Lesson 28 – Closed Loop Physician Referral Management – why

Being adept at physician referral management and patient referral management can grow your medical practice tremendously. We have covered this in our medical practice marketing guide as well.

Closed loop physician referral management is an amazing way to get new patients. As you already know, being adept at physician referral management and patient referral management can grow your medical practice tremendously. We have covered this in our medical practice marketing course as well. Learn how to grow your medical practice.

Whether you manage physician referrals via spreadsheets or use some healthcare referral management software or solution – you do need to have a plan for this.  The is the only way to ensure solidifying your relationship with a referring partner is to close the referral loop with them.

Just taking good care of patients is not enough. Use our free healthcare referrals management software to do this better.

Why?

Understand the following a bit further and you will know why closing the loop is so important.

  1. Each provider gets paid by payers.
  2. Each payer gets paid by members (i.e. people like you and me).
  3. Members get insurance from (mostly) their employers.
  4. Employers choose insurance plans available to their employees based on price (quoted by the insurance plans) and also based on HEDIS ratings – Employers and individuals use HEDIS to measure the quality of health plans. (see this link of NCQA)
  5. For Medicare/Medicaid, people use STAR Ratings (As an FYI, The Centers for Medicare & Medicaid Services (CMS) uses a five‐star quality rating system to measure Medicare beneficiaries’ experience with their health plans and the health care system. This rating system applies to all Medicare Advantage (MA) lines of business: Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO). It also applies to Medicare Advantage plans that cover both health services and prescription drugs (MA‐PD).)
  6. So, based on how NCQA rates plans (see this document), point #2 is for clinical measures “Rates for Clinical Measures: The proportion of eligible members who received preventive services (prevention measures) and the proportion of eligible members who received recommended care for certain conditions (treatment measures).“.
  7. How do plans prove it? By proving that members got those services. How is that proven? By documenting visit notes and closing the referral loop. 
  8. So, plans expect PCPs to refer patients out for preventive and treatment measures. PCPs are expected to prove to plans that they did send those patients out by providing visit notes. Specialists need to provide PCPs these visit notes – that’s where you have the power to help your PCPs do better with their plans. This helps the PCPs help their plans do better with NCQA. That gets them higher ratings, which in turn helps the plans be chosen by more employers.. It’s a cycle.

Once you understand the above, you know you need to ensure that:

  1. You keep your referring partner office in the loop about patient no-shows.
  2. After the patient is treated, you need to send the visit notes to referring partners within 24-48 hours. 

This alone will keep you on top of mind with ALL your referring providers. (HINT – this is very easy to do with EzMedicalReferrals)

Most provider offices are really bad about getting these done, so the bar is REALLY low. 

Take care of this aspect and your referring partners will reward you with all referrals.


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