A study released last year  revealed that more than half (54%) of referrals received by specialists come directly from other physicians – not from the referring physicians’ office staff, not from a referral service, but from the referring physician him or herself. The old-fashioned way.Source: Kyruus.com
To the average healthcare consumer, this might not be troubling at all. In fact, it might be comforting. After all, who better to select a specialist for you than the doctor who diagnosed you and has spent years developing relationships with the surrounding medical community? But when you consider that up to 26% of referrals end up in the wrong specialist office, comfort can quickly turn to doubt.
As it turns out, your doctor may the best person to know what type of referral you need, but is not always the best resource to know who specifically to refer you to. This is not necessarily the fault of the doctors themselves, but rather a symptom of a rapidly evolving healthcare market. Consider the following:
- Provider networks are growing and changing faster than ever before
- The last few years have seen unprecedented activity in hospital mergers and provider group acquisitions, which means that...
- Physicians don’t know who’s who anymore
- Rapid change in local market dynamics make it nearly impossible for doctors to learn / keep up with who is in their network and who in that network sees which types of patients. So, as a result…
- Physicians rely on old referral habits
- Because of the difficulties understanding complex networks, many newly-employed physicians will continue to refer to physicians with whom they had established relationships at previous systems or will refer patients inaccurately within their new systems.
During a recent webinar, leaders from the Houston Methodist Patient Access team, Lisa Griffin and Pam Ravare, spoke to these challenges, the resulting impact on overall patient access, and initiatives to help improve patient and referring provider experience. In 2013, Houston Methodist launched a new primary care group with over 150 primary care physicians, built to serve some of the underserved areas around Houston. However, soon after the formation of the group, Houston Methodist uncovered a few troubling issues:
“Our new providers that joined this network were really struggling to understand our employed physician network of over 450 specialty physicians,” said Pam Ravare, patient access manager at Houston Methodist. “They were struggling to understand where those physicians were [located], what their specific specialties were, what they preferred to treat, [and] what insurances they accepted.”
Even when referring physicians were able to identify an in-network provider, gaps in information and lapses in the referral processes made it hard to get patients into those providers’ offices effectively, ultimately leading to:
- Patients frustrated with access barriers
- Physicians frustrated with access barriers
A significant portion of referrals going out-of-network, reducing the system’s ability to coordinate care effectively
These issues led to the launch of a broad organizational initiative to enhance patient access by improving provider data accuracy and streamlining referral processes within the employed provider network. Houston Methodist began working with Kyruus’ ProviderMatch platform to arm referring physicians with comprehensive, accurate provider profiles for the entire Houston Methodist network.
While access to an up-to-date provider search application resulted in major benefits for referring physicians, it also uncovered some interesting findings about referral dynamics and physician preferences, specifically:
- Physicians send patients out of network because they don’t have better options
- Referring doctors aren’t trying to sabotage their health systems. But limited information about their system’s provider network forces them to send patients elsewhere
- Trust, or lack thereof, drives physicians to hold on to control of their referrals
- In many organizations, referral services are offered, but physicians struggle to trust these services and, instead fall back to their own judgment (even if it’s based on imperfect information)
- Physicians would relinquish control over referrals if provided a trusted service
- Doctors don’t want to spend time coordinating referrals any more than they do worrying over billing and coding. But they feel it’s important to delivering good care to their patients, and, therefore, a necessary part of their job
- However, if a referral service can be trusted to send patients to the right providers, they will willingly leverage that service
These findings led to Houston Methodist to build a full service Referral Management Center (RMC) to coordinate referrals and schedule follow-up appointments across their entire employed network. Using ProviderMatch as the “single point of access” for information about their provider network - serving referral needs in their RMC as well as their primary care offices - Houston Methodist is able to deliver on the promise to schedule timely and accurate appointments for referring providers’ patients.
Additionally, Houston Methodist drove remarkable gains in access efficiency after just 6 months of deployment, including:
- Major increases in appointment conversion rates (the rate of inbound referral requests that are converted into scheduled appointments)
- Follow-up with patients to schedule appointments within 24 hours
- Reduction in mis-directed referrals
To learn more about Pam and Lisa’s journey to improving care coordination at Houston Methodist, download their full webinar here.