The Treatspace Referral Management Blog

Healthcare reimbursement is undergoing “the most dramatic shift in Medicare payments in the program’s 50-year history,” from fee-for-service to value-based care. But most physicians aren’t familiar with the important law that is establishing these changes for the future, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Proposed details for MACRA were released by the Centers for Medicare and Medicaid Service (CMS) a few months ago, in April 2016.

Journalist Fareed Zakaria is certain that those who prevail in tomorrow’s health care arena are the ones who figure out how to use the troves of data at their fingertips to distinguish themselves from competitors.

“[W]hat you do with that data will probably be the key differentiator going forward,” Zakaria explains at a recent healthcare conference, the Health Forum and American Hospital Association Leadership Summit.

Courtesy of Youtube

You may have seen the news that well-known infomercial psychic Miss Cleo, whose actual name was Youree Harris, recently passed away from colon cancer at the age of 53. She died while she was surrounded by her friends and family after entering into hospice care.

Here’s an old commercial of hers:

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.

DSM is antiquated, backwards, and “meaningless work for meaningful use” - Physician testimony | ONC HIT Policy Committee

“ONC’s new ‘interoperability roadmap’ downplays the potential of Direct messaging” as a solution for interoperability - Medical Economics

Contrary to what some electronic health record (EHR) proponents believe, DSM (Direct secure messaging) by itself is an unpopular and ineffective solution when it comes to true interoperability, care coordination and referral management. It has almost no practical benefit for referral management beyond what primary care practices use it for right now: getting credit for Meaningful Use stage 2.

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

The leading cause of blindness worldwide is diabetes. However, referral management makes a significant impact on saving the eyesight of diabetic patients. Most people who have diabetes for more than 20 years develop diabetic retinopathy¹, a condition where elevated blood sugar damages the blood vessels inside the retina. Over 7.7 million American adults have diabetic retinopathy today and that number is expected to double by 2050. The condition affects almost 30% of the US diabetic population over the age of 40² and causes up to 24,000 new cases of blindness in the US each year.

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

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.

It would be easier to coordinate team-based medical care on facebook rather than with EHR systems.

- John Halamka, CIO | Beth Israel Deaconess Medical Center and co-chair of the federal HIT Standards Committee, at the HIMSS conference in March 2016¹

EHRs aren’t enough

A common misconception is that an electronic health record (EHR) can close referral loops and provide high-performance referral management for primary care practices. However, not long after EHRs were implemented, users quickly realized that EHRs alone are not able to establish a pipeline that allows data to flow between PCPs and specialists from different organizations.²