It’s no secret that access to healthcare is a challenge for patients. And it’s becoming harder and harder for patients to get appointments with their PCP or the specialists they have been referred to for advanced care. Now more than ever providers and their staff are faced with a growing number of challenges that prevent or delay them from doing what they are all there to do: get patients in front of a doctor to determine how to get them well. One of the biggest villains in this story is the old fax machine. No matter the practice’s type or patient volume, there are so many ways things can go wrong with a fax-dependent process that is nearly impossible to standardize, has no real built-in accountability and is dependent on significant levels of coordinated communication.
That’s why it’s vital for a practice to have processes, goals, and measurements that align with that core objective of both getting patients to schedule appointments and of course come in for their appointments. The easiest way to accomplish this is by managing the practice’s referral-to-appointment ratio, otherwise known as RTA. Aligning the staff’s objectives to optimize a practice’s RTA ratio means more patients are getting the care they need while simultaneously ensuring a practice’s financial health is secure.
Traditional referral intake systems haven’t changed significantly in the past 30 years. Rather, they are still based on paper and fax referrals that often get lost in the shuffle of busy days and patient care needs. This reliance on old-school methods flies in the face of significant connectivity and communication adoptions that are being successfully leveraged in other industries. Between the barrage of phone calls and faxes flowing between provider offices, provider office administrators struggle to confirm patient information, locate missing labs and medical records, and keep track of inefficient and disruptive back and forth conversations to facilitate quality patient care. With disparate EHRs, scheduling software, and office procedures, provider networks have historically lacked a shared language and a standardized process too easily connect and communicate.
Under this traditional model, even in the best-organized offices, the administrative point person – the patient coordinator – deploys basic spreadsheets or a handwritten sticky note with limited sharing functionality to help make sense of the referral and health data chaos. This type of analog reporting takes hours, and the information and procedures get siloed into that individual patient coordinator’s workflow with no visibility or accountability. As this position is one of high turnover, the knowledge and process efficiency disappears with each resignation. These archaic methods often lead to patients slipping through the cracks and never getting the callbacks needed to close the loop and schedule appointments. While this is a huge issue for patients seeking critical care from providers they are referred to, this also has serious impacts on a full health system’s patient and revenue leakage. Ditching the old school model for streamlined technology can change the paradigm and enhance the care coordination process for both patients and providers.
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For South Texas Physician’s Alliance, social determinants of health referral has been a learning experience. The organization, which has joined providers across the country in efforts to address social determinants of health, knew the best solution was connecting patients to social services providers. A patient presenting with food insecurity needs a referral to a food pantry, or a patient with housing insecurity might need the help of a medical-legal partnership. But even with that strategy, organizations are facing an uphill battle, largely in terms of networking.
“There's just so much that we need to learn because it's just not an area in which medicine is used to functioning,” Sheila Magoon, MD, the executive director of South Texas Physician’s Alliance, told PatientEngagementHIT. But through an understanding of how to collect SDOH data, the pain points in social services referrals, and the types of technology and interpersonal partnerships the organization would need, South Texas Physician’s Alliance said it’s on the path to building out a strong community health network.
Can you talk about some of the challenges facing health systems in regard to their referral to appointment ratio? How do these challenges impact revenue?
We believe at LeadingReach that this the most undervalued and undertracked metric in all of health care, the referral to appointment ratio. If you ask other organizations, anywhere from Facebook and Amazon all the way down to even nonprofits that are out there trying to grow, everybody tracks their conversion metrics, that classic close rate, if you will.
This is a metric that has gone largely untracked and unmeasured in health care. It's a real shame, in my humble opinion, simply because at the core of it, it's all about getting patients the care that they need in a more timely manner.
Obviously, if you start to look at this from a fee for service perspective and someone who's receiving referrals, there is a lot to gain around the ability to understand and track where your business is coming from and then, obviously, do things to optimize that business and capture as much patient volume as you can, whether you're a small, independent couple of doc orthopedic shop, as an example, or all the way up to the largest health systems in the world.
How can care teams avoid revenue leakage by communicating more effectively with each other while monitoring and facilitating care transitions?
At the end of the day, it's all about, again, getting back to that referral to appointment ratio number and tracking all sources of referrals that come into the business. For the receivers on the receiving end, whether that's a specialist or even things like PT or rehab, it's really important for them to make sure that they're aware of the full opportunity that's hitting their door.
Again, we see all kinds of different things out there since this our business and what we focus on. I see everything from referrals not getting called at all and the standard default is, "Hey, we just wait for patients to call us," to even referrals getting thrown in the trash at 5:00 because an employee wanted to go home. Anything and everything there in‑between.
The Southern Texas Physicians Alliance (STPA) in the lower Rio Grande Valley is working to improve communications between medical groups and social service agencies to better meet the needs of its patient population, which has among the highest rates of poverty and unemployment in the state.
One of the counties in its region, Willacy County, has the highest poverty rate in the state of Texas with 38 percent of the residents living in poverty. It also has the second highest child poverty rate at 45.9 percent. And its unemployment rate is at 13 percent.
The region’s high poverty rate contributes to a lack of financial resources for medication, food, reliable transportation and access to specialty care, said Sheila Magoon, M.D., director of STPA, which has approximately 100 physicians.
With a goal of eliminating the fax machine from its operations, last year STPA began working with a company called LeadingReach that offers a tech platform that helps organizations manage transitions of care, including referrals between primary care and specialist offices as well as referrals to social service agencies. Its web-based platform offers clinical workflow management tools, secure team-based chat, and clinical document exchange.
The referral-to-appointment ratio (RTA) is the most important metric in healthcare that no one is talking about, until now. What is RTA? It is the “conversion rate” on a transition of care. Said another way, it is whether or not the patient received the care they need, be it a traditional referral to a specialist, an order for ancillary services, or a surgical procedure. Every other industry scrutinizes, manages, and ultimately owns conversion metrics across their entire business — at least the most successful ones do. Familiar names like Amazon, Facebook and Salesforce can tell you their respective “close rates” across all of their various channels and go-to-market strategies, in real time.
In this second part of a two-part article series, Curtis Gattis, CEO and co-founder of LeadingReach, discusses how healthcare organizations participating in risk-based contracting or value-based financial and care delivery models are currently facing major challenges with integrating, managing and tracking care coordination and communication capabilities within provider networks.
In the first part, we discussed four ways that value-based care can achieve seamless coordination and communication. Now we’ll take a deeper dive into the benefits of implementing a solution that will increase provider networks, provide detailed metrics on what’s working and what isn’t, and how narrow networks and value chaining set practices up for success.