Male doctor sitting in hospital hallway, looking at digital tablet

A lack of communication between post-acute care providers and their patients’ healthcare networks strains operational efficiency. It also makes care transitions more challenging, according to a recent survey conducted by health technology firm WellSky.

The researchers surveyed 65 ambulatory care physicians across the United States in July 2023 regarding their referral methods. The results of the surveys showed that effective communication between these physicians and post-acute agencies is critical. However, ineffective tools and other inefficiencies can hurt providers’ ability to best serve their patients.

“In the ambulatory segment of healthcare, they’re really starting to hone in on the importance of post-acute,” researcher Lissy Hu, MD, president of connected networks at WellSky, said in an interview with McKnight’s Home Care Daily Pulse. “What we’re seeing is that physicians more and more are looking for ways to better work with their post-acute care providers. And there’s a growing awareness of the importance of post-acute and community partners as they look at managing patients across the care continuum.”

Wasting valuable time

These physicians refer about 1 in 3 home health episodes, according to the report. They also refer patients to personal care, hospice and community providers. But 75% of the doctors also said they do not have established partnerships with post-acute care providers, making referrals and other communications more difficult.

Oftentimes, however, these referrals happen over the phone or by fax, which can reduce physicians’ “visibility into their patients’ care journeys,” according to the report. The majority of physicians also said that they are immediately alerted when their patients are admitted to or discharged from a hospital. Meanwhile, only 63% are notified when their patient enters the care of a post-acute provider.

“We all know that with fax and phone calls, a manual process can be quite an inefficient process,” Hu said. “The more manual processes that you have in place, that creates inefficiencies.”

When physicians do hear word from their patients’ post-acute agency, it is often delayed or inaccessible. More than 75% of respondents said they receive delayed responses after making post-acute referrals. Some 21% said that sharing patients’ medical records can often be difficult or even impossible. Furthermore, 28% noted uncertainty about providers’ quality of care due to a lack of information, making referrals more challenging. As a result, patients can receive delayed care or even lower-quality care, according to Hu.

Rewarding efficiencies

“You have to hire more people to service more demand, but you also need to enable people to be more efficient in the way that they’re doing,” she said. “I would encourage folks to start to have conversations around how we really take this process to the next level.”

And as the home care industry dives fully into value-based purchasing, providers can earn financial incentives for building more efficient systems to better serve their patients.

“There’s more and more participation in these value-based care programs,” Hu said. “As they start to move into payment models that reimburse on outcomes and on quality, then they’ve got more and more sort of the funding to be able to invest in systems that enable them to have more visibility across the full continuum of care.”