are a few signs that a customized, referral management program needs to be implemented:
Poor communication or exchange of patient information between either Primary Care Physicians (PCP), VA, DHA and Specialists.
Appointment scheduling errors
Inefficient patient referral tracking
Low referral utilization rates
Referral Management in the Private Healthcare Sector
In the private sector, referral management encompasses not only ensuring that veterans and beneficiaries have access to high-quality healthcare, but that their appointments can be scheduled efficiently and excessive wait times can be avoided. Recently, VA implemented its new community care program (VCCP) as required by the VA MISSION Act of 2018. Under the VCCP, VAMC staff are responsible for community care appointment scheduling; their ability to execute this new responsibility has implications for veterans receiving community care in a timely manner.
By streamlining the demanding tasks that are associated with the administration aspects of referral management, more time can be spent ensuring that the veteran or their beneficiary has access to the care they require.