Blog Post

The Emergency Department Referral Problem: “Follow Up with Your Doctor” Isn’t Cutting It.

Aug 16, 2018 · 4 min read
2018-08-ed-referrals-mobile-healthcare-chatbots

If you’ve ever had the misfortune of visiting an emergency room, you were most likely sent home with a pat on the back, a hefty medical bill, and a referral to see your primary care provider.

You’re not alone. 136.9 million people visit the emergency department (ED) each year, and almost all of them are discharged with instructions to obtain follow-up care.

Here’s the problem: no one ever does.

A shocking 80% of patients never actually attend a follow-up appointment after their ED visit. Most of the time, it’s simply because the patient has forgotten to schedule an appointment. Once a patient is discharged and released back into the whirlwind of everyday life, scheduling a referral appointment is often the furthest thing from mind. An ED physician scribbling the words “follow up with your primary doctor” on a patient’s discharge summary doesn’t carry enough weight to prompt patients to follow through on the next step of their care.

Allowing patients to walk out the door and expecting them to manage their own treatment without follow-up has very real consequences. When patients fail to attend their follow-up appointments, their probability of being readmitted to the ED increases by 31%. Follow-up appointments allow healthcare providers and specialists to ensure patients understand and are sticking to their prescribed care plans. It enables physicians to catch potential misdiagnoses and manage new symptoms or complications. It’s also an opportunity to enforce messages about preventative care and chronic condition management.

Readmissions and poor follow-up carry significant financial ramifications for hospitals in addition to clinical ones. Hospitals who exceed their CMS-designated 30-day readmission targets are slapped with Medicaid and Medicare reimbursement reductions as part of the Hospital Readmissions Reduction Program (HRRP), and providers caring for patients as part of an Accountable Care Organization (ACO) end up bearing the cost of readmission.

Even worse, every patient who walks out of the hospital without a return ticket for a referral appointment represents a significant chunk of lost follow-up visit revenue for the hospital. Each follow-up no-show misses a chance to form a long-term, loyal relationship with a patient. The potential value in creating a strong, dependable consumer base makes referral compliance a key strategic priority for hospitals.

So why haven’t hospitals been able to successfully close the referral loop?

It’s not for lack of trying. Hospitals are attempting to address the issue, but the approach they’ve taken is highly manual and expensive. The industry has proven that having nurses and care navigators call patients after discharge improves their referral adherence by nearly 40%. While the ROI is there, it’s incredibly difficult for a hospital to justify the staffing and operational overhead of calling every patient after discharge. A successful referral adherence program requires dedicated resources like monitoring discharged patient lists, following up with patients who don’t pick up, and reaching out to scheduling and Patient Access staff across the organization.

Luckily, hospitals no longer have to rely on today’s tried-and-true (but expensive) outbound call approach. They now have a much more effective way to reach patients at scale: mobile messaging channels. We’re on our phones all the time, messaging our friends and family, and we’re increasingly interacting with businesses as well. For example, Kayak’s Facebook Messenger chatbot allows customers to book flights directly without having to go to the website. It can even suggest places to go within a certain budget and provide recommendations on things to do, along with finding the best deals on car rentals and hotels.

Messaging has become consumers’ preferred method of communication, one that healthcare systems can utilize to interact with patients when they’re not within the four walls of a hospital. It allows hospitals to hold thousands of concurrent, personalized conversations that meet patients in their preferred communication channels — primarily their mobile phones.

To harness the power of messaging, hospitals are leveraging automated conversational technology with chatbots. Equipping a hospital with chatbots is the highly scalable equivalent of staffing an entire department of nurses and navigators in charge of tracking down patients and nagging them to go to their appointment. Chatbots can meet patients in messaging channels and simultaneously hold a variety of different conversations, from explaining why follow-up appointments are important and scheduling appointments with appropriate doctors, to sharing information with care navigators and delivering appointment reminders. They’re flexible and personable, allowing hospitals to reach out to patients at the right moments without losing the genuine feel of a conversation.

It’s a win-win for both hospitals and patients. From a patient’s perspective, messages from chatbots are more unobtrusive than a half dozen calls and voicemails from a nurse, and more convenient than being put on hold with the Patient Access team. A simple reminder from a chatbot to attend a follow-up and an offer to help schedule it can help patients get the care they need, allowing them to recover more quickly and avoid preventable trips to the ED.

Imagine you’re recovering from pneumonia, and you’ve been discharged from the ED. A conversational chatbot reaches out to you a day after discharge and explains that your ED doc has recommended a follow-up appointment with your primary care provider to review and manage your condition. The chatbot asks what clinic locations would be most convenient and when you’re available and helps you schedule your appointment. Thanks to a reminder the chatbot sends you a day before your appointment, you remember to attend your follow-up. The doctor prescribes new medication to address new symptoms that have cropped up, and you return home with an updated treatment plan. No return visit to the ED, no unexpected medical bill, and a lot less undue stress.

It’s this tailored, high-touch experience, replicated across thousands of patients, that will help hospitals transform populations of patients lost to follow-up into highly engaged, loyal patients who remain in close contact with their healthcare systems all the time, from anywhere.