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Discovering the value of automated referral management

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  By Julie Martin,  June 26, 2012

A Dallas-area hospital deploys automated referral management solutions in the emergency department (ED) to improve care coordination and build stronger ties with physician practices.

Primary care physicians expect that hospitals will let them know when their patients received care in the ED. Yet, sometimes that doesn't happen. A hospital may have faxed a notification to a patient's primary care physician (PCP). But, for one reason or another, the physician practice may never have received it.

Fortunately, an increasing number of hospitals are realizing the need to improve the way they handle referrals and patient transitions.

Solving the referral problem
In 2010, I assumed a new position as director of business development and marketing at Texas Regional Medical Center (TRMC) at Sunnyvale, a 70-bed facility in a rapidly growing area of Dallas.

We implemented T-System PerformNext Care Continuity, an automated referral management system for the ED. I had encouraged the implementation of Care Continuity to establish solid referral processes in our ED, where we see about 100 patients a day.

Having been in hospital business development for many years, I knew that it's not uncommon for hospitals to receive complaints from medical staff that they didn't know their patients had been admitted to the ED. Throughout the years, I've heard from physicians who were frustrated by having to chase down records of patient encounters after the fact. In other cases, I've heard from physicians who were upset because their patient had mistakenly been referred to a competing practice. As one of Dallas' newer hospitals, I wanted to help TRMC avoid those types of complaints from the get-go.

Establishing best practices
Now using our Web-based ED referral management system, physicians are automatically alerted of the admission or discharge of their patients from the ED. As a result, we can cut down on miscommunications and bridge the gaps between the hospital and the physician community. The system also assembles a patient encounter record from the EHR and pushes it directly to the physician.

By identifying the non-staff physician practices with the greatest number of patients visiting the ED, we were able to reach out and initiate a discussion about how we could work together to improve care coordination and reduce readmissions.

Tapping into new business opportunities

Using the system, we are automatically assigning 60 percent of the approximately 3,500 patients we see in our ED each month to their PCP for follow-up care. However, up to 40 percent of our ED patients have medical insurance but do not have an assigned PCP. These unassigned patients receive a follow-up call from a call center and a referral to our physicians on staff.

That represents a phenomenal new business opportunity for our physician practices. By helping build these practices, TRMC can recruit, retain and win physician loyalty, while partnering with them to take better care of patients.

Generating revenue streams
Physicians are one of the most lucrative revenue streams for hospitals, accounting for nearly 60 percent of a hospital's inpatient business and $1.5 million in revenue each year, according to a report by Merritt Hawkins. By strengthening ties with the medical community, we can increase our hospital's ancillary business when physicians will refer patients back to the hospital for radiology tests, sleep studies and outpatient surgeries, for example.

Automated referral management is helping our hospital make the cultural leap from discharging patients to managing smooth care transitions.

As TRMC partners with physician practices and gradually moves toward more of an accountable care business model, T-System's Care Continuity will help us connect patients to the follow-up care they need. It will also provide us with tools to manage high-risk populations, track key performance metrics, improve patient safety and reduce unnecessary readmissions.

About the author

Julie Martin, MBA, is director of business development and marketing at Texas Regional Medical Center at Sunnyvale in suburban Dallas.


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