Simione™ Healthcare Consultants

Accelerate Referrals by Focusing on Three Customer Service Goals

When a patient is referred for hospice services, several people and organizations are typically involved in a flurry of activity to support the admission process. In order for this process to work effectively, Katherine Northcutt, RN, says that the referral and admission process must focus on communication and a sense of urgency to provide the patient with an experience that eliminates common barriers to care.  On the business side, the first goal of the referral process should be accuracy to meet all regulatory requirements and maintain optimal reimbursement to keep hospice organizations thriving to meet future community needs.  The challenge is to improve the accuracy while maintaining that critical sense of urgency.

The Atlanta-based Senior Manager at Simione Healthcare Consultants, explains, “The requirements for hospice admission these days are very extensive in terms of the documentation necessary to meet quality and regulatory requirements. Among the many requirements for admission are a certification of terminal illness and an order. Consents for treatment are certainly part of the process, as well as determining what expectations and goals the patient and family have. Clinical information and other documentation that support the medical prognosis must also be included in the medical record.  All of this critical information is coordinate by the referral center in most agencies.” 

In addition, Northcutt says financial requirements for referrals include insurance verification/pre-certification, and determination if a face-to-face visit by the hospice physician or nurse practitioner is required.  Comprehensive clinical and financial information is required to ensure the ability to bill effectively.

The second key goal of a referral process should be an appropriate level of urgency to help patients and families experience the full benefits of hospice care.  “Quality management begins when the phone rings! Hospice agencies need to examine their current response time from referral to first visit,” says Northcutt, “while involving the team to improve scheduling and response time, and following up on all details that may delay hospice admission. This level of diligence requires that hospice teams track the time from referral to first visit.”

The third goal area for a customer service-focused referral process relates to assisting patients and families with barriers to care, according to Northcutt. She suggests that hospice teams develop strategies for common barriers to care, and identify who or what plays a role in assisting patients, families and referral sources to remove the barriers to timely hospice care. 

For each of these three goals, Northcutt recommends that customer service-focused referrals be considered for each key customer group:  referral partners, consumer callers, professional callers and internal customers. “By evaluating each kind of customer, the referral and admission teams will better understand potential barriers to timely admission.  They need to remember that they ‘carry the ball’ to not only connect with patients and families, but also to use technology, ensure accurate data and respond in a timely way that results in a high level of satisfaction for people, and appropriate reimbursement for their hospice agency,” Northcutt explains.

She also suggests that every hospice organization incorporate ongoing coaching for all staff, and use mystery calls, call metrics and customer surveys to continually refine its strategy. “Once you hire the right people, keep them motivated and focused on their customers. Ask them what matters to their patients and families, help them address those needs, and celebrate their successes along the way to generate new energy for the effort,” Northcutt says.

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