Referral Management Risk: Beyond the EHR for Primary Care Practices

Posted by Jeremy Guttman on 2/17/16 3:10 PM


A tsunami of change is shifting the healthcare reimbursement system towards value-based care.

As a result of legislation passed in 2015, called MACRA, Medicare is supercharging its emphasis on value-based payments and the first performance year will be 2017. As a result, the way medical practices manage referrals will impact their revenue.

“Providers that hope to succeed under the new payment methodology need to begin making changes now.“
- Dave Wofford | Healthcare Financial Management Association

The effort in closing patient gaps in referral care is outrageously time consuming. To stay above the waves, leading primary care practices are using tools that require functionality far exceeding what most electronic health records provide on their own.


For this reason, we have put together a referral risk assessment so you can determine the readiness of your primary care practice before it’s too late. Get a taste for some of the reimbursement changes by completing three sample assessment questions below. For the full assessment, and to benchmark yourself against the top innovators in independent primary care, fill out the form at the end of the post.

 Starting in 2017, don’t let your reimbursements sink to the bottom


CMS declares that by the end of 2018, 50% of all Medicare reimbursements will go towards alternative payment models (ACOs, PCMHs). By 2020, some private insurers plan to commit 75% of their reimbursements towards value-based care. There are plans for every provider in the country to shift towards at-risk payment models over the next two decades.

“Few appreciate the magnitude of payment reform embedded in the new legislation”
- David Johnson | 4sight Health

The relationships you have with your specialist crewmembers will immensely impact your cost and quality metrics, which is a crucial component of most upcoming regulations.

 1)  Are you and your network of specialists prepared to be evaluated under the proposed guidelines that start to apply to next year’s performance? Referral-Question-1.png

 Claim your treasure chest with referral management


According to Dave Wofford of Healthcare Financial Management Association, the upcoming regulatory landscape “will be essentially a zero-sum game that rewards certain providers at the expense of others.” Similarly, a significant number of providers in the system will be paid less.

To reap these benefits and claim their bounty, Medical Economics claims that “physicians must begin building effective teams that can hit quality goals, keep patients healthy and satisfied, and sustain their practice’s financial success.”

2)  How confident are you that the performance of your specialty partners won’t cause you to be penalized under the new regulatory standards in 2017? 


 Have a lifeguard for closing referral loops


Andy Slavitt, the captain/administrator of Centers for Medicare and Medicaid, recently singled out closing referral loops as a priority for upcoming regulatory initiatives.

“We are deadly serious about interoperability. We will begin initiatives in collaboration with physicians and consumers toward pointing technology to fill critical use cases like closing referral loops”
- Andy Slavitt | J.P. Morgan Annual Health Care Conference, 2016

Closed-loop referrals require functionality far exceeding what most electronic health records systems provide.

3)  When your physicians refer to specialists, what percentage of the time does your practice share transition of care documents and receive consult reports timely and electronically, closing referral loops?


Hold on to your barnacles, don’t think you’re getting off that easy!


Our full assessment will give you a comprehensive understanding of where you stand in preparation for regulatory reimbursement changes. CLICK the button below to get a copy delivered to your inbox.



How are you refining your referral management strategy to hit success targets in 2017? Weigh in in the comments below.

Topics: Coordinated Care, Referral Network, Referral Management