The Connected Practice

How ClinicianCore Helps Concierge Medical Practices

Hosted by Dr. Kevin Halow, MD MBA FACS

S3 · Ep12 · 12:27

What You'll Learn in This Episode

Patient expect a physician who closes the loop

Access and responsiveness matter, but concierge patients most want a physician who helps them navigate care after the visit.

Concierge medicine is growing

A national study in Health Affairs found concierge practices in the US grew by 83% between 2018 and 2023.

Referral information often never arrives

In research behind CMS's closing the referral loop measure, 68% of specialists had no information from the primary care physician before the visit.

The EHR holds the record, not the conversation

EHRs keep orders and referral entries, but they rarely connect to each other, so the communication between practices gets lost.

One thread per referral keeps the promise

Receipt confirmed, missing information asked for, the recommendation returned in the same thread, and the physician knows what happens next.

About This Episode

Concierge care coordination is tested after the patient leaves the office. In this episode of The Connected Practice, Dr. Kevin Halow, MD, MBA, FACS, follows Jennifer, a concierge patient whose MRI order goes out by fax and disappears into voicemails and queues. He looks at what concierge members expect, why referral information so often never reaches the other physician, what the EHR does and does not cover, and how a practice can keep referrals, consultations, outside organizations and prior authorizations in one thread, so the physician always knows what happens next.

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Transcript

How ClinicianCore Helps Concierge Medical Practices

0:04

Jennifer Smith is a 58-year-old female who's been very pleased with her move to concierge medicine. Yeah, it's an extra expense, but she enjoys the peace of mind. She has access to her physician. When she messages her physician, she receives a call back, usually within the same day. Jennifer likes the fact that her doctor knows her, her doctor knows her history, knows her goals, even knows her family. On this particular occasion, Jennifer's doctor orders an MRI in an outside imaging center. And then the problems start. The order goes out by fax. Nobody confirms that it arrived. The imaging center needs a prior study, so someone calls and they get a voicemail.

0:50

An authorization question surfaces and it sits in a queue. Three weeks later, the patient messages her physician and asks, "Did anything happen with my MRI?" Well, the physician doesn't know. Hmm. "Well, I'll have to look into it," responds Jennifer's physician. I'm Dr. Kevin Halow, co-founder and chief medical officer at ClinicianCore. On today's podcast, I want to talk about the part of concierge medicine nobody puts in the brochure. What happens after the patient leaves your office to go back into that healthcare jungle? Let me start with what I think

1:36

concierge members expect. Physician accessibility, responsiveness, personalized care, trusted specialist relationships, but mostly a physician who can help the patient to close the loop and navigate the healthcare system. Concierge medicine is growing rapidly because people want it. A national study in Health Affairs found that concierge practices in the United States grew by 83% between 2018 and 2023. That's up from about 1,600 sites to over 3,000. Inside the practice, I can easily see concierge physicians keeping their promise. However, once the patient ventures back into that healthcare world, things change. Our concierge colleagues know

2:22

plenty of trusted specialists. They have fax numbers for imaging centers and laboratories and pharmacies. They know the location of their local ambulatory surgery center. They occasionally seek outside billing support. That network is large, but every single one of those organizations works somewhere else. For our concierge physicians, they have contacts. However, they do not necessarily have the visibility to what happens after the patient walks out the door. That is the gap. Now, I'm not a concierge physician. I'm a surgeon in an independent practice with 19 other surgeons. We have a huge support staff that's capable of nearly anything. Yet we see these issues all the time. One of my partners spends about six hours every Sunday night prepping for her office

3:09

visits on Monday with such mundane tasks as pulling up and reviewing images from more than five different imaging centers where patients receive their care. She just doesn't have the time to do it during the office. I myself routinely receive calls and messages from patients wondering why they have not seen the cardiologist or other referral. Maybe the patient requires a cardiac clearance prior to a surgery. All of this occurs despite our very large and experienced support staff. So I can't even imagine how difficult it could be for a concierge physician in a solo practice with a limited staff. I want to be careful here because this is not necessarily a concierge problem. It's a problem across all of outpatient care.

3:54

But it does hurt the concierge physicians more because of their direct promise to manage it. CMS has a quality measure called closing the referral loop. In the research behind it, 68% of specialists reported receiving no information from the primary care physician before the referral visit. 68%. And on the other hand, a quarter of primary care physicians had no information from the specialist for up to four weeks after that visit. The same measure cites a study where 963 referrals where pediatricians scheduled a specialist appointment for, and only 39% of them actually had referral information sent. Another study looked at similar

4:39

issues where they found that patient information was sent to specialists in only 51% of the time. Remember that it doesn't require a lot. Physicians all speak the same language. Oftentimes, one or two sentences is all you need. But even that isn't getting to the referring physicians. The Agency for Healthcare Research and Quality, AHRQ, defines care coordination as the deliberate organization of care activities among everyone involved, carried largely by the exchange of information. Deliberate. But when that exchange runs on a fax machine and voicemails and other antiquated technology, coordination doesn't run on design.

5:25

It runs on persistence. Somebody on your staff calling again and again. You, as a physician, chasing down the referral. I'm not sure that's what you trained to do when you were in residency. You know the friction points. Referrals faxed with no confirmation, phone calls and voicemails that eat up physician time and staff time, a separate portal for every specialist, hospital and imaging center, missing clinical information that delays the evaluation, nobody is sure who should act next, and almost no visibility into what happened after the referral. Now, a natural question is, what about my EHR? Why can't it handle these issues?

6:10

And the honest answer is it does. It handles part of it. Your electronic healthcare record holds the patient record, the orders, the referral entries, the billing data, and the rest of it. Well, EHRs do not necessarily connect to each other well, so the communication piece is lost, and with it, the continuity of care. That is precisely the gap that ClinicianCore fills. To be clear, ClinicianCore is not for patients. It's not an EHR. It's a secure, HIPAA-compliant, unified communication platform built exclusively for physicians, and it runs beside whatever EHR you're already using. There's no change in your charting. What it replaces is fax, voicemail,

6:55

telephone tag, all the roadblocks that prevent you as a concierge physician from getting your patient the care that they need. Day-to-day, HCO Practice HQ is where practice communication occurs and where it gets coordinated. Trusted Entity status connects the practice with other organizations. ConsultCore structures formal consultations, and Physician Lounge gives physicians a private space with their peers. Four activities. Communicate, collaborate, consult, connect. That's what ClinicianCore does. Let me clarify the role that ClinicianCore plays in your concierge practice. First of all, ClinicianCore manages the conversation around the referral by creating a secure thread both within your organization and between

7:43

medical practice organizations. When a referral is sent, the specialist team confirms receipt and can ask for any missing information if needed. The specialist evaluates the patient. Their recommendation can come back in the same thread. You follow up with the patient and adjust the plan. ClinicianCore provides visibility and closes the communication loop. And yes, you can finally ditch that antiquated fax machine. You just won't need it. Secondly, in ClinicianCore, organizations such as imaging centers, laboratories, pharmacies, surgery centers, billing organizations, all of these can become trusted entities. These are formal connections with verified identity, defined access, shared policies, and an audit trail. This allows for referral

8:29

and scheduling coordination, clinical questions, prior authorization, billing and documentation, and patient care continuity. This is all done with full HIPAA compliance and encryption and complete privacy. Thirdly, ClinicianCore tackles the problems with physician shortages and long patient wait times for referrals. Picture a concierge internist who reviews an abnormal EKG on a patient, a patient in her 60s. Using ClinicianCore, the concierge physician can connect directly to the cardiologist, send the relevant data to include the EKG images, and perform an interprofessional consult for which both physicians are paid. The concierge physician gets an instant answer. The patient does not have to wait

9:15

three months for a referral, and both physicians are paid for their time and effort. Everyone wins, especially the patient. Finally, this is the one thing that every practice dreads, which is prior authorizations. Even a concierge practice that does not take insurance has patients whose plans have to approve things like advanced imaging, specialty medications, procedures, or diagnostic tests. These orders oftentimes require preauthorization, many of which now have to be done within seven calendar days, or expedited ones within 72 hours. ClinicianCore eliminates the stress and burnout with these prior auths by creating one workflow so that everyone on both

10:00

sides of the referral has visibility. Fewer repeated phone calls, less faxing, fewer missing documents, clearer status. This is medical practice efficiency in concrete terms. Let me bring it back to where we start. As a physician, I know that my patients judge me by what happens after they leave my office, not necessarily by how quickly I answer the phone. I suspect the same holds true for every concierge physician. Closing the loop with every specialist is part of the promise. Concierge patients like Jennifer Smith in the example we started out with have come to expect that kind of care.

10:46

Today, a patient's healthcare journey can involve faxes, portal messages, emails, phone calls, and voicemails. On the other hand, in ClinicianCore, the patient's journey is guided by one connected record of communication that physicians and their staff can follow from the first question to the final recommendation. Concierge medicine promises personalized attention and a physician who stays involved. Keeping that promise means trusted relationships with specialists and organizations beyond your walls, ways to get specialist expertise, ways to coordinate referrals, and a guarantee that recommendations come back to the physician who is responsible for the patient.

11:31

ClinicianCore is how you keep that promise. Okay, that's all we have for today. If you want to see how ClinicianCore can help your practice communication, collaboration, consultation, and connection across healthcare networks, especially in your concierge practice, request a live demo. The link is in the show notes. I'm Dr. Kevin Halow, co-founder and chief medical officer of ClinicianCore. The next time a patient walks out of your office, ask yourself one question. Do I know what will happen next? If you do not, then it's time that you visit cliniciancore.com. Thanks for listening.

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