The Treatspace Referral Management Blog

Insight, ideas, and resources for high-performance referral management

PCMH Redesign Reduces the Heavy Load on Reporting

Posted by Christian Kratsas on 4/20/17 1:04 PM

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Patient Centered Medical Home (PCMH) embodies the current trajectory of healthcare in that the patient is the focus of the medical model. The National Committee for Quality Assurance’s (NCQA) PCMH program is vastly adopted, with more than 12,000 practices, 60,000 clinicians, and 100 payors participating. In fact, 1 in 6 eligible physicians in the U.S. practices in an NCQA-Recognized PCMH.

With the objective to strengthen patient-provider relationships, reduce healthcare costs, and improve quality, NCQA continues to accelerate the growth of value-based care with the remodel of their PCMH program. Changes to the new PCMH model reduces the burden of the reporting process and focuses on increased healthcare quality and practice performance.

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Topics: Care Coordination, Healthcare Analytics, Value-Based Care, PCMH

The Evolving Landscape of Independent Primary Care

Posted by Christian Kratsas on 4/13/17 12:26 PM

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Independent primary and speciality care practices have challenging years ahead. MACRA, MIPS, APMs, and the ACA are posing uncertain regulations and complicated payment models.

Despite this uncertainty, there is one thing that’s clear: independent practices must prepare to take on risk in order to stay profitable.

We sat down with Mark Kissinger, executive director of Genesis Medical Associates, to get the inside scoop on the challenges a large independent primary care practice faces in a value-based care and regulatory-driven world.

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Topics: Care Coordination, Coordinated Care, Referral Network, Closed-Loop Referral Management, Value-Based Care

7 Reasons DSM Does Not Get the Job Done

Posted by Christian Kratsas on 3/6/17 1:43 PM

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Once considered a critical component of meaningful use, DSM (Direct secure messaging) within an EHR poses significant limitations to referral management. While it conveys information electronically within a practice,  DSM alone does not provide for comprehensive data exchanges between PCPs and consulting physicians. The Journal of General Internal Medicine notes that communication breakdowns affect care delivery between two practices on different systems. Specialists report that, 86% of the time, they do not receive information from the PCP prior to the referral visit. Additionally, poor referral tracking leads to inappropriate or unnecessary referrals and inefficiencies in care delivery. DSM in EHRs presents inevitable challenges for both primary and specialty care practices.

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Topics: Care Coordination, Referral Management, DSM, EHR

How Poor Communication Between Providers Can Be Costly

Posted by Christian Kratsas on 1/31/17 5:15 AM

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The loop in communication and clinical documentation between healthcare providers has traditionally been open for many organizations. Often when referrals are made, they are left largely to the patient to schedule. Many physicians may not even check whether the patient was seen by the specialist until the patient's next appointment or if contacted for records.

There are a million moving parts to the healthcare landscape today, so it's understandable that follow up with referrals might slip through the cracks without a proper protocol. Unfortunately, the cost of poor care coordination can be exorbitant - for the patient's own health and for the physicians and organizations involved.

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Topics: Care Coordination, Referral Management, Provider Accountability, Direct secure messaging

Why PCPs and Specialists are Focusing on Automated Referral Workflow in 2017

Posted by Jeremy Guttman on 1/3/17 5:10 PM

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Relationships between PCPs and specialists are sacred. On average, a single PCP is connected to 68 specialists. However, lack of electronic connectivity makes it difficult to coordinate care and manage referrals—apart from hiring additional administrative staff.

Without patient referrals from PCP to specialist, it is estimated that only half as many patients would show up to their specialty care appointment1. Furthermore, “self-referral” patients who see specialists without recommendation from a PCP are associated with higher patient dissatisfaction and poorer continuity of care with the primary care doctor2. As PCPs refer more patients to specialists each year, coordinated care and automated referral workflow become an urgent issue for both independent and hospital-based practices.

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Topics: Care Coordination, Referral Network, Referral Adherence, Referral Workflow

How to Create a Better Referral Workflow

Posted by Christian Kratsas on 12/19/16 1:50 PM

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As value-based care takes center stage in healthcare, primary care providers (PCPs) and specialists must find ways to eliminate communication deficiencies and share information more effectively to ensure a more well-rounded and positive patient experience. Strong quality scores, efficient operations, and credible customer service are no longer just admirable traits of a positive care coordination environment; they’re quickly becoming characteristics that define whether primary care succeeds or falls short in value-based care.

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Topics: Care Coordination, Referral Management, Referral Workflow

Is Your Practice Making These 6 Common Care Coordination Mistakes?

Posted by Christian Kratsas on 12/13/16 6:08 PM

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Care coordination missteps are damaging to providers across the healthcare industry and one huge, overarching mistake is apparent: not enough information is being shared. A study by Health Affairs shows that only 14% of physicians share information with providers outside of their organization.

Unfortunately, care coordination mistakes can be costly...and not just in terms of financial expenses. Some of the most common care coordination mistakes are also major culprits for death and exacerbated patient health problems. U.S. News & World Report indicates, “Medical errors are [the] third leading cause of death in the U.S. 10 percent of U.S. deaths are due to preventable medical mistakes.”

We’ve identified six areas of care coordination where many practices make mistakes -- check out what they are, and see how many apply to you.

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Topics: Care Coordination, Care Transitions, Referral Workflow

Don't Tumble Blindly as You Make Your Way Across the Continuum of Care

Posted by Jeremy Guttman on 9/8/16 2:13 PM

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Value-based care models are said to represent “policymaking at 80,000 feet.”

Healthcare leaders who were once optimistic about value-based reimbursement models are becoming doubtful after seeing the performance of several programs. Accountable Care Organizations (ACOs) are achieving modest gains and a meager 28% of Medicare Shared Savings Program (MSSP) participants have generated cost savings.

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Topics: Care Coordination, Referral Management, Population Health

Getting Hands-On With Handoffs

Posted by Jeremy Guttman on 8/31/16 2:45 PM

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Image courtesy of flickr

Problems with handoffs are a big deal in clinical practice. Defective handoffs lead to patient harm, treatment delays, inappropriate treatment, and longer stays in the hospital. In a typical patient handoff between physicians, important patient information is often not given to physicians who take over care of a patient. In a hospital, “[s]hift changes, also known as handoffs, are prime opportunities for key information about a patient’s condition to get lost in the shuffle,” according to a recently released study about patient handoffs in JAMA Internal Medicine [1].

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Topics: Care Coordination, Healthcare Analytics, Referral Management, Healthcare Data, Care Transitions

So Many Colonoscopy Referrals, So Few Appointments

Posted by Jeremy Guttman on 5/27/16 12:58 PM

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8 out of 100 missed or delayed cancer diagnoses are a result of a failure of a requested referral to occur.1 Furthermore, a recent study found that the risk for colorectal cancer almost doubles when a patient with a positive stool test waits over a year to have a colonoscopy.2 Colorectal cancer is the second leading cause of cancer-related deaths in the United States3 and up to 90% of colorectal cancer deaths are preventable with early detection.4

A significant amount of gastroenterologist referrals are for colonoscopies.5 But for every two patients who are referred by their physician to get colonoscopies, only one of them will end up getting the colonoscopy.6

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Topics: Care Coordination, Referral Management, Closed-Loop Referrals, Patient Adherence

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