Referral Reconciliation

What Works: Effective Practices for Office-based CareReferrals
Reconciliation of Referrals

Recommendation: The practice has a system to ensure patients attend referred appointments.

Source: CRICO/RMF Office Practice Handbook


 Exemplary Practice

  • Designated "Check-Out" secretary to schedule referral at the time of the appointment
  • Referral information is conveyed to the specialist by phone or e-mail
  • All referrals are entered into a database
  • An outstanding referral report is reviewed weekly and reconciled against ordered referrals

Benefits:
  • Enables reconciliation
  • Patients don't fall through the cracks
  • Enhances coordination of care across multiple disciplines
In practice at: Harvard University Health Services


 Exemplary Practice

  • Designated staff member to schedule referrals and communicate appointment information to both the patient and the provider
  • Scheduling may be completed at the time of the appointment
  • Providers can communicate electronically through a clinical message system
  • Use of back-dated electronic clinical messages prompt the provider to cook for a consultation report

Benefits:
  • Patients don't fall through the cracks
  • Enhances communication and coordination of care across multiple disciplines
  • Providers see results in real time
In practice at: MGH Senior Health (MGH), HVMA Burlington


 Effective Practice
Reconciliation of Critical referrals includes the following compenents:
  • The practice uses a referral coordinator to make the appointments for the patient. The patient is notified of the details of the appointment by phone and letter.
  • The specialist reports are reviewed by an administrative coordinator who reconciles the report against a list of outstanding referral requests.
  • Reports are sent to the ordering provder either through the EPIC system, or if they are on paper they are scanned.
  • Patients who do not keep an appointment are contacted, and a letter is sent up to three times. The last letter sent certified mail encouraging the patient to keep the appointment or to fill out a refusal of treatment form.
  • Documentation regarding follow up is included in the patient record.
Benefits:
  • Provides a system for reconciliation of critical referrals.
  • Documents patient preference regarding completion of referral.
In practice at: CHA Revere Family Health, Somerville Primary Care


 Effective Practice
  • Most patients are referred to Children's Hospital specialists.
  • A referral form is sent to the Children's Hospital liaison that contacts the patient and makes the appointment.
  • The office receives appointment notification and obains third party authorizations.
  • The liaison notfies the office when a patient fails to schedule an appointment.
Benefits:
  • Ensures patients are compliant in scheduling the specialist appointment.
  • Improves ease of scheduling multiple appointments.
In practice at: PPOC Aisling Gaughan, Westwood-Mansfield Pediatrics


 Effective Practice
A designated employee keeps a copy of the referral request in a central file. These referral requests are reconsiled monthly. If the consult report is not available, the medical assistant is notified. The MA follows up with the patient and the physician regarding the referral.
Benefit: Enhances communication and coordination of care across multiple disciplines.
In practice at: MAH Physician Associates of Mount Auburn (PAMA), MAH Office of Dr. Christopher Peckins


 Effective Practice
For specialist-to-specialist referrals, a practice-based system reconciles reports and requests.
Benefits:
  • Enables reconciliation.
  • Patients don't fall through the cracks.
In practice at: Salem Women's Health (NSMC), Brookside Community Health Center (BWH), The Doctors Group Brookline (BIDMC), HVMA Quincy


 Effective Practice
LMR to do list to track referrals.
Benefits:
  • Enables reconciliation.
  • Simplifies coordination of the referral process.
In practice at: Harbor Medical Group Infectious Disease (NSMC), Office of Dr. Skowronski (NSMC), Office of Dr. Macomber (NSMC), North Shore Family Medicine (NSMC), Puritan Medical Center Harbor Medical Group Infectious Disease (NSMC)


 Effective Practice
A color-coded card system to identify patients sent for referral. Referrals are reconciled weekly by staff.
Benefits:
  • Easy to implement.
  • Enables reconciliation.
In practice at: Office of Dr. Bassaly (BWH), Prima Care Office of Dr. Harrision (BWH)


 Effective Practice
  • Preferred medical specialists are listed on the practice web site.
  • An e-mail is sent to the specialist with the referral information and pertinent notes for reference.
  • The specialist's office contacts the patient to make the appointment.
  • PCP is notified if the patient is a "no-show."
  • The LMR's to do list is used to track ordered referrals.
Benefits:
  • Promotes dialogue between consultant and PCP.
  • Notification of PCP if specialist appointment is not kept.
In practice at: Family Medicine North (NSMC)


 Effective Practice
Referral is entered into the IDX scheduling system. All referrals have an end date and reports are generated that highlight patients who have not been seen by a specialist.
Benefits:
  • Enhances communication and coordination of care across multiple disciplines.
  • Enables reconciliation.
In practice at: Harbor Medical Group Salem (NSMC), Harbor Medical Group Infectious Disease (NSMC)


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