When a patient has an encounter with an organization, it is part of a larger journey across the care continuum. Their visit always has a point of origin, and one of the biggest gaps in clinical data today is where the patient came from.
One in three adult patients who see a primary care provider (PCP) are referred to a specialist. If a patient is seeing a specialist, it’s likely a direct referral from a PCP. According to a study by Merritt Hawkins, the average PCP contributes $1.5 million annually to their affiliated hospitals. Despite this, they aren’t always recognized for the encounters they refer. A large majority of organizations are failing to document where the patient came from, or who referred them. They aren’t capturing that information in the patient’s electronic record; therefore, it isn’t being transferred into transcription, billing or claims data – ultimately affecting the subsequent events in that patient’s journey.
If the involved referring physician’s (RP’s) information isn’t captured consistently and accurately, it negatively affects the care continuum of patients, the satisfaction level of referral providers and the physician/hospital relationship in the following ways:
- For patients, failure to document PCP and/or referring physician may prevent important communication from occurring between physicians. As a result, the PCP or RP may not have all the necessary information to provide quality follow-up care for the patient. The overall patient experience suffers when care is disjointed, disparate, and uncoordinated. Capturing this information helps support a complete continuum of care, and improves patient and physician satisfaction.
- The healthcare system or hospital loses its ability to track or identify physicians who are referring patients and where they are referring them to. By simply recording the referring information, hospitals establish and/or strengthen relationships with providers. Also, if the provider is not accurately identified, confidential patient information may be sent to the wrong provider.
- 3. When it comes to the physicians involved, PCPs have choices in where to refer. Once the referring physician or PCP makes the referral, they believe they have a relationship with the referred-to entity. If the referring physician is not identified as being involved with the patient’s care at the time of the patient’s admission (whether it is at the ED, with a specialist, or another point of care) that physician may not receive feedback on the patient’s condition, but may still be expected to provide follow-up care. Additionally, if the relationship isn’t captured, the PCP or RP’s information may be left off of medical records, patient profiles, etc. The specialist will not know there’s a referring physician involved, and that physician will not be recognized for that encounter. All of this can lead to referring physician frustration, dissatisfaction and distrust of the referred-to entity. This can also affect the patient’s confidence in their PCP/RP, and ultimately jeopardize the physician’s satisfaction with the medical staff. PCPs/RPs should be treated as a respected member of the care team, and those who do not receive acknowledgement of the business they send may be easier swayed by the competition. Processes must support retaining and improving the relationships with all involved providers.
- For those organizations with physician referral management (PRM) systems, capturing this information can help liaisons know exactly where to focus their outreach efforts, and which physicians to build stronger relationships with. Also, if the PRM system shows shared claims, then the organization knows the information they’ll need for the shared claims is being captured up front.
The referring physician is currently populated on only 25% of claims. This decreases the value of referrals within healthcare systems tremendously. Providers struggle with capturing the information, as it requires internal coordination and organization. However, with the right process, it can be done.
To learn the steps your organization can take to improve: the accuracy and fill rate of PCP/RP information, the efficiency of the business development team in targeting physicians for growth initiatives, and ultimately patient and physician satisfaction, contact your Lead Strategist for a copy of our white paper, The Importance of Capturing the Referring Physician in Clinical Data. You can download it now by clicking here.
Or, you can read more about this in the Becker’s ASC Review article, “How a Pizza Party Can Help Your ASC Boost Referrals: 4Qs with Expert Lori Brenner.”