Referral Agreements Have Positive Impact on Measures

Referral Agreements Have Positive Impact on Measures

June 29th, 2017 | Network NewsNews

Diabetic Eye Exams are one of the quality measures that has presented challenges across our network – be it because of communication, patient access, or data integrity. AHP has a dedicated task force exploring different solutions to these challenges. One possible solution may be implementing a referral agreement. Some of the Primary Care practices in AHP have experienced the positive impact of referral agreements when coordinating care for diabetic patients with Ophthalmology practices.

A referral agreement is a formal understanding of the expectations between a Primary Care Provider and specialist when coordinating care for a mutual patient. NCQA emphasizes the positive impact on patient safety and efficiency that can result from coordinating care in this manner. In the agreement, both parties agree to a referral process, the exchange of information that would be helpful to both providers, and the timeliness of a returned progress note. Ophthalmologist have found they can more easily identify and treat diabetic patients because of the relevant referral information, while Primary Care has felt the positive impact from the timely return of progress notes. Both of these actions translate to improved diabetic eye exam quality measure scores across the network.

An AHP primary care practice in Ontario County has experienced this impact first hand. The practice set up a referral agreement in June of 2016 with an Ophthalmology group near their practice. By the end of 2016, their diabetic eye exam measure score increased by 13.8% and as of this past May, it had already surpassed the 90th percentile for 2017.

A referral agreement does not mean a practice must send all their patients to one specialist, but rather if your patient does see a specialist you have an agreement with, the agreed upon terms will be upheld. As an added bonus, setting up 3 referral agreements with specialists will earn you a point towards your 2017 PCMH submission.

You can click here to download a Word version of the referral agreement template that you can use and adapt to fit your practice’s preferences. If you have any questions please contact Kimberly Povec at [email protected]