Physician consultation with a specialist is designed to remove barriers in our healthcare system that make referrals complex and challenging for PCPs and patients.
To optimize patient care, physicians are increasingly embracing tools and resources, including evolving telehealth solutions, that extend their clinical offering without delegating patient care. Electronic physician consultation, or eConsult, solutions are creating a peer-to-peer communication channel between individual PCPs and a range of specialists.
Using this technology, the providers can confer, share the patient’s medical history, and collaborate on a care plan. The patient remains in the capable hands of the PCP while benefiting from specialized medical expertise.
PCP referrals are the core of today’s healthcare
Physician-to-physician referrals play a central role in our healthcare system. Primary care providers (PCPs) deliver essential first-line health services that combat the specialist doctor shortage, including:
- Health promotion
- Disease prevention
- Health maintenance
- Counseling
- Patient education
- Diagnosis and treatment of acute and chronic illnesses
However, PCPs also act as gatekeepers, referring patients to a wide range of specialists who have advanced training and expertise to ensure their patients have access to the highest quality care.
This referral process has been described as “the link between primary and specialty care,” with more than a third of U.S. patients being referred to specialists each year and specialist appointments constituting more than half of outpatient visits. In fact, the number of U.S. patient visits resulting in a physician referral have increased by 159% in recent years.
Improve Access & Reduce Patient Referral Wait Time
The referral process is essential, yet problematic
Because PCPs and specialists constitute core aspects of the healthcare system’s infrastructure, issues in the PCP-to-specialist referral process are seen as contributing to the system’s many ongoing challenges. Mehrotra et al found “… breakdowns and inefficiencies in all components of the specialty-referral process.” According to their review study:
“… the process itself has been a long-standing source of frustration among physicians … These frustrations—along with a desire to decrease costs stemming from perceived inefficient use of resources by specialists—have led to numerous strategies to improve the specialty-referral process …”
Attempted improvements include the managed care referral authorization process, financial incentives implemented by medical home programs, electronic medical records, and bundled payment arrangements.
Referral-related effects remain intractable
Despite extensive implementation of these and other strategies, the referral process continues to face significant challenges. Consider the following:
Information transfer
- Up to 68% of specialists receive no information from PCPs prior to patient referral visits.
- As many as 45% of PCPs do not receive timely information back from specialists after the patient referral is made and the patient has been examined.
- Referrals frequently lack full and complete medical workups
Appointment wait times
- Patients needed 24 days on average to get a doctor’s appointment in 2017—a 30% increase over 2014—with wait times for appointments reaching up to a year in several specialties
Quality of care
- PCPs at times refer to a physician in the wrong specialty
- PCPs refer some cases even though specialty treatment is unnecessary
Obstacles to care optimization
Physicians’ ability to optimize patient care is obviously constrained when facing referral-related issues. According to Mehrotra, poor communication is a key concern, with both PCPs and specialists citing a need for better information transfer and approximately one-quarter of U.S. patients reporting that one provider’s records did not reach a second provider in time for their appointment.
In addition, delays in care delivery caused by long wait times put patients at risk. And such basic mistakes as incorrect or unnecessary referrals also reduce care effectiveness.
PCPs also recognize that obstacles inherent in the traditional referral process can hamper their ability to gain knowledge from specialists—knowledge they could use to treat future cases more effectively.
These and related issues cause significant levels of dissatisfaction with the entire care process among everyone involved: patients, physicians, and payers, and also within hospitals and health systems. A number of these concerns also contribute to many other long-standing—and yet still very pressing—challenges facing the nation’s overall healthcare system, such as:
- Continuously escalating cost of care
- Poor clinical outcomes
- Systemic inefficiencies
PCPs and specialists seek a new, more effective approach
Even as healthcare leaders have become increasingly concerned about the shortcomings of the referral process, many have taken note of new problem-solving technologies proliferating across industries outside of healthcare. Could such technology be applied to referrals? It didn’t take long for explorations to begin:
- New thinking, from multiple perspectives, was applied to the PCP-specialist connection
- Ground-breaking insights were developed
- Myriad ways to improve referral relationships were considered
- Experimental ideas matured into practical, viable tools.
Today, technological innovations supporting more effective and efficient referral process are resulting in new products that encourage direct PCP-specialist contact. Known as virtual online consultation (or “eConsult”) platforms, these products are already producing far-reaching results, with benefits for the nation’s entire healthcare delivery system.
Advanced technology improves patient care and reduces cost
Until the advent of eConsults, or online doctor consultations, there simply was no way to ensure optimal peer-to-peer communication between PCPs and specialists. What’s more, the very nature of the old system—where hundreds and thousands of hands-on patient exams needed to be done in-person right in the specialists’ offices—contributed significantly to the system’s own inefficiencies.
Now, by using eConsult platforms, providers can fluidly share the patient’s medical history and current status, exploring every nuance. As partners, PCPs and specialists can confer in-depth and in detail, and work together synergistically on a joint care plan.
With eConsult, patients remain in the capable hands of the PCP. In fact, utilizing eConsult technology has been shown to reduce face-to-face specialist follow-up visits by 35%.5 At the same time, patients also reap the benefits inherent in the high level of training and in-depth expertise that specialized physicians are able to provide.
Additionally, eConsult technology has obvious benefits for patients who could not otherwise afford to see a specialist.
- Liddy et al estimated $1,100.93 per eConsult in total savings was associated with the technology.
- Dullet et al showed that eConsults produced average cost savings of $156 per patient
Patients also saved an average of 245 minutes in travel time because fewer specialist visits were needed. And, in those cases when a specialist visit is appropriate, appointments can be available sooner because unnecessary appointments are not crowding the specialist’s schedule.
Despite all of these benefits, some wonder if physicians are ready to adopt this high-tech approach. And, even if they do, will utilizing technology really make a practical difference?
PCPs recognize the value of eConsults
One recent survey showed that PCPs are receptive to the eConsult and its many benefits, specifically because of the challenges known to be inherent to the traditional referral process. The survey found that 81% of PCPs believe that enabling direct contact with specialists about their patients is likely to help their practice.7 Providers also believe that eConsults can lead to fewer inappropriate referrals and more complete information sharing. This, in turn, will translate to higher patient satisfaction and retention.
PCPs understand that the eConsult platform can:
- Expand their own care capabilities
- Increase their knowledge base
- Enhance co-management of patient care with specialists
- Improve health outcomes for patients with chronic diseases
- Help retain patients and expand scope of care, creating financial benefits
However, as with any new technology, awareness of specific brands of eConsult products is low and use of eConsults remains in the early stages. According to the MedPanel research, PCPs tend to limit eConsult platform use to non-critical issues, at least so far.7
In addition, only 3% of those surveyed know about the $37 per consult reimbursement that Medicare pays for eConsults.7 This can become a significant revenue source for some practices.
A path to lower costs for insurers, better quality for health systems
While physicians—both PCPs and specialists—will see the most immediate and measurable differences from eConsult adoption, the benefits to other healthcare sectors are also becoming tangible.
For example, because more patients can stay within the primary care setting, health insurers may be able to significantly reduce unnecessary costs of care. Opportunities include:
- Eliminating spending on unnecessary specialist visits
- Ensuring timely access to care
- Reducing unnecessary emergency department visits and hospitalizations in some cases
Health system managers can improve access to specialty care for primary care patients using eConsults. The new technology can strengthen population health initiatives, enhance care coordination, and support quality metric initiatives.
A path to better care, lower costs, and expanded PCP scope
Increased patient access to specialists and decreased wait times are top features of the eConsult platform. But the best news is that every healthcare sector, without exception, can benefit from information sharing and an open channel to specialist expertise. Diagnoses and treatments are more accurate and faster; patients are more satisfied and their outcomes improve; the cost of care is reduced; and the entire healthcare system operates more efficiently and effectively.
This is the exciting vision of the future that eConsults have already begun to realize.