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The Importance of Getting Referrals Right

Posted on Thursday, March 16, 2017 12:20 PM

The home care industry faces constant changes, including the transition to value-based purchasing and the effects of Pre-Claim Review in certain states. Therefore, referrals have never been more important. In order to have a successful referral program, agencies must have a strong process to build upon, starting with employees and intake staff.

The foundation of a referral program is the intake staff. Empowering and educating staff is vital to improving a home health referral process, Mary Ericson, Director of Nursing at Farmington, Illinois-based Spoon River Home Health, said during a panel at the Illinois Home Care and Hospice Council Annual Conference in Lombard, Illinois, last week.

“Agencies need to ask themselves if their intake staff is feeling empowered to say yes or no to referrals and if they are giving staff the proper tools to do so,” Ericson explained.

Helping intake staff feel confident to ask any questions they may have about a patient is one way to empower them and ensure the necessary information is getting passed along, Maria Ferraro, Clinical Manager of Home Health at Arlington Heights, Illinois-based Northwest Community Healthcare, said during the session.

“Questions surrounding homebound status, what kind of support patients are getting in their home and if the patient is even aware of what services he or she will be receiving are extremely important,” Ferraro said. “As we look at new CoPs [home health Conditions of Participation], it’s going to be increasingly important to make sure referrals turn into successful outcomes.”

“If we unknowingly go out and give a patient service before evaluations and end up not billing for a certain service because they actually didn’t need it, we are placing resources that aren’t necessary on ourselves,” Ferraro explained.

The person calling in the referral also doesn’t always know everything about a patient’s situation and should be asked numerous questions regarding the patient’s health, Ericson added.

“Sometimes the person calling in the referral knows exactly what the patient’s situation is but other times they may not have even met the patient before,” she said. “That’s why it’s the responsibility of the intake staff to ask questions.”

An important part of a successful referral program includes refusing patients, if necessary, Ericson explained.

Once all the details are collected about a referral patient, there must be an open line of communication between liaisons and intake staff – this is an important factor when determining if a patient should not be accepted into home care.

“A home assessment where a staff member would determine if home care services are even necessary should be a top priority,” Ericson said. “You need to know if the home environment is safe and conducive to care and if it’s the right transition destination for the patient if they are coming from the hospital or a skilled nursing facility.”

There is nothing wrong with refusing patients if an agency has the choice, Ferraro adds.

“Being a good referring partner includes giving a response within 24 hours, offering in-house assessments, offering in-house meet and greets, making sure you have adequate staffing and understanding your capacity,” Ferraro said. “Even if you need to refuse a patient for a legitimate reason, if you are consistent in handling referral partners, there’s more of chance your agency will be chosen again down the road.”

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