Webinar on Physician Referral Management

Recently, FierceHealth and Keri Silvernagel from PowerObjects teamed up to lead a webinar on physician referral management. This webinar centered around the changing healthcare industry and how these changes will drive different needs in referral management. With these topics in mind, the present and future healthcare environment is perfect for Dynamics CRM and its ability to offer the flexibility and agility to meet each organizations needs.

A couple of hot topics are pay for performance models like Accountable Care Organizations (ACO's) and how the change to shared savings and shared risk arrangements shift who may need a physician referral management system. Now, primary care organizations will need to know if patients are staying in the ACO for specialty care or if they are leaving the system for care. This is known as leakage. These organizations all need a central place to track, review, communicate, and schedule specialty care appointments to best understand patient behavior and follow through as well as where your primary care physicians refer patients.

While ACO's continue to gain traction with over 600 already established, the traditional fee for service payment model will continue. This means that the independent specialty clinics and independent hospitals need to continue to market and track their referrals to increase volume through their referrals. Knowing referral patterns of primary care physicians will provide the kind of analytics that will help drive future marketing campaigns or contract arrangements.

If you would like to hear more on physician referral management, the webinar is available on demand through January! Simply click the link and register!  

Happy CRM'ing!

RxRM Blog Series: Physicians, Patients & Providers—How RxRM Can Help Ensure Quality Care

This blog post is part of an ongoing series on the RxRM initiative at PowerObjects—configuring Microsoft Dynamics CRM to address the highly specialized needs of healthcare organizations. This post features guest blogger Timothy Pratt, Ph.D., Solution Design Consultant for the Health and Life Sciences at PowerObjects.

What is RxRM?

Microsoft Dynamics CRM is a powerful development platform for a broad range of business relationships, and is commonly referred to as "XRM" in non-traditional applications, often "built-to-order." In healthcare, due to its complexity, regulation and ramifications (someone's health is, after all, often a matter of life and death!) highly specific product CRM/XRM development undertaken in conjunction with clinical experts can be appropriately spoken of in terms of "RxRM" These are processes and methodologies appropriate for healthcare activities are developed and proven, and then configured as needed for the individual circumstances rather than built from the ground up in every instance.

How the physician referral process typically works

When considering the continuum of care for most patients, it is very often the case that the primary care provider (PCP)—which could be a physician (MD), nurse practitioner (NP), physician assistant (PA), etc.—may refer the patient to another provider for specialist opinion or treatment. This is commonly called a referral, and this seemingly simple process looks something like this:

This belies the many points of failure and problems that are commonplace in the process today. A number of effects arise from the "usual" referral process: dissatisfaction/frustration, less-than-desirable patient outcomes, reduced productivity, missed opportunities, unnecessary cost overheads. Worse still, problems with referrals have been identified in 55% of malpractice lawsuits as contributing factors (See Brigham & Women's research paper below).

Common problems with physician referrals and ongoing care

Patients referred for specialist consultation commonly go through a process where the PCP requests their clinic's scheduling assistant to make an appointment for the patient for a particular service. It is at this fundamental point that problems begin to emerge. Difficulties in communicating with the specialist clinic (usually by phone) means the patient is often simply given contact details and requested to make their own appointment—and over 20% of the time they don't. Almost always, if the patient is a no-show, the PCP will not become aware of the issue until the next time the patient is seen at their clinic. This can be months or even years into the future, by which time easily correctible conditions may well have become serious and intractable.

Assuming patients do make the specialist appointment, they often arrive ill-prepared. The PCP may not provided adequate information about their condition, or they may not be appropriately prepared (such as fasting, when to take medication, etc. In turn, PCPs often express frustration about not receiving feedback/diagnoses/treatment from the specialist after the patient visit. This occurs far more often than anyone interested in quality health outcomes would prefer.

RxRM Physician Referral Management as a solution

EHR, varying as it does across practices and institutions, and being primarily concerned with managing individual patient encounters, is not the answer. So what is? Well-designed Dynamics-based RxRM physician referral management (PRM).

Appropriately designed PRM can critically contribute to specialist clinic or services success on both the strategic and tactical level. Implementing such a system would allow specialist practices to:

Beyond the basics outlined above, a PRM system could be configured to add further value without great difficulty in most cases. For example, specialists often require test and diagnostics from other providers as part of the process of diagnosis and treatment – these activities and associated documentation can easily be handled by the Dynamics platform. CPT, ICD-9, DRG, APC etc. codes can be loaded into the system for automatic, semi-automatic or manual assignment for tracking and billing purposes – the fewer systems personnel need to use to complete their work the more productive they're likely to be, and the benefits of working with a common set of tools/interfaces such as that provided by Microsoft and the dynamics platform are well known.

Related articles

Brigham & Women's Hospital, MA: Research involving 84 PCPs and 405 Specialists – details problems and the utility of electronic referral management systems in improving communication and outcomes.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495590/

American Academy of Family Physicians: article detailing referral access problems, identifies need for process to ensure all relevant PCP information provided to specialist and audit metrics.

http://www.aafp.org/fpm/2002/0300/p39.html

JAMA Archives of Internal Medicine Journal, January 2011: comprehensive analysis of data from >4700 physicians highlighting ongoing problems with Specialist-PCP communication.

http://archinte.jamanetwork.com/article.aspx?articleid=226367

About Our Guest Blogger

For the past 25 years, Dr. Timothy Pratt has worked around the globe both as a clinician and technology solutions designer/advocate in the life sciences and healthcare industries enhancing patient care, profitability and productivity in areas including clinical trial operations, practice/market development, sales and systems integration. Leveraging post-graduate qualifications in cardiology, cardiac electrophysiology, critical care, psychiatry and business, Dr. Pratt has assisted organizations from small start-ups and clinics to Fortune 500 enterprises source and adopt technology solutions that dramatically improve outcomes for patients, practices, life science companies and hospital systems. A firm believer in automating processes to reduce costs and provide visibility into critical data, Pratt is known for his work as a long-time member of the Applied Clinical Trials Journal editorial advisory board and many publications and lectures regarding information technology use in the healthcare and life sciences space.

At PowerObjects, Dr. Pratt's role is to collaborate with healthcare organizations to drive the design and delivery of technology solutions that run the gamut from referral management, community outreach campaigns, clinical trial operations systems, chronic disease management, grant management, safety surveillance/monitoring and health maintenance/prevention programs.