When health systems consolidate and specialize, emergent transfers increase
November 25, 2019
By Angie Franks
Healthcare merger and acquisition (M&A) activity increased 14.4 percent in 2018 over the previous year, led by agreements between hospitals, physician groups, home health agencies and long-term care facilities. Likewise, a quarterly healthcare M&A report from consulting firm PwC notes that these agreements are continuing at a brisk pace in 2019, increasing by 24 percent among hospitals, while physician groups’ and other services’ M&A grew by 17 percent and 14 percent respectively. The firm notes that “[h]orizontal integration (e.g., health system mergers) is likely to continue due to its potential to strengthen service lines or mitigate volume pressure and high costs.”
As health systems consolidate and specialize as predicted, maximizing patient volume and retention will be essential for long-term financial success.
With much of a large health system’s higher revenue-generating patients coming from referrals to its specialty centers, organizations need to ensure the transfer process is as easy and simple for the referring physicians. Such transfers need to be managed by more than a call center, but rather a centralized care orchestration hub, staffed by highly skilled clinicians that ensures patients receive the right care, at the right location, without delay. Having the right processes in place can create operational efficiencies and cost savings, while meeting the broader mission of health systems to drive growth, stem leakage, increase revenue and ensure comprehensive access to all services.
The end goal is visibility throughout the enterprise, systems integration, and actionable insight. Such comprehensive awareness can avoid situations such as a patient being admitted to a specialty center when they could have been treated in a more general setting; or another patient who may be sent home to wait for an open bed when another hospital within the system has availability.
This capability is even more crucial when organizations are spread over large geographic areas. Limited and siloed data lead to cumbersome transfer processes, resulting in multiple wasted phone calls to the wrong physicians, waiting, and ultimately, extended care delays, which are unacceptable in emergent situations. Instead, agents working within a health system’s transfer center should have a real-time view of the enterprise’s facility capacity and provider availability across a broad range of specialties.
Evolving to a health system focused on improving care access should be about making it easier for patients and physicians to work with health systems. When a health system makes care access easier, referral bases expand and leakage to competitors decreases, even in consolidating markets.
Beyond a call center
In most cases, referring emergency departments initiate a patient transfer by calling the health system to which the patient is being referred. Busy clinicians who make these referrals need more than a call center; they need support from a highly trained team equipped with integrated, predictive and enterprise-wide analytic tools to guide physicians to the appropriate care location, whether that is a specialty center focused on trauma, heart and vascular, neurology, or a less specialized care venue.
To serve in this consultative role, agents serving in the transfer center would have the right composition of personalities, skill sets, roles and training. To effectively support physicians and other providers in emergent situations with high-acuity patients also means that additional training and assessing for interpersonal skills and a service-focused attitude is essential.
However, difficult transfers that require excessive waiting, callbacks, and unproductive consultations with physicians who cannot approve a transfer or admission can be a source of frustration, often causing referring physicians to choose a competitor. Transfer request decisions should not be made lightly, but the faster the health system can arrive at a “yes” to the transfer request, the happier the referring physician will be.
Likewise, during a difficult medical event, patients and their loved ones will remember that they or a family member received the care they needed quickly and smoothly. Conversely, they’ll remember — and share with anyone who will listen — a negative experience. The patient and family don’t care about all the complex calculations that go into a successful transfer. They only want a quick resolution and to come out of the experience feeling well-cared for.
Understanding true capacity and load balancing
Improving the speed of that resolution requires access to facility and physician data, as well as analytics that integrate actionable information from a multitude of disparate systems. Unfortunately, some healthcare organizations may only have a high-level overview of their main hospital, or data sets that are hosted on different applications, requiring switching back and forth between platforms, and multiple phone calls to verify information, all of which slow the time to definitive care. Instead, well-designed, easy-to-use dashboards would facilitate answering referring physicians’ questions faster and more accurately. Having the most up-to-date information about systemwide capacity and on-call physicians would also speed the time from first contact to appropriate care.
Actionable, high-quality, real-time data help agents in the transfer center make efficient, informed decisions as they move patients throughout the health system. This enables them to avoid overloading any one facility, and rather balance transfer requests so clinicians are not overwhelmed, and patients receive timely care. Quantifiable, easily interpretable results allow for swift, accurate decisions based on individual patient needs, doctor availability, and the ability to accommodate new patients.
To support such decisions, data available should include comprehensive patient history, conditions, medications and past encounters, in addition to information on facility and physician capacity. In some cases, the right care choice is to keep the patient away from higher-cost settings. The health system needs to assist with those types of decisions, too, by facilitating a rapid consult with a physician specialist who can view data and recommend safe and effective next steps.
Technology to support clinician expertise
Standardized and optimized processes ensure every patient receives high-quality care, and helps ensure that both patients and referring physicians have a positive experience. Automation also allows agents to spend less time on repetitive data entry, eliminates the need for switching between multiple screens and systems, and reduces their overall cognitive workload.
Automated workflows support rather than supplant the essential human element behind enabling care access. Electronic transportation orders that auto-populate information about patients such as medication lists, medical history, last seen details, and more, save time so access center agents and clinicians can find the best solution, customized for each patient.
Less time searching for and inputting data means the clinicians involved in coordinating critical patient transfers can practice to the top of their license, using problem-solving skills, judgement and communication, which again supports an improved service experience for referring physicians and their patients.
Reporting for continuous improvement
Healthcare leaders can use the real-time data that the transfer center technology captures to analyze both clinical and financial ROI. They can also use those data to pinpoint missed care access opportunities and take corrective action to reduce network leakage and repatriate patients who have received care from another health system.
This emphasis on patient retention is essential at a time when the industry is being shaped by tremendous external forces. Health system leaders must work to adapt their care delivery models to the realities of operating with significant risk-based revenue arrangements and consolidating markets. Focusing on rapid and efficient transfers and offering agents within the transfer center complete visibility over the enterprise’s facilities and physicians can help organizations thrive in a rapidly changing, competitive environment while also improving patient outcomes and access to the right level of care.
About the author: Angie Franks is the CEO of Central Logic, a company that partners with leading health systems to deliver an enterprise-level view of every point of access within their system, and the tools needed to accelerate access to care, increase revenue, and become the health system of choice in their market.
Healthcare merger and acquisition (M&A) activity increased 14.4 percent in 2018 over the previous year, led by agreements between hospitals, physician groups, home health agencies and long-term care facilities. Likewise, a quarterly healthcare M&A report from consulting firm PwC notes that these agreements are continuing at a brisk pace in 2019, increasing by 24 percent among hospitals, while physician groups’ and other services’ M&A grew by 17 percent and 14 percent respectively. The firm notes that “[h]orizontal integration (e.g., health system mergers) is likely to continue due to its potential to strengthen service lines or mitigate volume pressure and high costs.”
As health systems consolidate and specialize as predicted, maximizing patient volume and retention will be essential for long-term financial success.
With much of a large health system’s higher revenue-generating patients coming from referrals to its specialty centers, organizations need to ensure the transfer process is as easy and simple for the referring physicians. Such transfers need to be managed by more than a call center, but rather a centralized care orchestration hub, staffed by highly skilled clinicians that ensures patients receive the right care, at the right location, without delay. Having the right processes in place can create operational efficiencies and cost savings, while meeting the broader mission of health systems to drive growth, stem leakage, increase revenue and ensure comprehensive access to all services.
The end goal is visibility throughout the enterprise, systems integration, and actionable insight. Such comprehensive awareness can avoid situations such as a patient being admitted to a specialty center when they could have been treated in a more general setting; or another patient who may be sent home to wait for an open bed when another hospital within the system has availability.
This capability is even more crucial when organizations are spread over large geographic areas. Limited and siloed data lead to cumbersome transfer processes, resulting in multiple wasted phone calls to the wrong physicians, waiting, and ultimately, extended care delays, which are unacceptable in emergent situations. Instead, agents working within a health system’s transfer center should have a real-time view of the enterprise’s facility capacity and provider availability across a broad range of specialties.
Evolving to a health system focused on improving care access should be about making it easier for patients and physicians to work with health systems. When a health system makes care access easier, referral bases expand and leakage to competitors decreases, even in consolidating markets.
Beyond a call center
In most cases, referring emergency departments initiate a patient transfer by calling the health system to which the patient is being referred. Busy clinicians who make these referrals need more than a call center; they need support from a highly trained team equipped with integrated, predictive and enterprise-wide analytic tools to guide physicians to the appropriate care location, whether that is a specialty center focused on trauma, heart and vascular, neurology, or a less specialized care venue.
To serve in this consultative role, agents serving in the transfer center would have the right composition of personalities, skill sets, roles and training. To effectively support physicians and other providers in emergent situations with high-acuity patients also means that additional training and assessing for interpersonal skills and a service-focused attitude is essential.
However, difficult transfers that require excessive waiting, callbacks, and unproductive consultations with physicians who cannot approve a transfer or admission can be a source of frustration, often causing referring physicians to choose a competitor. Transfer request decisions should not be made lightly, but the faster the health system can arrive at a “yes” to the transfer request, the happier the referring physician will be.
Likewise, during a difficult medical event, patients and their loved ones will remember that they or a family member received the care they needed quickly and smoothly. Conversely, they’ll remember — and share with anyone who will listen — a negative experience. The patient and family don’t care about all the complex calculations that go into a successful transfer. They only want a quick resolution and to come out of the experience feeling well-cared for.
Understanding true capacity and load balancing
Improving the speed of that resolution requires access to facility and physician data, as well as analytics that integrate actionable information from a multitude of disparate systems. Unfortunately, some healthcare organizations may only have a high-level overview of their main hospital, or data sets that are hosted on different applications, requiring switching back and forth between platforms, and multiple phone calls to verify information, all of which slow the time to definitive care. Instead, well-designed, easy-to-use dashboards would facilitate answering referring physicians’ questions faster and more accurately. Having the most up-to-date information about systemwide capacity and on-call physicians would also speed the time from first contact to appropriate care.
Actionable, high-quality, real-time data help agents in the transfer center make efficient, informed decisions as they move patients throughout the health system. This enables them to avoid overloading any one facility, and rather balance transfer requests so clinicians are not overwhelmed, and patients receive timely care. Quantifiable, easily interpretable results allow for swift, accurate decisions based on individual patient needs, doctor availability, and the ability to accommodate new patients.
To support such decisions, data available should include comprehensive patient history, conditions, medications and past encounters, in addition to information on facility and physician capacity. In some cases, the right care choice is to keep the patient away from higher-cost settings. The health system needs to assist with those types of decisions, too, by facilitating a rapid consult with a physician specialist who can view data and recommend safe and effective next steps.
Technology to support clinician expertise
Standardized and optimized processes ensure every patient receives high-quality care, and helps ensure that both patients and referring physicians have a positive experience. Automation also allows agents to spend less time on repetitive data entry, eliminates the need for switching between multiple screens and systems, and reduces their overall cognitive workload.
Automated workflows support rather than supplant the essential human element behind enabling care access. Electronic transportation orders that auto-populate information about patients such as medication lists, medical history, last seen details, and more, save time so access center agents and clinicians can find the best solution, customized for each patient.
Less time searching for and inputting data means the clinicians involved in coordinating critical patient transfers can practice to the top of their license, using problem-solving skills, judgement and communication, which again supports an improved service experience for referring physicians and their patients.
Reporting for continuous improvement
Healthcare leaders can use the real-time data that the transfer center technology captures to analyze both clinical and financial ROI. They can also use those data to pinpoint missed care access opportunities and take corrective action to reduce network leakage and repatriate patients who have received care from another health system.
This emphasis on patient retention is essential at a time when the industry is being shaped by tremendous external forces. Health system leaders must work to adapt their care delivery models to the realities of operating with significant risk-based revenue arrangements and consolidating markets. Focusing on rapid and efficient transfers and offering agents within the transfer center complete visibility over the enterprise’s facilities and physicians can help organizations thrive in a rapidly changing, competitive environment while also improving patient outcomes and access to the right level of care.
About the author: Angie Franks is the CEO of Central Logic, a company that partners with leading health systems to deliver an enterprise-level view of every point of access within their system, and the tools needed to accelerate access to care, increase revenue, and become the health system of choice in their market.