Referral Patterns in Healthcare: The Key to Growth

With so much competition in the long-term and post-acute care (LTPAC) market, maintaining growth takes work. Because of the rapid expansion of the over-65 demographic, it’s essential that LTPAC organizations and referring physicians understand the impacts of referral patterns in healthcare. The networks you participate in affect your ability to attract hospital referrals and drive new revenue.  

What are Referral Patterns?

Referral patterns are the processes that hospitals and physicals use to move patients from one care facility to the next. For example, when patients are ready for discharge from a hospital but still need extended care, they typically get referred to an LTPAC facility.

In the traditional healthcare referral pattern, you had physician groups acting in a sort of lobbyist role to get patients directed to their choice of LTPAC facility. They established personal relationships with hospital personnel and even offered gifts and other perks. Because decisions were based on personal relationships rather than health metrics, patients sometimes ended up in facilities unequipped to handle their health needs.

Those informal connections also increased the potential financial risks for both patients and hospitals. For example, patients released to an LTPAC too soon are more likely to return to the hospital for another costly stay.

The financial stakes for hospitals were compounded by the October 2012 Hospital Readmissions Reduction (HRR) Program. The program aimed to ensure that hospitals gave patients the proper level of care and weren’t referring to LTPAC environments before they were ready. Any hospital with high Medicare patient readmission rates faced hefty financial penalties. Because of that, hospitals and LTPAC facilities started paying closer attention to what happened to patients when they left the hospital.

How are Referral Patterns Evolving?

In the traditional healthcare referral pattern, the informal relationships hospitals formed with various physicians’ groups, rather than patient needs, often influenced a patient’s LTPAC destination. Now, hospitals understand the costs of not looking beyond a single recommendation. Instead, they’ve shifted to working with a smaller network of trusted LTPAC providers with proven experience helping patients receive quality care.

Hospital executives have turned to data analysis to inform their LTPAC referrals. They examine how many patients the LTPAC facility returns to the hospital and pay attention to what patients say about their overall experience. Any facility that meets a hospital’s standard of care gets placed in its referral network. That doesn’t mean that the opinion of a referring doctor no longer matters. However, many hospitals now consider data an essential component of LTPAC referrals.

Data-driven health decisions enable better patient outcomes while reducing overall healthcare costs. There’s less risk of a patient bouncing back and forth between the hospital and LTPAC because of a lack of adequate care.

What’s Driving the Change in Referral Patterns?

Gone are the days when a physician’s group could drive business to their LTPAC with nothing more than clever marketing. These days, hospitals want to see metrics telling them that patients will be safe and well-cared for at a facility. They tend to look at LTPACs who already participate in their system of health plan preferred networks to save money for themselves and their patients.  

Some healthcare providers are partnering with companies that supply health data to fill information gaps. These companies provide information about LTPACs' accessibility for clients, primary languages, and ability to shoulder costs for patient care.

Modern LTPAC facilities can offer various services, including skilled nursing and home care. However, they must back up their capabilities with hard facts if they want to be included in a hospital’s LTPAC referral network. To maximize their role in the new referral patterns in healthcare, an LTPAC needs to join more preferred provider networks by showing an exemplary standard of care.

How LTPAC Facilities Can Build Referral Prospects

A better understanding of referral patterns allows doctors to influence patient care positively. Likewise, healthcare providers gain the ability to provide care beyond the confines of a hospital bed.

As an LTPAC provider, you can build your referral prospects by showing hospitals that you are taking purposeful steps to prioritize patient care, such as by:

• Using data analysis and care metrics to show that you're capable of providing a high level of care to discharged patients.
• Providing unique care options, such as home upgrades to accommodate individual medical needs, to give hospital physicians more faith in their referral.
• Improving on your Merit-Based Incentive Payment System (MIPS) scores by focusing on quality, improvement activities, interoperability, and cost.

Ensure Better Health Outcomes With ChartPath

At ChartPath, our electronic healthcare record (EHR) platform allows providers to access critical data relevant to patient care. We also partner with referring software to make navigating the new referral patterns a breeze. Learn more about how ChartPath can play a part in attracting new referrals by trying out a demo of our platform.