How online referral management boosts primary care revenue

July 20, 2022

Online referral management for PCPs

Primary care practices are looking to online referral management applications to improve the referral process and grow revenue. A study of 105 million referrals by the Archives of Internal Medicine found that only about half of referrals resulted in a visit to a specialist. This means roughly 50% of the time, patients fail to receive the care they need, and specialists do not capture the most revenue.

There are several reasons why patient referral and follow-up is a complex, manual and time-consuming process. The referral coordinator must:

  • Determining which specialists work with a patient’s insurance
  • Accommodating patient preferences around the location
  • Identify if the appropriate sub-specialty is available within the practice
  • Confirm that appointments are available soon at the selected specialist

One study showed that less than 50% of specialty care remained within a health system — leading to network leakage. While some leakage is to be expected, most of it can be avoided by using an online referral system.

Physician referral service technology to improve the referral process and capture more revenue.

Online referral services increased scheduling by nearly three times and reduced the median time-to-appointment by more than 50%.

The revenue impact of a poorly managed referral system can be quite significant:

  • Time and energy is wasted by staff to coordinate a referral.
  • Unscheduled referrals often due to long wait times drive patients back to the primary care clinic – further wasting staff and provider resources.
  • Poor outcomes result in lower ‘bonus’ reimbursements
  • High out-of-network specialists drive up the cost of care for clinics operating within a value-based care payment model.
  • A single ED visit due to delayed specialty care appointments or failure of the patient to schedule can have an even greater impact on clinics focused on value-based care

According to The Annals of Internal Medicine and The Advisory Board, it is possible that $50 million in referral-related revenue is sent outside the network and another $40 million falls through the cracks as referrals go uncompleted.

Much of this revenue can be captured by using a cloud-based physician referral service that offers physician-to-physician virtual consultations.

One study of more than 50,000 referrals, at an urban health system with over 1.2 million annual patient visits, found that a web-based referral system increased referral scheduling by nearly three times and reduced the median time to appointment by more than 50%.  Nearly 80% of the health organization’s physicians felt ready for online scheduling, and 75% said the system made it easier to schedule patients.

Considering that about 10% of patient visits to a PCP result in a referral, the amount of practice resources devoted to calling, faxing and following up on patient referrals is tremendous.

A referral management platform can present a significant opportunity for clinics to reduce costs and retain revenue by avoiding high-cost care utilization and poor outcomes.

AristaMD’s physician referral service streamlines the referral process for patients, specialists, and their referral partners. By automating the primary care to the specialist referral process, practices can expect both increased efficiency and a healthier bottom line.

Do more with online referral management plus eConsults

Five ways eConsults support value-based care

Combine your referral management platform with an eConsult solution to reduce patient wait times and reduce the cost of care. Learn five ways our eConsults support value-based care by allowing primary care physician, nurse practitioner or PA to submit electronic requests for patient advice to our team of specialists to manage low acuity patients.

#1 Help patients avoid unnecessary face-to-face specialty visits

About 70% of eConsults can address what physicians would typically send forward for a face-to-face specialty visit. As a web-based physician-to-physician consultation, there is no need for any particular technology or integration — the PCP orders the referral the same way they would traditionally order one. Or suppose the patient was to go face-to-face for a specialty consult, with the provider using our referral nurse coordination, RNN service, and our nurse navigators. In that case, our nurse will curate the eConsults by grabbing all of the data needed for the patient from the chart. Private health information is then sent to our specialist, who reviews the data and provides an evidence-based response on the best practice and management of that patient. Within four to six hours, the primary care provider receives a notification and can view the eConsult specialist’s recommendations.