Referral Strategies for Specialty Care Clinics that Reduce Administrative Work

The staffing crisis impacts both healthcare practices and patients. With nearly 1.7 million healthcare workers quitting this year – on the heels of an unprecedented time of challenges and industry impacts of COVID-19 – everyone from referral coordinators and administration to nurses and physicians are at risk of employee burnout. The healthcare industry is stretched thin, and the responsibilities of managing staff and onboarding new team members on top of providing quality care contribute to a crisis that, if not effectively dealt with, will ultimately cost patients and practices alike.

To overcome these challenges within healthcare, it’s essential to streamline referral management in specialty care by doing more with less. The AristaMD platform can improve and streamline referral management in the specialty care setting. Regardless of whether your practice uses integrated technology or traditional manual processes, these strategies will support patients, practices and overall business success.

Referrals Drive Patient Healthcare

First, let’s explore the manual referral processes and their challenges, as manual work correlates to staffing turnover. Patients require primary care provider (PCP), hospital or clinic referrals to receive specialty care, and most often, these referrals come through via fax, and from there, the digitization process begins. Many times, the daunting process looks similar to this:

• Administration: The referral coordinator gathers information about the patient’s condition, but often, this involves contacting the referring PCP for more information. Additionally, the patient’s insurance information must be checked and confirmed. Referral and follow-up challenges arise due to failed fax and phone follow-ups.
• Clinical Review: Once the information is successfully received, a healthcare team member reviews the referral to determine the urgency of the request. This step may determine how long the patient will wait to be seen by the specialist. A patient with a low acuity condition will typically wait longer for a specialist appointment. Wait times have significantly increased since the pandemic, and depending on location and specialty, specialist wait times can range from 30 to 90 days, all the way up to 120 days. For instance, cardiology specialists in Portland are experiencing over 120-day average wait time.
• Appointment: After clinical review, the referral comes back to the administrative team, and the patient is notified when the next appointment is available with the specialist.   ​

Strategies to Support Streamlined Referrals

Reduce the Time Required to Gather Patient Information

Almost 20 million referrals per year go to the wrong specialist. Incomplete or insufficient patient information on referrals, the possibility of wasted appointments and increased administrative costs cause further delays. When patients experience delays in care, it’s a lose-lose scenario. The specialty care practice misses the opportunity to see new patients, and patients suffer by possibly not getting the care needed. To combat this common challenge and close the gap, a referral management platform and technology ensures specialists receive all referrals submitted and no communication falls through the cracks – so say goodbye to those scribbled sticky note referrals. Key strategies to support streamlined referrals include:

1. Online Referral Forms

Online referral forms provide a centralized process with accountability and visibility that ultimately eliminates fax and phone follow-up. Better yet, referring practices receive a desktop link to encourage online entry without the need for software from the referring clinic.

2. Attach and Share Documentation

It is known that 20% of patients receive duplicate tests due to incomplete electronic record transfer. Attaching and sharing documentation via online forms and attachments to efficiently capture patient demographics, medical history, office visit notes, lab work and imaging is crucial to avoid ordering redundant tests. In addition, this digitized approach eliminates unnecessary steps to providing care by validating insurance information upfront, confirming with the referring practice and the patient to avoid the manual back and forth, and automating patient intake paperwork.

3. Validate the Patient’s Insurance

Allow referrers and your staff the ability to confirm insurance coverage and receive insurance information online to eliminate the manual process and paperwork that takes away valuable time that your administration could be spending elsewhere.

4. Receive Referrals for In-network Patients

Eliminate the all-too-common issue of patient no-shows that result from the patient not having insurance coverage, and prevent collection problems when out-of-network copays and deductibles are high with referrals for in-network patients.

5. Confirm the Appointment

With a referral management platform, it’s easy to confirm with the PCP via the application by email and confirm with the patient in the application by text and email. Everyone is kept in the loop with this secure real-time digital communication that requires no extra work.

6. Make Patient Paperwork Painless

With just a few clicks, you can easily send forms to patients in seconds by selecting the appropriate form or packet of documents from the easy-to-use platform. Also, view completed patient forms and send reminders when forms are incomplete or more documentation is required. These reminders are easy to send and are convenient for patients to complete. Through these automated notifications, 70% to 80% of patients complete forms ahead of time without any follow-up needed.

7. Prioritize Patients with Urgent Needs

With the dramatic increase in wait times, ensuring that the most urgent-care-need referrals are top priority is critical. According to the American Journal of Managed Care, 52% of PCPs report making unnecessary referrals, often at the patient’s request. With that, it’s even more important to prioritize patients effectively.

8. Avoid Delays with Urgency Flags

The new referral form will include the urgency of the patient’s needs to share with the specialist to bring these patients to the top, and the specialists can then make their own expert opinion on the urgency.

9. Assign Tasks and Tag Urgent Patients

Clear tasks must be assigned to team members to streamline the process. One platform centralizes all tasks, from assigning team members to perform clinical reviews to evaluating completed lab work.

10. Make Appointment Booking Fast and Easy

Patient appointment notifications, such as pre-call text alerts, personalized patient texts and click-to-call options, eliminate the need for referral staff to make phone calls.

11. Reliable Fracking and  Communication

It is possible to have faster appointments and less “referral leakage” while improving completion rates through asynchronous work. Review new referrals at a glance and prioritize those that need follow-up with reliable tracking.

Expedite Appointment Scheduling at Your Specialty Care Clinics

Efficient, faster scheduling is critical to improving practice success and patient outcomes while preventing visits to local emergency departments. Online referral forms, easy document sharing, real-time insurance validation, in-network referrals, and automated appointment confirmations are all elements of a referral management platform that expedites appointments while maintaining a high volume of visits that are all top quality.

Every minute wasted waiting for a no-show patient, managing reschedules, and dealing with cancellations is precious time the administration has been burdened with manual tasks. In contrast, a patient is likely not receiving needed care, and specialists are losing out on the compensation for that care. At AristaMD, we are dedicated to innovation that improves the primary care to specialist referral process to support timely, high-quality care.