Increasing referrals: as easy as E, F, G - post-acute care referrals

Nursing Homes, March, 1996 by Laura Hyatt

One of the most often asked questions by post-acute providers is, "How can my organization become more attractive to referrers?" The first consideration is, what do referral sources want? What process do they use in selecting a service delivery site? I queried a number of case managers, physicians, social workers and discharge planners on just that point. Here, in order, are the elements that were the most important to them:

Geography was number one. In rural areas and small communities, choices may be limited or non-existent. Urban areas often have the same type of service offered at many sites, and more specific geographic factors come into play. For example, a facility should be geographically desirable not only to the patient and family, but also to the attending physician, consultants and other health care service providers. The patient's need for, and tolerance of, transportation to the site is an important factor. So is convenient access for providers and for families. The patient may have special needs that require frequent visits by the physician as well as other specialists. Also, research has shown that the patients length of recovery is directly influenced by the involvement of family and friends.

Financial reimbursement ranked a close second-no surprise to providers, but what may be surprising is the depth and complexity of the issues involved. There are many potential reimbursement streams. Private pay, worker's, comp, indemnity, Medicare and Medicaid. hi addition, the post-acute provider has to be versed in managed care's demands, including Medicare cost and Medicare risk patients, Medicaid managed care, per diem rates, case rates, partial capitation and full capitation. And as if that were not enough, there are also many Federal, state and community demonstration projects underway using varying combinations of the above. Referring parties expect the provider to have a clear understanding of this financial maze and to take responsibility for negotiating it.

Third on the fist is effectiveness. This category encompasses the range of services offered, the ability of those providing the services and the measurable quality of those services.

The range of services includes those which are appropriate to the diagnosis and needs of the patient who is being referred. For example, the post-acute provider may have an excellent traditional nursing home, but the patient may require the services of a subacute care program. Often the patient presents with secondary and tertiary conditions. The referral source, seeking one-stop shopping, would prefer that the facility be equipped to provide for these. A patient who has renal deficiencies and is recovering from a hip replacement is more likely to be referred to a nursing home facility that can provide for dialysis as well as comprehensive rehabilitation therapy.

The perceived skills and experience of the staff contribute significantly to new as well as repeat business from referral sources. The referring party will want to become familiar with the qualifications of physicians, nursing staff, therapy staff, activities and social service directors as well as the administrative and other professional personnel. It has always been true that a facility is only as good as the people who work there-it's just that now there are so many different types of professionals involved.

The outcome of services offered is, of course, the best measurement of effectiveness. Continued business is assured if the post-acute facility can document that it meets or exceeds the expectations of the referring party and the family involved. As an initial cut at this, it is most important to ascertain what exactly is expected, from whom and in what time period. The facility's response must then be communicated clearly. A facility-based case manager can provide a single point of accountability and offer consistent information.

Licenses, survey results, community involvement and accreditations, such as those offered by JCAHO and the CARF can influence the referring party's perception of your organization's ability to deliver quality services. Often, because of the world in which they have traditionally operated, they understand the accreditation language best, although nursing facilities should make a concerted effort to educate them about the OBRA requirements they face.

These concerns cut across every level of health care -- acute care, nursing home care, home care, outpatient services, mental health, private practice or community-based services. You can simplify your understanding of them with the alphabetical acronym EFG: effective services, financial reimbursement savvy and a geographically desirable location.