The best physician relations people are only as good as the support they receive from the scheduling department. Scott & White Healthcare (now part of Baylor Scott & White Health) recognized this in 2010 after referring physician offices continually bemoaned the length of time it took to obtain a referral and a lack of communication from the scheduling department to the referring physician.
A large part of the issue was the fax-based system the Physician Referral Network (PRN) was using, which relied on physical pieces of paper, multiple fax machines, filing cabinets and spreadsheets to schedule patients. Keeping track of paper was difficult, especially in instances where the referring physician office did not include all relevant information the first time. Even after a referral had been scheduled, the referring office rarely was updated with the status of the patient.
Recognizing the need for better communications and quicker response among referral sources and Physician Referral Network staffers, the health system decided to leverage the Salesforce.com solution it was using for Physician Relations to help automate and streamline this highly manual process, including fax management services from zPaper.
‘ Automating manual referral scheduling process increases efficiency, improves satisfaction with referral process ’
As a result, satisfaction scores from referring physician offices has improved by 26.5%, while negative ratings have dropped by more than one-third. What’s more, patients are being seen quicker, and PRN staff now have time to perform service-related duties they didn’t have time for previously.
“We now have insight into this process that we didn’t have before,” says Brian P. Borchardt, director of Physician Relations. “The automated processes that zPaper helped implement have brought us great efficiencies and helped us maintain good relations with physicians who refer patients to us.”
Beyond low-hanging fruit
Scott & White Healthcare strives to be the go-to referral source in its Central Texas service area, bringing Borchardt on board in 2007 to launch its Physician Relations program. During the first two years, Borchardt and his staff spent time meeting and educating physicians to develop positive relationships that result in referrals.
“ We really didn’t know how long the (referral scheduling) process took ”
While talking to physicians and their staff, Borchardt kept hearing about scheduling issues that were hurting the system’s reputation. “We were known as the black hole department,” Borchardt says. “Physicians would send patients to us and never would hear back. They didn’t know whether we had lost their records or had taken the patient away.”
The issue Borchardt was hearing about only affected physicians outside the S&W network, since internal referrals are handled by the health system’s EMR. Although the Physician Referral Network was not part of his department, Borchardt received permission to study the referral process.
A year-long review revealed that nearly every process was manual and could be improved upon. The department received more than 140 paper faxes a day, each of which had to be taken from the machines, sorted, manually logged and filed away. The machines often were busy and were prone to break down.
Few referring physicians received confirmation that an appointment had been scheduled, and those referrals that required additional information often got lost in the paperwork shuffle. “We really didn’t know how long the (referral scheduling) process took,” Borchardt says.
Automated solution speeds referral process
Borchardt reached out to Salesforce.com, the cloud database solution that Physician Relations uses, for its assistance within automating and creating consistency in the referral process. The Salesforce consultant S&W uses brought in zPaper to help craft a custom solution to automate the fax receiving, storage and communication processes.
‘ Surveys before and after the system was implemented show a 26.5% improvement ’
Now when a fax is received, a new referral record is automatically created, with the digital fax attached. Caller ID technology links the referral to the referring practice record and routes it automatically to the appropriate person based on the fax number used: the “normal” number, the “urgent” number or the one used in South Texas.
The person working the referral can electronically “separate” the fax into multiple files or multiple referrals, make the appropriate notations and automatically acknowledge receipt through a template, resulting in consistent communications the organization didn’t have previously.
“zPaper set up a barcode system that’s used in requests for additional information from clinics,” Borchardt says. “When the sheet with the barcode is used as a cover sheet, the new information automatically is linked to the appropriate referral record.”
Not only are referral requests quickly acknowledged, the referring physicians receive daily reports that show where each patient is in the referral process. As part of its internal tracking, the system creates weekly reports for S&W department heads showing the status of referrals.
Surveys before and after the system was implemented show a 26.5% improvement among those practices that “strongly agree” or “agree” that it is easy to refer to S&W. What’s more telling is the 36% drop among those that “disagree” or “strongly disagree” with the same statement. Answers to a question about the overall patient referral experience improved 17% following implementation.
Impacts beyond initial deployment
“ They’re not just a fax solution but a great Salesforce.com resource ”
Leadership at Scott & White Healthcare strive to have urgent patient referrals seen within three days. The baseline goal is 65%, but average department was meeting that goal only a quarter of the time, Borchardt says. “We have seen a significant improvement in that metric, which we can track now but couldn’t before,” he notes. Most departments are at 70% or higher.
The timeliness of appointments has not gone unnoticed among referring physicians. On a survey question that asks whether referred patients are seen by a “reasonable” date, responses improved by nearly 50%.
By electronically receiving faxes, S&W saves on paper, toner, filing space and equipment maintenance. But freeing the department from handling paper also has brought labor savings. Scheduling staff frequently was supplemented by other departments. Now the staff can not only handle all external referrals, they also now are performing other service activities they previously did not have time to handle.
“zPaper as a whole was very responsive, focused on our needs and focused on developing a really good solution,” Borchardt says. “They’re not just a fax solution but a great Salesforce.com resource for anything related to this project.”
