Primed for Success: How LeadingReach Modernized the Referral Process for Prime Healthcare in the North Texas
“When you’re talking about incoming referrals, there are two customers to consider: the patient and the sending provider.”
Becky McIntire, Director of Business Development
- 46 Hospitals in 14 States
- 2.6 Million Patients seen Annually
- 50,000 Staff and Physicians
About Prime Healthcare
Prime Healthcare is one of the nation’s leading health systems, operating 46 hospitals and more than 300 outpatient locations in 14 states and providing over 2.6 million patient visits annually. In the Dallas-Fort Worth area, Prime operates the Dallas Medical Center, a 155-bed hospital with four medical plazas, the Dallas Medical Regional Center, a 202-bed hospital, and the Dallas Physicians Medical Group.
For any health system, providing comprehensive services to a large metropolitan region such as the Dallas-Forth Worth metroplex would be a challenge. For Prime Healthcare, it is fortunate to be able to serve this area with two large hospitals, the Dallas Medical Regional Center (DMRC) and the Dallas Medical Center (DMC), as well as the Dallas Physicians Medical Group (DPMG), which has highly-trained physicians board-certified for family medicine, internal medicine, cardiovascular disease, geriatrics, gastroenterology and colorectal surgery, pulmonary medicine, and other specialties.
Prime faces the same hurdles in the North Texas market as any large regional health system. While providing high-quality care, Prime also seeks to keep its patients in network and maximize its revenue opportunities. Minimizing patient leakage and maximizing customer service are the order of the day. And this requires a well organized, 100% accountable way to manage the handling of the patient referral process.
“When you’re talking about incoming referrals, there are two customers to consider,” explains Becky McIntire, Director of Business Development for both DMRC and the physicians group. “It’s the patient who is the first customer, they want to get into the physician’s office. And then the primary care physician is the second customer. They expect that their patients are going to get taken care of in a timely and efficient manner, and that they’re going to receive the appropriate notes back post- visit.”
According to McIntire, the majority of Prime’s Dallas-area incoming referrals come from independent primary care clinics. Those clinics want their patients prioritized, and they are often parts of clinically integrated networks that require patient follow-up. Accordingly, specialists need to ensure these referring physicians are satisfied with the referral process and patients are getting scheduled in a timely manner.
For outbound referrals, effective management is also crucial, especially for ER referrals. Discharged ER patients need continuity of care and effective follow-up with the specialists to whom they are referred, so they do not end up back in the ER.
“They expect that their patients are going to get taken care of in a timely and efficient manner, and that they’re going to receive the appropriate notes back post- visit.”
Before working with LeadingReach, the Dallas Prime system did not have any specific tools or standardized processes in place for referral management.
For incoming referrals, the outpatient clinics were relying on their EHR and faxes without effectively tracking the referral process. “We didn’t have a count on how many were coming in,” says McIntire. “We didn’t have a thumb on where that patient was in the referral process, how long it was taking, who was responsible for it. It was really just a stack of papers that were on somebody’s desk.”
So if a specialist complained of inadequate volume, it was impossible to pinpoint the issue. Among many possibilities, perhaps the referrals were going to that specialist and not being processed. “Maybe they were out of network,” says McIntire. “Maybe the patient chose somewhere else. Maybe the PCP that sent the referral was sending for the wrong reason, so we needed some education with that doctor’s office.“
But Prime had no insights into the number of referrals or the status of the referral process for each patient. Office managers had very little control over the process and could not enforce accountability on their staff. “Our customer service was really lacking,” says McIntire.
On the hospital side, specifically the wound care clinic, Prime faced similar issues. There were no expectations for the speed of processing incoming referrals, and no formal documentation of the process. The staff had to locate the paperwork for the specific referral to determine the status of scheduling and communication with the referring physician. “There was just nothing in place where we could track anything or trend anything,” says McIntire.
As for outbound referrals, the ER physicians would often discharge patients and recommend follow-up with a primary care physician or specialist. But Prime did not connect with the physician directly, instead leaving this in the patient’s hands, which inevitably resulted in a lack of follow-up.
This was all a function of using outdated manual processes for the referral process. “The fax machine gets clogged,” explains McIntire. “Papers get lost.” Relying on faxes, hard copies of paperwork, and telephone calls was a cumbersome and ineffective system.
“We didn’t have a thumb on where that patient was in the referral process, how long it was taking, who was responsible for it. It was really just a stack of papers that were on somebody’s desk.”
Prime discovered the benefits of LeadingReach in 2017, through a gastroenterologist at the DMC facility, whose staff notified McIntire that their office had been receiving referrals on the LeadingReach Network for some time.
McIntire ultimately engaged LeadingReach as Prime’s referral solution. Now all incoming and outgoing referrals are managed with LeadingReach by their hospital ER, radiology department, and their outpatient wound care clinic.
Not only was the platform an effective portal solution for referral management, McIntire immediately appreciated the direct messaging and team chat functions to allow ongoing discussion care coordination around specific patients. Compared to the usual method of a fax followed by a phone call, the platform could facilitate both secure document transfer and follow-up messages. This streamlined the process immensely.
“It also helps that multiple employees have access to this referral system,” adds McIntire. With multiple Prime locations receiving incoming referrals, now employees at different locations can help process referrals. “And then everybody who has access to LeadingReach knows everything going on with that referral process and ultimately individual patient care. And we’re also getting email notifications, that’s nice.”
From McIntire’s business development perspective, the most attractive features of the LeadingReach platform were the tracking function, the dashboard, and the access to reporting tools. Now they could show the types and amounts of referrals, the referral sources, and the rate of conversion to appointments. This allowed McIntire to demonstrate her own impact from a growth perspective.
“Everybody who has access to LeadingReach knows everything going on with that referral process and ultimately individual patient care.”
The positive results for Prime of implementing LeadingReach were immediate and drastic. “It is a huge physician satisfier,” says McIntire.
Overall, McIntire finds the platform allows for a much cleaner process that is easier on staff everywhere. Now employees can send messages without phone calls, specialist’s offices can reply at their convenience, and documents can be exchanged without faxes. “It just cleans up that whole process for communication back and forth, whether it’s documents or talking,” she says.
Another major benefit is Prime’s ability to share referral data with physicians to demonstrate what the market looks like. McIntire says physicians are always surprised when they go through a referral report, by such things as the volume of referrals coming from different providers.
Cardiologists in particular were not familiar with many of the newer providers. “They didn’t know who they didn’t know,” says McIntire. “I was able to show them, ‘Well, here is this new doctor that can send you 50 referrals this year, have you met them before?’ And no, they hadn’t met them before, and I said ‘Well, you need to go meet them.’”
The impact on physician recruitment has been another plus. As a result of implementing LeadingReach, Prime was able to recruit an orthopedic surgeon and a pain management physician to the local area by showing them metrics on Prime’s ER outbound referrals. The surgeon was already on Prime’s medical staff, but his clinic was forty minutes away. “And so I was able to provide him with data to show him, ‘If you have a satellite clinic here, here’s the immediate volume that you will have,’ ” McIntire explains.
For ER outbound referrals, LeadingReach was able to “close the gap” in the referral process. Now instead of the patient having to handle the process, the ER is able to communicate directly with the outside PCP or specialist and increase the chances of effective follow-up.
An added benefit is the ability to track long-term trends once LeadingReach has been in place for some time. “We’re able to go back to 2018 and say, ‘We’ve had this many referrals from this doctor, and we’ve had half that this year,’ ” says McIntire. “What’s going on? Did we have a competitor that came into the market? Is that doctor not seeing as many patients? Is he seeing a different kind of patient? Is he seeing a different payor mix that maybe we are or are not in- network with? Is he now requiring his notes to get back within a specific timeline? What is the reason those referrals have dropped off? And be able to go to the physician and engage him on that.”
McIntire says Prime’s biggest advantage from implementing LeadingReach is the ability to manage, track and trend the referral process. From the physician standpoint, they add quality to their patient care with better customer service and efficiency. From the business perspective, “it just provides a really good landscape of information that allows you to see what your market is doing – where the patients are coming from, where there’s opportunity for improvement, where there’s opportunity for education. It just really shows what’s happening in your clinic from a market perspective.”
“It just cleans up that whole process for communication back and forth, whether it’s documents or talking,”