The quality of your referral network can define your medical career.
Your network impacts elements of your work including income stability, the satisfaction if your patients, even information security. That’s why it’s crucial to build a strong referral network in strategic ways from the very beginning (we’ve put together some tips on that here.)
That’s not the end though. Once your network is established, it requires maintenance, and there are a few, key mistakes that can break the quality of your referral network and the well-being of your practice overall.
1. Failing To Monitor Patient Satisfaction
While there are multiple ways to evaluate the health of your network (we’ll discuss some in a few), patient satisfaction is arguably the most important to keep an eye on.
Since the nature of referrals inherently means that your patients are interacting with other providers, it can be easy to think that this absolves you of monitoring or even addressing their overall satisfaction. This couldn’t be further from the truth. Patient satisfaction is inversely correlated with risk of lawsuits, so having patients who are happy with their entire care experience means less chance of you being sued, or being involved in a lawsuit.
Take the case of The California Medical Association. They’re the largest physician group in the state and back in 2012, along with 60 individual doctors, were involved in a lawsuit claiming that Aetna had illegally threatened patients and doctors who wanted to use out-of-network medical providers.
These threats left patients facing high out-of-pocket costs for going out of network, and undoubtedly frustrated and dissatisfied. While this example included doctors, there are many elements of patient-insurance interaction that you will not be privy to, and that can taint your patients’ care experience and consequently, their opinion of you as a provider.
To address this, keep up with your overall patient experience. Conduct surveys and if any warnings pop up (such as a patient stuck in a particularly difficult situation with an insurer), investigate what’s actually going on. Remember, not every patient that’s having an issue will speak up and getting a feel for your patient group experience may take some proactive work on your part. Additionally, make sure that your staff is trained to flag issues with payors and other providers if they are brought up, even in casual situations by your patients.
2. Ignoring Audit Trails
If you do end up in a malpractice situation or even a simple dispute over patient experiences, a concise and informative audit trail will be essential to things working out in your favor.
Audit trails track referrals from beginning to end and allow you to report on various points of information for years into the future. They allow your staff to see what procedures are scheduled to be performed, as well as what is in process, and what has yet to happen. Ideally, they also give you the ability to report on trends and patterns within your patient population and pull essential information from that data.
Ignoring all that potential and discounting the audit trail means navigating your referral process in darkness. It means not fully understanding the type of care your patients are receiving, incomplete understanding of their medical history, and piecemeal information on diagnoses from other physicians in your network.
On a legal level, audit trails serve as proof of the part you played in a patient’s treatment and could potentially save you from massive headaches if your actions and responsibilities are ever called into question.
3. Choosing Bad Network Partners
While seemingly obvious, this is an easy mistake to make.
Not being selective in very strategic ways can leave you stuck in the middle of a sea of bad patient experiences and difficult partner relationships. Doing this right and connecting with the best providers will take some work. Here are a few tips:
- Take your time: It may be tempting to just sign on with any provider with good credentials, but you’ll need to spend some time getting to know them and their practice. Do you service the same type of patient? Do your personalities differ so much that it will shock anyone who’s referred? Do you practice medicine with similar philosophies and purposes? Do your administrative policies and procedures align? Evaluating (and sometimes re-evaluating) partners takes time, but it’s time worth spent minimizing potential future headaches and conflict.
- Think Long-Term: Choosing good partners is a strategic decision and in turn, one that should be looked at as having a very real impact on the well-being of your practice for years to come. If you plan on establishing a stable practice, look to find partners who have similar goals and aren’t apt to relocate soon or retire a year or two after your partnership is formed.
- Don’t forget technology: In the age of the EHR, make sure that you and your partners are on the same page. EHR compatibility issues can influence whether a physician will refer a patient to you, or in a worst-case scenario, it could end your partnership altogether. Have an open and honest IT-talk with potential partners before anything becomes formal.
Remember, poor choices here will reflect negatively on your practice too, and not just that of your partner.
4. Communicating Poorly
Communication is everything in the referral process and it’s the foundation of patient perception of the experience. Patients want to feel as if they’re communicated with and that their understanding of their care is a priority…not that they’re being shuffled blindly from office to office.
As important as personalization is in medical care today, you should have existing rules around your communications. All staff should be properly trained and training should be evaluated on a regular basis. This will help ensure that when a patient is referred to another office, all the essential information moves with them and they understand what to expect and what their responsibilities are.
Listen to your patients. Begin managing their expectations around the referral process from the beginning and make sure any questions they have are met. Patients come to you under the assumption that you communicate smoothly and flawlessly with your care partners. Making efforts to live up to this expectation will keep patient satisfaction high and your practice running as smoothly as possible.
Communication doesn’t end with the patient though. Your communication standards should include rules around follow-up so that you receive updates on patient actions and response to treatment. Remember to reciprocate and comply with the referral protocols of other physicians. Doing this will make all business in your network run more smoothly.
Pro-TIP: Use a real-time HIPAA-compliant messaging and file sharing program like referralMD to manage communication between health practices.
JAMA published a study on communication between primary care and specialist physicians that gives some insight into ways to improve communication effectiveness in your referral network:
- Spend Time With Your Patients: While not incentivized by many reimbursement structures, spending adequate time with each patient was found to be associated with improved communication between practitioners.
- Make Use Of Quality And Care Management Reports: Physicians who received feedback on their performance appeared to be better communicators. This practice is less common with specialists, but worth consideration if communication is an issue for your practice.
- Have A Nurse On Staff: The study found a correlation between having a nurse on staff and greater receipt of interspecialty communication. If a nurse isn’t an option for your practice, it’s worth noting that non-physician staff tasked with patient communication had similar effects.
Remember that communication is a connected system and keep all paths healthy and functioning well is important to maintaining a healthy referral network.
5. Neglecting Measurement
Staying aware of general patient satisfaction may not be enough, and more formal methods of evaluating the health of your network might be necessary.
Getting a high-level view of what’s going on in your practice could require everything from surveys to software, but it’s essential if you want to keep track of the health of your network. These tools can be used to get patient opinions, evaluate the smoothness and timeliness of transitions, even how well you’ve established patient expectations around referrals and how well they’re being met.
Surveys can be anything as simple as a form created in a service such as SurveyMonkey to feedback options integrated into your patient portal solution. Regardless, make sure that your surveys cover topics including:
- Coordination of care
- Access to care
- Quality of care
- Appointment experience
- Confidence in providers
For additional guidance, review CMS’ Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS).
Measurement at this level may require a dedicated staff member, or at the very least, making the required duties a formal part of an employee’s job description. If it’s not something you want to do in-house, there are vendors that specialize and can conduct regular, referring physician, and peer-to-peer surveys to help you understand the realities of your referral process. Modern Healthcare maintains a list of patient satisfaction measurement firms that can be accessed for a fee. An older list is available for free here.
Once you have a clear picture of what’s going on, it’s time to improve. You can use the information you’ve gained to highlight specific areas of improvement and inform future training and protocol standards as you move forward.
6. Overlooking Over-admissions
Unofficial referrals between physicians are relatively common, and they make sense — doctors refer patients to other clinicians who they trust and believe can solve their patients’ problems.
According to research from Weill Cornell Medical School though, these informal networks can have very real impact on preventable hospital admissions, and hospitals are taking note.
The published results are encouraging ACOs, hospitals, and health insurers to make efforts to identify these informal networks, learn from the best-performing ones, and work with poorer-performing networks to improve care. If your practice or network is not tracking hospital admissions and comparing them to acceptable rates, you may soon be under pressure from multiple organizations to evaluate and clean up your practices.
7. Going Or Staying Low-tech
As you look to address the issues we’ve discussed here, it may be tempting to simply adjust the call and faxing process you have in place to make it more efficient. This though, is almost certainly a mistake.
Referrals are about transferring information and information in healthcare is only becoming more complex. ICD-10 has exponentially increased the complexity of describing the patient situation and phone calls will simply no longer suffice.
Health IT solutions offer benefits including:
- Understanding of the full patient life cycle
- No longer losing patients in the process or having them fall through the cracks
- Reducing no-shows and improving quality of care through audited referral histories
referralMD provides features that allow you instant views into tasks that have to be completed by both you and the receiving facility, and also grant you the ability to remind coordinators and providers of statuses and to-dos.
Any solution you choose should be mindful of HIPAA compliance, and allow for smooth, secure communication in the form of file sharing, and human-to-human options such as direct messaging that will end games of phone tag and staff time wasted on hold.
This isn’t to say that phone calls and hand-written notes won’t help to maintain highly positive relationships with your referral partners, but it does mean that technology-driven solutions are almost certainly worth considering for your practice. According to a Practice Fusion survey, providers who used an electronic process to generate referral letters indicated significantly higher satisfaction levels around their referral method than those who called.
8. Putting Growth On The Back Burner
If your practice doesn’t have a solid business strategy, it needs one. The American Academy Of Orthopedic Surgeons proposes a 10-step process to help doctors take a more strategic approach to practice growth.
- Conducting market evaluations
- Creating a budget
- Building 5-year financial projections
- Developing strategic plans
- Diversifying revenues
- Having a marketing plan
- Understanding your patient mix
- Negotiating managed care contracts
- Thinning the herd
- Preparing for new reimbursement models
The backbone of that strategy will rely on business development, something that a strong referral network can greatly bolster. Failing to treat the growth of your network seriously though, can mean a poor bill of health for your business overall.
Once your network is established and you know who you work well with, you can begin adding more doctors and professionals to optimize the processes and standards you already have in place. A mature and well-tended network focused on growth will not only be financially profitable, but it will be better able to weather regulatory and market changes that are becoming more frequent in the modern era of healthcare.
9 Discounting Security Needs In An Era Of Data Breaches
One of the few downsides of a well-connected referral network is increased exposure to data breaches.
Since 2009, 15 million patients’ PHI has been exposed, and opening your informational gates makes you more susceptible to being affected by one of these breaches. That risk though, shouldn’t scare you off optimizing your network. Take it as encouragement to take advantage of the many options to properly protect your patients’ valuable information.
Unfortunately, the connected nature of referral networks makes addressing security more complicated than simply shoring up your own systems. Consider some of the following solutions:
- Hire a professional to audit not only your internal security risk, but also risk that impacts your region and network. Audits can be used to do things such as detecting unauthorized access to patient information, reducing risk associated with inappropriate accesses, tracking disclosures of PHI, and addressing compliance with regulatory and accreditation requirements.
- Consider partnering with other network members to share the cost of bringing in outside consultants and solutions. Take for example solutions such as Updox’ Dmail–a HIPAA-compliant secure messaging solution that is EHR-agnostic and can be used by multiple providers in your referral network to communicate everything from continuity of care documents, to referrals, and patient notes.
- Keep all personnel properly trained not just on HIPAA guidelines, but also on general recommended security practices that extend beyond base regulations. There are many advances in healthcare technology that federal regulations have not yet had a chance to catch up with. These include:
- The growth of wellness trackers and their integration into more traditional modes of care
- Data being exchanged directly between medical devices and patients
- The advent of mobile medical devices for patient use
- Cloud technology and the risks and concerns around it
- Information sharing that takes place with an entity not subject to HIPAA/HITECH regulations (non-covered entities)
Informational security breaches are no longer a rare occurrence in the industry and you can fully expect either you, or one of your partner organizations to be directly affected by healthcare information crime.
Keep all of these tips in mind as you continue to grow a physician network that benefits you and your patients and positively influences your local medical community overall. To get started laying the foundations of that network, request a demo of our network management software today.
