Engaged patients push doctors to improve referral management

Physicians face new struggles with referral management, with some looking at facilitating referrals to select specialists, while other doctors just want easier access to information to complete referrals.

With patients having more options to receive care out of network, an effective referral strategy is important for clinicians and healthcare systems hoping to keep patients within networks, according to Kyruus, a software vendor that uses data to match patients to providers and reduce barriers to care.

The firm recently contracted for research to survey 100 primary care physicians and 100 specialists to determine how clinicians make referral decisions, facilitate appointments and track outcomes.

Findings disclosed that more than 70 percent of physicians refer to the same specialist for a given specialty because they know the clinical expertise of the specialist but they also may lack awareness of other in-network options. On average, these physicians send a quarter of their patients out of the network.

“Inadequate provider information could be to blame for unnecessary out of network referrals, as providers who refer out of network expect one-third of these referrals would be avoidable if they had access to more robust information about providers in their networks,” according to the Kyruus report, available here.

In general, providers referring out of network were significantly less likely to have access to availability, location, network affiliation and insurance information, which can lead to relying on providers within a personal network who may not be the best options for a patient.

Three-quarters of hospital-owned practices are significantly more likely to have access to a provider directory from their health system, compared with surveyed academic medical centers at 33 percent and solo private practices at 44 percent.

While 60 percent of physicians have access to their health system’s provider directories, they are not using the directories because they don’t have the level of information that is needed.

Further, lack of information within a delivery system can result in missed opportunities to connect a patient with a provider with similar expertise who could see the patient sooner, which improves patient satisfaction and retention, as well as care coordination.

Nonetheless, while 77 percent of responding clinicians say it is important to keep patients in network to support care coordination, 79 percent still refer out of their delivery system.

“While the occasional out-of-network referral is to be expected, providers who knowingly refer out-of-network and are aware which patients are in network still estimate they send an average of 22 percent of patients to out-of-network providers,” according to the report.

For providers who schedule an appointment for the patient, 44 percent make the appointment within a shared electronic health records system, and 60 percent schedule it by phone. Heavy use of the phone occurs as it is difficult for providers to see capacity in their network to book the next available appointment, so they bypass the network and book the appointment before the patient leaves the office.