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Jerris Heaton

Reduce the Number of Out-of-Network Patient Referrals with Robust EHR Medical Management

November 19, 2018

Patient Portal, PM 4 Minute Read

Patient referrals are an important part of helping patients find the specialists they need. However, it’s not always easy to find in-network referrals. The referral process can be complicated without the right medical management tools. If you have a robust EHR (electronic health record) system that includes internal provider information and a directory, you can easily find providers within your network to refer patients. When patients stay in-network, they have easier access to nearby doctors, communication, appointment scheduling and more.

Providers Struggle with In-Network Referrals

Physicians and providers understand the importance of in-network referrals. They know it improves care coordination and helps retain patients. However, a survey by Kyruus revealed that 79 percent of physicians still refer patients to providers outside their network.[1]

There are lots of reasons for this high number, but much of it is tied to a lack of data and information like schedules and specialties. When providers have access to this kind of data, the referral process goes much smoother both internally and for the patient. Ultimately, you want your patients to get the best care and make it convenient for the patient. The right EHR empowers proper medical management ensuring that you can do both.

In-Network Referrals Bring Convenience to Patients

In-network referrals are more likely to be close by or local to the patient, meaning they don’t have to venture far outside their community for care. Inability getting to providers for care can be a significant issue, so making this easier for patients is key.

If a provider refers a patient out of their network, they risk having to pay more seeing as most insurance companies will cover less of the payment for going out of network. Staying in-network keeps costs down for patients as well as increases the practices medical management efficiency. Special cases may require patients to go out of network, however, it is in the patient’s best interest to give them the care they need at a cost they can afford.

In-Network Referrals Make Things Easier for Doctors

The most important aspect of in-network referrals is the ability to deliver patient-centered coordinated care. When providers are in the same network, they can converse easier about the patient’s care plan and share information more readily, often through the EHR system.

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When all the patient’s data is in one place and all providers are on the same page, the patient gets the correct treatments or medications, and all providers stay in the know about his or her progress.

How a Robust EHR Enables More In-Network Referrals

All EHR’s are not the same. Some have limited access to data that would determine a provider’s network status. When they don’t have the data available in the EHR, the provider must do their own research or use another external resource. Without the proper data and information, providers may make referrals not in the best interest of the patient. According to the Kyruus survey, providers lamented they did not have access to essential data about other providers with only 63 percent saying they had information about the specialty or subspecialty.1

In addition to a lack of clinical data, 57 percent of physicians said they had little access to scheduling information. 1 Because they have all around limited information, physicians are more likely to refer to the same provider, which leads to poor network usage and can cause challenges with scheduling, and patients may have to wait longer to see the specialist. Physicians could overcome these challenges with an EHR that delivered easy access to the information.

Patient referrals generate revenue for networks. Yet, the referral system for many networks is outdated and doesn’t take advantage of the EHR medical management, which can be a powerful tool. When patients go out of network, coordination of care suffers, patients have a poor experience, and systems lose revenue. The solution is a better EHR, and better medical management.

ChartLogic’s EHR Makes Things Simpler

Thousands of providers use ChartLogic’s EHR every day because it gives them the functionality and flexibility they need. Known as the first meaningful use certified EHR in the industry, it offers a customizable template builder, a Patient Portal, ePrescribing, data share capabilities, labs, and referral replies amongst other efficiencies. Learn more about the ChartLogic’s EHR today.


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