Physician Referral Management

The Medical Group Management Association (MGMA) research indicates a massive negative financial impact on Physicians: Every physician faces excessive financial losses of over $200,000 on an average. The emergence of value-based care model has had dramatic effects on Hospitals and Physician Practices getting their reimbursements for their care services by the insurers.

Physician referrals are the lifeblood of hospitals and Physician Practices, considering the tremendous impact it could have on the outcomes and revenues. Healthcare organizations must build a robust Physician referral strategy such as:

• Track and monitor physician referral patterns and identify issues
• Estimate the physician referral relationships and their value
• Build new strategies for better collaboration and engagement

Track Performance

Hospitals must measure the physician referral performance to identify and prevent leakage, which gives actionable insights into critical factors including the key metrics and outcomes. This analytics help enhance performance by laying a strategic roadmap on the changes to be implemented and how they will impact the results. It is also equally important that the right information is communicated to the right person at the right time.

To deconstruct the physician referral performance, organizations need to focus on three key criteria.

• Claims data, which is gathered using these three ways
  • 1. Payer contracts (risk based)
  • 2. New digital technologies that have been invested on
  • 3. Health plans of the care provider
• Internal data
  • 1. Remote patient monitoring
  • 2. Value-stream mapping
• Strategic amalgamation of both internal and claims data

Most care providers do not have sufficient access to the claims data. However, organizations can leverage the internal data analytical capabilities in such scenarios—to maximize efficiencies and performance.

Patient Monitoring Insights

Taking a patient-centric data model approach is one of the key ways to simplify patient tracking and monitoring. This strategy will accelerate the revenue cycle performance of your hospital or practice by:

• Synthesizing complex data sets including the inpatient and outpatient data
• Allocating a unique identifier for each patient
• Identifying the first touchpoint of patient visit (the first visit made by the patient to the care provider)
• Segmenting patient visits in terms of the entry point made
• Analyzing the downstream time and the interim time period after every patient visit
• Estimating the costs incurred and the revenues generated post the initial visit

Patient Engagement and Relationship Management

Relationship management is a significant aspect of patient engagement that can be combined with other strategies including:

• Forms and surveys from physicians
• Gathering insights on the Physicians’ performance and focusing efforts on performance improvement
• Leverage patient engagement solutions to track and monitor patient experience and satisfaction
• Treat the Physicians as one of the key stakeholders and partners

Care providers need to take strategic initiatives to integrate physician referrals into their patient engagement solutions and revenue cycle models. This can further be elevated using the internal data that hospitals and practices have accumulated. However, data and analytics are just a starting point. As large volumes of physician referral data are gathered, these data need to be turned into actionable insights that support patient management and enhance collaboration.

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To learn more about how your healthcare organization can leverage Physician referral management to improve care coordination and drive revenue cycle success,talk to our team