To Strengthen Post-Acute Referrals, Healthcare Must Take a Fresh Look at Data Exchange

5 minute read

For too long, the healthcare industry has focused on how well healthcare organizations can exchange data with one another—not on how easily the data can be digested by the recipient without a significant amount of manual labor. 

As an executive focused on healthcare IT strategy and policy, I’m beginning to see a lot of federal regulations around communication protocols for sharing healthcare data, including FHIR protocols, or standards for ensuring data exchange is effective and secure. I’ve even been involved in a discussion around how to advance the use of structured data formats in post-acute care settings to ensure continuity in care.

But skilled nursing facilities (SNFs) and post-acute care facilities typically do not have an EHR. They weren’t part of the meaningful use incentives that helped support EHR implementation in acute care facilities. And even if they did have an EHR, the reality is that even within a single health system, most providers work from disparate systems. 

The barriers to meaningful collaboration around post-acute care are significant:

  • More than half of post-acute care facilities say they sometimes or often receive patient information after the patient is in their care.
  • Even when the information does arrive, 76% report that at least a portion of the data isn’t usable or it’s incomplete.

That’s why improvements to protocols for the exchange of patient data must take into account the impact these changes will have on post-acute facilities—especially when it comes to referral management. These facilities care for our most vulnerable individuals, and most aren’t prepared to accept data in an advanced format.

Proactively Improving Post-Acute Data Exchange

How can post-acute providers more effectively advocate for themselves in improving information transfer, especially when it comes to referrals? During a recent webinar by McKnight’s Senior Living, which focused on ways that technology can help streamline post-acute care referrals, two colleagues in the senior living space and I shared the following tips.

  1. Look for opportunities to collaborate with other providers around continuity of care. “We’ve seen a rise in what I call collaborative or shared care planning,” says Majd Alwan, PhD, an aging services technology expert and thought leader. “This offers the opportunity for multiple care partners from different organizations to participate in building a care plan together. We’ve seen significant improvement in health outcomes and patient and family satisfaction through this approach as well as reduction in hospital admissions and care costs. Much of this is due to the increased attention to the patient’s goals and purpose.”
  2. Make sure post-acute providers are aware of technological options to act on referral data. For instance, while the implementation of an EHR could cost $75,000 to $100,000, moving from paper-based fax to a digital cloud fax solution can help centralize the intake and referral process. It enables staff to process paperwork faster. When paper discharge plans might be up to four inches thick, a faster option to get the work done can be a Godsend. Documents spend less time in the network and patients spend less time waiting for the right care. And, when digital cloud fax is paired with advanced integration solutions, including Natural Language Processing (NLP) and artificial intelligence capabilities, this technology can turn unstructured data into actionable structured data, making it easy to automatically route the needed information to fields in an EHR or a portal. Staff and clinicians can easily find the information they need at a glance. It can also alert staff to the need to take specific actions—like coordinating hospice care—or flag requests containing handwriting that says “urgent,” with alerts delivered directly within clinicians’ workflows.

    “Referral management is our lifeline in skilled nursing. It is where we receive all our information upfront about a patient we are going to admit,” says Kelly Reese, admissions coordinator for The Oaks Skilled Nursing at Bethany Village. “It’s good to have all of the data you need at our fingertips rather than search for the information we need to make the right decisions for our patients.”

    Seven out of 10 hospitals
    still rely on paper faxing to transfer patient records or orders for prescriptions. New technologies are available today that are a less expensive and highly effective alternative for strengthening referral management and intake.

    Post acute care providers should consider taking advantage of an advanced cloud faxing solution for improved data transfer, and combining it with an integration tool that includes NLP AI technology to transform the information into HL7, FHIR or X12 messages, which can then produce actionable data.

  3. Push for financial incentives for post-acute facilities’ use of FHIR-based standards for prior authorization. Prior authorization is an essential aspect of referral management. The Centers for Medicare & Medicaid Services (CMS) has proposed that payers be required to send expedited decisions around prior authorization within 72 hours. This would be a positive move for post-acute patient care. However, CMS also proposes that requests for expedited prior authorization review be sent using FHIR-based standards—something most post-acute facilities are not equipped to do. Currently, there’s no financial incentive for post-acute facilities to implement FHIR-based capabilities. If the proposed rule were to pass, it would disqualify the care facilities that treat our most vulnerable patient population from attaining interoperability. Collectively, post-acute care providers could advocate not just for financial incentives to make this transition possible, but also for relaxing the proposed rules and letting the industry innovate. Companies like Consensus Cloud Solutions can translate any type of document into the preferred format to satisfy the proposed rule data standards. We can start with a cloud fax and apply our advanced technology to turn that document into a structured FHIR message or X12.

By taking a proactive and collaborative approach to strengthening referral management and prior authorization processes with new technologies, post-acute providers can more effectively meet the needs of patients and their families, while empowering clinicians to provide better care sooner, rather than later.