By using this site, you agree to the Privacy Policy and Terms of Use.
Accept
Health Works CollectiveHealth Works Collective
  • Health
    • Mental Health
    Health
    Healthcare organizations are operating on slimmer profit margins than ever. One report in August showed that they are even lower than the beginning of the…
    Show More
    Top News
    An Expert’s Guide To Building and Improving Endurance
    June 30, 2022
    medical assistants
    What Do Medical Assistants Do On a Day to Day Basis?
    April 5, 2022
    superfoods to help with prostate health
    10 Healthy Foods That Can Help Protect Your Prostate
    August 29, 2022
    Latest News
    3 Ways To Deal With Health Issues In Cities With High Pollution
    March 22, 2023
    What Tools Should Your Caregiver Have?
    March 22, 2023
    How to Combat Home Sickness After Moving Abroad
    March 19, 2023
    4 Ways to Recover from a Broken Hip
    March 14, 2023
  • Policy and Law
    • Global Healthcare
    • Medical Ethics
    Policy and Law
    Get the latest updates about Insurance policies and Laws in the Healthcare industry for different geographical locations.
    Show More
    Top News
    Health Links for Senior Citizens
    January 11, 2012
    The Flu Vaccine: Pros and Cons
    February 10, 2012
    What Mental Health Parity Has Wrought
    August 26, 2017
    Latest News
    What Are Bioidentical Hormones Made With?
    March 23, 2023
    Cover Medical Costs of Child Dog Bites with Legal Specialists
    March 23, 2023
    3 Ways to Improve the U.S. Healthcare System By 2030
    March 14, 2023
    6 Steps To Ensure Speed And Efficiency Of Clinical Studies
    March 14, 2023
  • Medical Innovations
  • News
  • Wellness
  • Tech
Search
© 2023 HealthWorks Collective. All Rights Reserved.
Reading: Primary Care to Specialist Referral Communication – 12 Reasons to go Electronic.
Share
Sign In
Notification Show More
Latest News
The Best Natural Sleep Remedies & Aids
The Best Natural Sleep Remedies & Aids
Wellness
Bioidentical Hormones
What Are Bioidentical Hormones Made With?
Medical Education
chemical peels for skin disorders
Chemical Peels Can Do Wonders for Treating Skin Disorders
Skin
health benefits of lip enhancements
Cleveland Clinic Cites Health Benefits of Lip Enhancements
lifestyle
child dog bite lawyer
Cover Medical Costs of Child Dog Bites with Legal Specialists
News
Aa
Health Works CollectiveHealth Works Collective
Aa
Search
Have an existing account? Sign In
Follow US
  • About
  • Contact
  • Privacy
© 2023 HealthWorks Collective. All Rights Reserved.
Health Works Collective > Business > Primary Care to Specialist Referral Communication – 12 Reasons to go Electronic.
Business

Primary Care to Specialist Referral Communication – 12 Reasons to go Electronic.

Jonathan Govette
Last updated: 2013/02/25 at 5:35 AM
Jonathan Govette
Share
7 Min Read
paper communication
SHARE

 

Contents
Specialty Referral Process:Problem with the current system:Shocking statisticsSo what does all this mean?

 

paper communicationPrimary Care Physicians use referrals to supply additional opinions, order laboratory tests, or imaging studies. The variation in referral use and management is varied and is dependent upon several variables. Variables include patient characteristics, practice size, health plans with gate keeping arrangements, as well as the variation of practices with managed care (Forrest, 2006).

The dissimilarity leads to the high cost of referral management and communication, un-uniform patient care, the inability to track referral needs as well as inaccurate data collection.

More Read

saving money in healthcare

Best Money-Saving Tips for Health Managers

HR Must Navigate Polarizing Views in Healthcare Workplaces
Should Hospitals Use SASE or Traditional Network Security?
The Technology and Services You Need to Open Your Own Counseling Office
Should Nurse Practitioners Form an LLC?

Specialty Referral Process:

primary care to specialist communication

Problem with the current system:

The referral and authorization process per insurance plan is complex and labor intensive for the providers and the payers.  Each plan has its unique requirements for the providers to submit information and access the plan.  Since there are multiple insurance plans with a variety of benefits, it is increasingly more difficult to manage the process in a streamlined and cost effective manner.

Managed care transactions require an enormous amount of paperwork, especially when the referral requests and authorizations never catch up to the claims submitted for the already provided services.  This results in a delay in payment to the provider and resubmitted claims as well as phone calls to the plan to resolve the problem.  Because the system is so fragmented and contracts and coverage for members is changing it is extremely difficult to stay current with the requirements on a daily basis.

Reimbursement is declining and costs are increasing for getting authorizations and receiving payment for services from the health plans.  Healthcare is known for being labor intensive, but a majority of those costs are not associated with direct patient care but for administrative costs associated with the system of coordinating the services of authorized care.

This requires meeting all the insurance plans requirements for each of their members and then they will provide payment.  Cash flow is a significant issue for providers today and delays in reimbursement for submitted claims needs to be addressed because of the overall negative impact on the hospitals, physicians, payers and the patients requiring services.

Shocking statistics

      1. It costs nearly $250 billion to process 30 billion healthcare transactions each year 1
      2. The average ratio of staff handling paperwork to doctors can be as high as 8:1 1
      3. 86% of mistakes made in the healthcare industry are administrative 3
      4. Three of every 10 tests are reordered because results cannot be found 4
      5. Patient charts cannot be found on 30% of visits 5
      6. Providers need to fill out an average of 20,000 forms every year 6
      7. Organizations, on average, make 9-11 copies of each document, spend $20 in labor to file each document and lose one of every 20 documents 7
      8. Annual Number of Ambulatory care visits (1.2 to 1.3 Billion) 8care visits
      9. 15 billion faxes are still sent by US physicians per year 9
      10. To quantify the savings achievable per physician, Milliman10 estimated the annual transaction volumes of a typical solo physician practice and then estimated the cost to perform these transactions manually and electronically. The annual cost for manual transactions was over $70,000; the annual cost for electronic transactions was less than $28,000. Subtracting the annual electronic cost from the annual manual cost resulted in savings of over $42,000 per year from implementation electronic transactions, as indicated in the following table.cost of a referral
      11. Each misfiled document costs $125. 11
      12. According to a 2009 report in the health policy journal, Health Affairs, when time is converted to dollars, physicians, nurses and their clerical staff spends between $21 billion to $31 billion per year interacting with insurance plans, inquiring about prior authorizations, formularies, claims, contracts and other patient information. The same article noted medical assistants earn an average of $30,000 per year, so essentially a medical practice is paying $12,000 a year per worker to talk to health plans. 12

So what does all this mean?

An average small practice can save $1,000′s a  year (much more for a large healthcare facility) by updating to a standalone (agnostic) referral system such as referralMD.  But this is really not the main benefit, the reduction of errors and the ability to capture many more referrals as revenue are much more important.

Not only is time a factor, but a very high percentage of paper referrals are either physically lost by the patient or by the facility thus incurring a huge liability to both the primary care and specialist provider.  Every patient referral that is lost or misplaced  can affect patient care quality and cause a direct reputation hit on the facility.

Think about this the next time you send a 1-way fax communication.

Sources:

1 Woodworth, Glenn. “2003: The Year of Medical Paperwork Simplification,” Journal of Healthcare Information Managament Winter 2003, vol. 17. no. 1, pp. 12-13.
3 Woodworth , Glenn, “2003: The Year of Medical Paperwork Simplification,” Journal of Healthcare Information Management
4,5,6 “A Healthy System,” Technology CEO Council, 2007
7 Pricewaterhouse Coopers
11 http://www.thepaperlessproject.com/what-are-the-facts-about-paper/
12http://tinyurl.com/aqg4mnm
8 http://www.cdc.gov/nchs/fastats/docvisit.htm
9 Marketsandmarkets, July 2, 2012
10 http://tinyurl.com/bgzjtxu

The post Primary Care to Specialist Referral Communication – 12 Reasons to go Electronic. appeared first on Electronic referral software for primary care and specialists.

TAGGED: referrals

Sign Up For Daily Newsletter

Be keep up! Get the latest breaking news delivered straight to your inbox.
By signing up, you agree to our Terms of Use and acknowledge the data practices in our Privacy Policy. You may unsubscribe at any time.
Jonathan Govette February 25, 2013
Share this Article
Facebook Twitter Copy Link Print
Share
Previous Article Image HealthCare Social Media: What Makes Sense?
Next Article image How to Test Health IT Interoperability: Advice From an Expert

Stay Connected

1.5k Followers Like
4.5k Followers Follow
2.8k Followers Pin
136k Subscribers Subscribe

Latest News

The Best Natural Sleep Remedies & Aids
The Best Natural Sleep Remedies & Aids
Wellness March 23, 2023
Bioidentical Hormones
What Are Bioidentical Hormones Made With?
Medical Education March 23, 2023
chemical peels for skin disorders
Chemical Peels Can Do Wonders for Treating Skin Disorders
Skin March 23, 2023
health benefits of lip enhancements
Cleveland Clinic Cites Health Benefits of Lip Enhancements
lifestyle March 23, 2023

You Might also Like

medical call centers benefits
Wellness

Best Practices for Healthcare Call Centers Should Follow in 2023

February 16, 2023
employee's wellness
Health

How Hospitals and Other Healthcare Providers Can Boost Employee Morale

February 13, 2023
BusinessHospital Administration

What are the Benefits of Hospitals and Clinics Using Expense Management Services?

February 13, 2023
healthcare workers with gloves
Hospital Administration

Tips to Keep Health Workers Safe in the Workplace

February 8, 2023
//

We influence million of users and is the most authentic source of information on healthcare business and technology news.

Quick Links

  • About
  • Contact
  • Privacy
Subscribe

Subscribe to our newsletter to get our newest articles instantly!

Follow US

© 2008-2023 HealthWorks Collective. All Rights Reserved.

Removed from reading list

Undo
Welcome Back!

Sign in to your account

Lost your password?