The Treatspace Referral Management Blog

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

MIPS Reimbursement Benefits of Closing the Referral Loop

Posted by Christian Kratsas on 6/5/17 2:47 PM

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Sizable regulations enforced upon physician groups are holding practice executives to a glowing screen late nights and through the weekend. Practices are dedicating substantial hours and personnel to determine which value-based initiatives to focus on in the coming years in order to remain profitable.

One thing that remains true is that physicians who bill Medicare more than $30,000 in Part B  and provide care for more than 100 Medicare patients a year are subject to the Quality Payment Program (QPP) of MIPS or APMs under CMS’s MACRA reimbursement regulations. Several details including practice structure, size, and reporting capabilities, will determine the category under MACRA in which it applies. 

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Topics: Closed-Loop Referrals, MACRA, Referral Automation, Automated Referral Management, MIPS, CMS

Faulty Referral Management Raises the Risk of Malpractice Claims and Tragic Effects

Posted by Jeremy Guttman on 1/27/17 5:05 AM

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What you don’t know can hurt you.

When practices fail to manage a standard and consistent patient referral process across all locations, patients get sicker. And when PCPs and specialists aren’t on the same page about a patient referral, urgent health conditions worsen while important diagnoses get missed or delayed.

But a defective referral communication process isn’t just a big problem for patient care - it’s also a big problem for medical practices’ morale and bottom lines. Practices often get sued for medical negligence when a patient referral falls through the cracks.

Referrals play a role in an immense number of medical malpractice claims. Patient handoffs in medical settings contribute to 20% of diagnostic errors that lead to malpractice suits1.

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Topics: Referral Management, Closed-Loop Referrals, Malpractice

As Healthcare Digitizes, Medical Referrals Fall Far Behind

Posted by Jeremy Guttman on 7/25/16 2:05 PM

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Entirely paper-based healthcare is going the way of the dodo bird. Since 2008, the number of office-based physicians who have adopted electronic healthcare records (EHRs) has doubled from 40% to over 80%. In fact, the number of physicians using EHRs has actually quadrupled in the past 12 years.

Poorly handwritten prescriptions are no longer a problem for the 70% of physicians who now prescribe medications for their patients electronically. The advancement of e-prescribing has led to a reduction in medical errors and prevents fraud, such as opioid abuse.

In addition, telehealth is booming, robotic surgery is more common, and robots are even roaming the hallways of hospitals to deliver food and transport trash.

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Topics: Referral Network, Closed-Loop Referral Management, Closed-Loop Referrals, HIT

EHR Alerts: A Real Bummer for Colonoscopy Adherence, Study Suggests

Posted by Jeremy Guttman on 6/16/16 6:07 PM

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As the CDC sounds the alarm to increase awareness for colorectal cancer screening, primary care practices find that their EHRs can’t support the task of getting patients to complete colonoscopy referrals. In addition to the CDC, there is a growing focus by medical societies, advocacy organizations and media personalities like Katie Couric to ensure that adults over 50 get referred for colonoscopies to detect and prevent colorectal cancer. Awareness initiatives are critical because half of all patients referred for colonoscopies fail to complete the procedure.1

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Topics: Coordinated Care, Referral Management, Closed-Loop Referrals, Referral Adherence

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

The Government is Driving Referral Management and So Should You

Posted by Jeremy Guttman on 5/24/16 10:15 AM

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Updated February 2017

In almost every speech given in 2016, Andy Slavitt, the former Acting Administrator for the Centers for Medicare and Medicaid Services (CMS), has emphasised the priority of closing referral loops to strengthen patient care coordination.

Independent practices have less than a year to prepare for newly developed value-based care reimbursement guidelines. The option to test the quality payment program under MIPS and MACRA will no longer be in play beginning in 2018. In view of the challenging financial penalties of value-based payment, many practice leaders are struggling to find an efficient way to close referral loops.

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Topics: Referral Management, Closed-Loop Referral Management, Interoperability, Closed-Loop Referrals

The Perilous Referral Management Journey [INFOGRAPHIC]

Posted by Jeremy Guttman on 4/22/16 6:02 PM

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The New England Journal of Medicine describes the traditional patient referral process as a perilous journey [1]. Right off the bat, only half of patients show up to their referred specialty physician appointments [2].

In fact, the referral process is so fragmented that even when patients do show up to their specialist appointments, only 32% of specialists will receive clinical information from the PCP prior to seeing the referred patient. [3]

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Topics: Coordinated Care, Healthcare Analytics, Referral Management, Interoperability, Closed-Loop Referrals

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