Solution helps shorten referral wait times
University Health System uses referral-automation and decision-support software to reduce wait times for specialty care.
o give the uninsured in the area access to af- fordable, high-quality healthcare services, San Antonio’s University Health System, an academic medical center that offers a full range of medical services for patients in a 22-county area of south Texas, es- tablished the CareLink fi nancial assistance program. Families have monthly payment plans based on their family size and income, for which they may receive services through Univer- sity Health System. Each patient is assigned to a primary care physician (PCP), who serves as his or her medical home. The successful program cur- rently has more than 57,000 participants, who made more than 189,000 offi ce visits to a PCP in 2011.
Gary McWilliams, M.D., is executive vice president and chief ambulatory services offi cer at San Antonio’s University Health System.
Success was not without its own challenges, however. With the advent of the program, PCP referrals rapidly escalat- ed, which had a corresponding impact on specialty refer- rals. Waits to see specialists for non-urgent appointments lengthened considerably – up to six months in certain cases – as specialists’ calendars be-
came increasingly booked. Compounding the volume issue was the fact that referral requirements lacked clarity, so that many specialist referrals were inappropriate. Specialists be- gan reviewing referrals carefully, even discussing them with colleagues, to make sure they should see the patient, eating up valuable, billable time even if ultimately they didn’t see the patient. Referrals to non-network providers went up as well, driving up costs.
University Health System leadership realized that some- thing needed to be done, and quickly, to make sure guidelines for referrals were clear and referrals were ultimately appro- priate, both of which would help specialists maintain more manageable schedules. This, in turn, would reduce the wait
12 March 2012
times that were not only causing frustration for caregivers and patients but also having an impact on care quality.
A common online language improves communication, effi ciency
The health system found a solution in CareEnhance
Review Manager, a browser-based, interactive software from McKesson that automates care-review processes, such as referrals. Review Manager uses McKesson’s InterQual decision-support criteria – in this instance, InterQual Care Planning Criteria for Specialty Referral – to guide decision making according to evidenced-based medical standards, help- ing improve consistency among reviewers and making review processes more effi cient. Both the primary care providers and the specialists quickly saw the value in using an established set of guidelines to facilitate the referral process. University Health System uses Review Manager to make the InterQual Criteria available directly via its website home page for its provider network, including PCPs, specialists and administrators, giving everyone a uniform understanding of referral requirements. The health system delivers care to 200,000 unique individuals each year, utilizing more than 100 PCPs and 900 full- and part-time specialists. To encourage use, PCPs were assured that if they used the criteria, their pa- tients would quickly get to the specialists they needed. If they didn’t, referral may not be timely, if it occurred
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at all. To the specialists, the message was, “If we ensure that the patients meet these criteria, you will stop reviewing all referrals and just start booking patients.” According to Gary McWilliams, M.D., executive vice president and chief ambulatory services offi cer at University Health System, the combination of software and referral criteria have been a win-win for both primary care physi- cians and specialists. “We’ve had buy-in from both sides,” he says. “PCPs understand that if they follow the criteria, their patients will be able to see specialists in a timely man- ner. Cardiologists are happy because they’re seeing patients who really needed to be seen, not wasting time on those who
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