In today’s world, Primary Care Providers (PCPs) have the monumental task of managing 100s’ of specialty provider relationships in their referral network. We will discuss how implementing a consult management solution can prevent unnecessary referrals.
Did you know there are 21 sub-specialties just for internal medicine alone?
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When faced with a challenge, how can Primary Care Physicians (PCPs) help patients find the most suitable specialist when unaware of the available options within their referral network? Moreover, patients do not require another provider more than half the time. They can continue to receive guidance from their specialty care counterparts while remaining under the care of their PCPs.
What is an eConsult?
Electronic consultation (e-consult) is a mechanism that enables primary care providers to obtain specialists’ inputs into a patient’s care treatment without requiring the patient to go to a face-to-face visit.
The primary care provider (or another continuity provider) initiates the e-consult through a traditional referral pathway, ideally supported by
An e-consult can be as simple as a “curbside” opinion between the specialist and PCP that is intentionally general, often undocumented, and can not only delay treatment for the patient but carry a considerable malpractice risk. Did you know that 80% of all serious medical errors involve miscommunication during care transitions to different care settings?
In the United States, more than one-third of patients are referred to a specialist each year, and solutions to improve communication are greatly needed. Despite the frequency and importance of specialty referrals, the process has been frustrating for primary care physicians (PCPs) and specialists because only 45 percent of patient referrals are necessary.
The clinical question is often answered solely via e-consult, although the specialist will sometimes eventually see the patient face-to-face. The rate of conversion to face-to-face depends on the clinical condition. When a face-to-face is required, only one visit will often be needed thanks to the pre-visit preparation completed via e-consult.
Viewing diagnostic images at a time after data collection is another store-and-forward telehealth application, with radiology, dermatology, and ophthalmology (retinal scanning) being typical examples. The line between this telehealth application and e-consult is somewhat blurry, as e-consult platforms can also store and forward images attached to the e-consult.
Is Provider Communication a Problem Today?
Poor access to specialist care can be detrimental to patients’ health. Excessive wait times and delays in care can cause anxiety in patients and their families. They can also reduce patients’ ability to carry out day-to-day activities and lead to deterioration in the patient’s overall health as important diagnoses are delayed. In addition, 3 out of every ten tests or services are duplicated needlessly, causing frustration for patients and providers alike.
The most significant gap identified with EHR is that vendors lack standard functionality or the ability to customize e-consult functionality within the EHR to meet each client’s unique needs.
While Direct messaging is available amongst EHR systems, the drawback of using this as a sole means of e-consult functionality is the lack of closed-loop tracking, reporting, and reconciliation of electronic consultations back to the patient chart in a fluid manner. Agnostic platforms like ReferralMD meet this capability very clearly, providing bi-directional data integration to maximize data flow for clinicians.
How do Primary Care Doctors Get the Advice They Need?
Developing a referral network with specialty care providers can be time-consuming and takes years to accomplish. However, various ways exist to improve relationships with these providers, such as networking or receiving recommendations from other physician partners. Specialists may also create outreach campaigns to increase referrals from PCPs.
Previously, PCPs had limited control over finding great specialty care partners to seek advice about their patients. However, ReferralMD, a referral network management platform, is changing this by providing a technology-driven solution that facilitates the management of referral networks.
What does this mean?
- Improving the interface between primary and specialty care requires a new perspective on care delivery by providers. In-person referrals have developed as the mechanism for primary care providers to get assistance from specialists. Still, there are other ways to access this expertise and co-management support. E-consults eliminate the language of “denials? And “approvals” and instead focus on collaboration to find the best facility for a patient to receive care.
- Providers are concerned that the patients will perceive innovations such as e-consults as barriers to care if they do not result in a face-to-face visit. To address this concern, PCPs should discuss the positive attributes of electronic referral and consultation systems, which include closer collaboration between PCPs and specialists in co-management patients and the convenience to the patient associated with avoiding additional specialty clinic visits.
- Respecting the patient’s desire to see a specialist in person is essential. Suppose the referral is necessary or the patient requests a visit. In that case, ReferralMD allows all information, including the patient’s medical records, to be sent electronically within the referral network and without the need to fax.
- Collaboration between primary care and specialty care providers offers an opportunity for informal training and for providers to practice their full scope. With the Advent of EHRs, the old-fashioned curbside console has been lost, but E-consults bring back this opportunity for dialogue. EHRs are not necessarily developed to encourage discussion and interaction, which come from people using the tool.
- Selecting the right specialist is critical, as is providing constructive feedback to both PCPs and Specialists about the quality of their communication.
Thanks to the California Improvement Network
To steer patients to the most appropriate, high-quality doctor, you need an updated physician directory that shows which doctors in your area work with you, employed/contracted providers, or the competition (in/out-of-network affiliations) based on critical criteria such as…
- Accepted Insurance
- Proximity to patient
- Wait times
- and much more
Your care coordinators will love the immediate access to information at the point of care as they send referrals or request consults.
Another option is to think about who advises your patients before they end up in one of your examination rooms and begin your list with those names.
Continue your list with the non-competing clinics in your area you can think of (even if you think their loyalty lies with another doctor)—basically, any other office in town that treats people or provides medical advice. Make your list as long as you possibly can without self-editing.
Once your list is exhaustive, refine it by asking yourself these questions:
- Who do you already know and get along with well? (This is obvious, but you would be surprised how many facilities do not discuss their relationships thoroughly with other staff or clinicians.)
- Which clinics are on top of their marketing?
- Keep your eyes open for ads on TV and in local publications.
- Also, try web searches to see who proactively takes advantage of the online traffic. To review your competitor’s website, there are many tools like SemRush to view which websites are featuring their content and reach out to the same editors that published the content and ask if they would feature your website. Be clear: only post on high-quality sites, not spam directory sites, or you could risk getting banned from Google or other search engines altogether.
- Are there any impressive new doctors in town that are already doing a lot of business—or whom you would consider an up-and-comer? (Which doctors have full schedules and can’t fit in many new patients?)
It is recommended to look at your local county clerk’s office and review new doctors who have just received their business licenses. It may be a great way to build solid relationships early on and assist an up-and-coming doctor. Are any doctors breaking off to create a new practice of their own? (Again, keeping your eyes open for advertisements or announcements in local publications will help here.)
Of the clinics whose loyalty lies with your competitors, do they have any competing clinics you can contact?
You can establish the top targets to invite into your mastermind group with the answers to these questions. You may want to create a first-choice and second-choice list. The two lists will help you determine who to spend time on. If a doctor is already at the top of his or her respective positions, you may want to eliminate that person from the list. Targeting the people initially receptive to an invitation will be an essential time-saver.
Additional Information on How to Build a High-Performing Physician Referral Network from Scratch
Several factors contribute to the swift adoption of e-consults in some healthcare sectors, especially where there are difficulties with access to specialty care and a need to increase value. The following everyday experiences in ambulatory specialty practice demonstrate opportunities where e-consults could enhance physician satisfaction, patient experience, quality of care, and utilization of specialty services.
- Incomplete workups. Specialists often enter an examination room to see a patient referred by a PCP and find that none of the tests needed to assess the question or problem have been done.
- Low-value visits. Studies suggest that a significant percentage of referrals, depending on venue and specialty, are for issues that could be resolved and managed at the primary care practice level. (examples: neurology 17 percent, cardiology 36 percent, hematology 48 percent, nephrology 63 percent).
- The referral is directed to the wrong specialist. Much to the frustration of all involved, specialists sometimes see a patient for an initial consultation and discover the question or problem is inappropriate for their specialty practice.
- Poor access. PCPs and patients often face long wait times to see a specialist.
- Feedback delayed/disconnected. In many systems, the results from a specialty consultation can take weeks or months to be returned to the PCP, decreasing the chances that the PCP will learn from each referral and, over time, make fewer referrals for the same clinical question.
E-consults are designed to address and mitigate each of these negative experiences.
E-consult implementation is not without challenges, such as:
- Dual documentation. Providers are sometimes required to document in dual systems and are legitimately concerned that double entry is time-consuming and a potential source of errors.
- Lack of payment models. Payment models for e-consults vary. Using e-consults in a value-based payment system is optimal. Those at risk must be confident that face-to-face visits will decrease if specialists are paid for e-consults.
- Transitions of care from remote specialists. E-consults allow a specialist outside of a strained local network to provide access. Still, if there is a later transition to an in-network, in-person visit based on understanding, the change can be challenging and create redundancies and, therefore, must be monitored.
- Workflow consistency within practices. Using e-consults for some patients and not others (for instance, by the payer) is complex and may inhibit adoption.
- PCP adoption. Some referring providers will resist change and want their patients to be seen face-to-face. Identifying physician champions who understand the value of e-consulting is essential to the model’s success.
eConsult Market Developments
Evidence for the effectiveness of e-consults in safety net healthcare is building. Several articles detailing outcomes in a safety net environment have begun to emerge. These studies show high satisfaction among primary care providers, reductions of in-person consults of 40 percent, and overall cost savings.
E-consultation is becoming a more popular telehealth solution. This leads to payment programs being implemented in several states, such as Connecticut, Colorado, Oklahoma, and Washington. In California, e-consults have already been implemented or are being implemented in different arrangements. The 1115 Waiver Global Payment Program in California is a specific example that calls for e-consults as a service category. As the need for e-consults grows, local public health departments are expected to respond to the global budgets by further disseminating e-consults. To fulfill the need for e-consults, companies have emerged offering Software as a Service (SaaS) models, pre-designed clinical checklists for referrals, and additional specialist capacity to address access problems. The market need, proven results, and commercially available products are likely to bring about rapid adoption in settings where specialty access is limited.
Building a referral network has gotten much easier due to technology like ReferralMD, which allows PCPs to work more closely with their specialty care counterparts. If you have not leaped yet, we highly recommend you do; the ROI and benefits to your patients are massive.