Physical Therapy Referral Management System: Turning Physician Referrals into Patients
Start with Referring Practices and Referral Sources
Organizing the information around referring practices and referral sources would be a good place to begin.
- A referring practice is a group of referral sources (the physicians/practitioners). Each referral source could be associated with multiple practices. Likewise, each referring practice could have several referral sources associated with it.
- Whenever a new referring practice is added to the referral management system, it would be useful to note who the assigned field rep is, this would be the person responsible for following up with the referring practice to acquire new patients.
- For each referral source, it would be necessary to track both field rep activities and referrals generated. A key metric to monitor would be the expected number of referrals per month per referral source. A summary view of the referring practice would be a good place to start from and dive deeper.
- Each referring practice could have a health indicator flag. A green flag could indicate that all referral sources have met their target number of referrals (the expected number of referrals) in the last 30 days.
- If fewer than 50% of referral sources met their target in the last 30 days, then the indicator could show in red.
- A combination of filter criteria, for example all practices in a city with a certain referral status, along with multiple levels of sorting of rows would result in a focused list of referring practices to follow up with.
- Adding the referral source with details like the expected number of referrals and NPI number would be followed by associating the referral source with a referring practice and the field rep responsible for following up with the practice.
- Again, a combination of filters and sorting would achieve a more targeted list of referral sources. One such filter could be referral health status, the number by which each source is above or below the target.
Add on Field Rep Follow-up Activities
Next would be the follow-up activities to acquire new referrals that would be driven by field reps.
- Field rep activities recorded for a referral source would include who was contacted, what the type of activity was, and what the associated referring practice was.
- Again, a combination of filters followed by sorting would help zoom down on a specific set of field rep activities, for example filtering by met with the front desk, type of visit was initial contact, and sorting the list of activities in chronological order.
- Referred patients are all the referrals entered into the referral management system. Information updated would include the practice that the patient was referred to, insurance type, fee class, referral source, and field rep. That would be followed by adding the referrals insurance information (primary and secondary insurances).
- Referral activities refers to the process of converting the referral into a patient. These referral activities could be filtered by status, for example new referrals, and referral health, measured by when was the last activity on the referral, and then sorted by referral date and facility. Referral activity type would include email, phone, or fax.
Convert Referrals into Patients
Finally, there would be the all-important activity of converting referrals into patients along with insurance verification prior to patient arrival.
- It should be possible to check availability with a particular therapist at a particular location for a particular appointment schedule. Selecting the type of appointment (like an evaluation) for a date and time slot would be followed by scheduling the referral.
- That would book the appointment slot on the scheduler, confirm the activity in the EMR system, convert the referral into a patient record, and move the patient into the insurance verification list in the EMR. A referral waitlist activity result would also convert the referral into a patient case in the EMR and put them on a waitlist for a therapist, facility, and date range.
- An outcome of Refused or Not Scheduled could be followed by an automatic fax to the referring practitioner; creation of a follow up task in the EMR task management system; and assigning of the follow up task to someone.
- Once referrals are converted into patients, they are either scheduled or waitlisted. They are then moved into the insurance verification list. Insurance benefits would need to be verified before referrals arrive. The insurance verification list could be filtered by activity date, type etc.
- Referred patients could be monitored in terms of when they are scheduled and what the current date is. If they are past the scheduled date, that would imply a critical status. Those referrals that have an appointment scheduled soon, say in the next three days, would need insurances verified urgently.
- Other details like the verification activity type for example outgoing phone call and verification result say verified could also be tracked.
- By navigating to the patient record, it would be possible to access the insurance information in the EMR and mark it as verified. Post successful verification of insurance, the patient would drop off from the list of referrals.
While direct access continues to make headway, there is no getting away from physician referrals for most practices. This would involve staying on top of referring practices, referral sources, referral activities, and referred patients. With a Referral Management System that is seamlessly integrated with the EMR, that should be straightforward to accomplish.