Optimizing Patient Transfer Through Health Systems to Improve Outcomes, Reduce Costs

Angie Franks, CEO, ABOUT, discusses challenges health systems face when transferring patients between facilities, and shares how optimizing processes can improve revenue and clinical outcomes. 

Read the full transcript:

Welcome back to PopHealth Perspectives, a conversation with the Population Health Learning Network where we combine expert commentary and exclusive insight into key issues in population health management and more.

In this episode, Angie Franks offers advice for health systems to better facilitate patient transfers, improve outcomes and cut costs.

My name is Angie Franks, and I am the CEO of ABOUT. I have spent the last 30+ years in the health care technology space, helping to solve complex problems for hospitals, health systems, and our industry as a whole.

What factors drive the necessity of patient transfer through the health care system?

The patient transfer process is one of the front doors, if you will, for the acute care setting. It is for patients who may be in a suboptimal care setting, meaning the hospital does not have the ability to take care of that particular patient based on their acuity level; the hospital is filled to capacity and doesn't have room; or they don't offer the right service lines to support that patient's particular need. This necessitates the patient’s transfer to another facility.

The transfer process plays out millions of times per year across our health system. And it's critical when a patient is in the wrong setting of care and they need to be at a higher level of acuity. A sick patient needs access to care quickly.

When hospitals are trying to facilitate an interfacility patient transfer, it can take hours of time because of the data—the visibility of appropriate information to make a yes decision, that we can take the patient, we have the room, we have the right physician, and the patient is stable enough to move. That process is filled with friction. Data's in lots of different systems. No one person has the answer. They must make a lot of phone calls, and the person on the transferring end of that patient is sitting there waiting to get a ‘yes’ back from a health system. It can take hours of time.

The need here is to be able to facilitate this efficiently and quickly. It requires technology, automation, workflow, and processes to make that happen quickly and easily. The benefactor of that is, first, the patient, who gets to the care they need quicker. For the health system that's accepting that patient, it's a revenue stream. It eases working with the health system. It's a concierge-level service for the referring providers, and it helps the health system operate more effectively as a whole.

What we do is help health systems take that process from hours to minutes and positively affect patient outcomes.

My next question was about some of the challenges regarding patient transfer. You already touched on those. Did you want to add anything about that?

I think those are the biggest challenges. Information sits in lots of different systems and isn't accessible by any one person.

We help the health system pull this all together, and it’s for the entire system, not one individual hospital. Health systems often have many different facilities and hospitals—postacute, ambulatory, behavioral health. We put in place this infrastructure so they can operate as one system of care and utilize all their facilities to match the demand for care, with the appropriate resources to service those patient needs.

From your perspective, how would you say the pandemic has influenced these challenges?

We used to spend a lot of time educating the market that they actually had a problem.

There were hospitals that knew well the problem of patient transfers and the impact for their health system. And then there were health systems that didn't understand that they had a problem. They were managing, and transfers didn't seem like an issue.

I would say the pandemic was the best educator on the problem. It was better than anything we could have ever done. We saw it play out on the national stage, what happens when hospitals cannot communicate with other hospitals and don't have visibility to available capacity and resources. They didn't have one place to call to facilitate the movement of patients.

As a result, you had one hospital overflowing with demand and available capacity down the road, and patients suffered because of that. It wasn't just beds. It was critical care staff. It was access to resources like Remdesivir or ventilators. All that information can be centralized and codified in a manner that decisions could be made efficiently, not only for moving patients into the right care setting, but also moving patients out of the acute care setting to the appropriate postacute facility. This equally became a challenge and a backlog in our care delivery system during the pandemic.

ABOUT is all about connecting that end-to-end logistics for moving patients into and out of the acute setting and doing that in a centralized hub for the health care network as a whole.

You already mentioned this too, but what would you say are the consequences of inefficient patient transfer on outcomes, industry costs, provider burnout, or anything else you'd like to comment on?

The costs are manyfold. I think it all starts with the patient.

When the patient is delayed getting access to care, there is an impact to their outcome. Especially when you're talking about transfers, where patients are having an acute episode. We never want to compromise that patient's clinical outcome, and speed and efficiency is critical. That's the first important outcome.

The next outcome is for the health system to leverage all their resources, capacity, and various sites of care appropriately. There are financial and operational impacts. Financially, being able to facilitate the movement into and out of the appropriate facility allows you to maximize your capacity. It gets patients out of the acute setting when they're ready to go, to fill those beds with the higher, more acute patient demand. It allows you to align your demand for services with the appropriate resource, meaning you're aligning revenue and cost, keeping people and facilities always operating at the top of their license.

It becomes an economic engine for the health system because when you make it easy to move patients to your facilities, you're the first phone call from all the referring sources. When people don't have technology to make this happen, it's what I was describing earlier: a long, convoluted, friction-filled process, which means delays.

All those delays are unnecessary pressure on a workforce that, today, has so many pressures and demands on them. I'm speaking to the physicians and the nurses and the case managers. We take non-value-added paperwork, phone calls, waiting time, and delays off their plates and make this much more efficient, which allows those people to focus on what they got into their roles to do—take care of people.

How would you say health systems and partners can better facilitate patient transfer overall?

Health care systems first need to understand that when you're looking at patient flow, oftentimes we think, well, patient flow is all about what's happening inside the walls of the hospital or health system. Obviously, that's an important bottleneck and something that needs to operate efficiently. Health systems have made significant investments in electronic medical records to make sure that they operate efficiently and effectively once the patient is there at the hospital or postacute facility.

What I'm really talking about is reimagining what the definition of patient flow is. It starts before the patient gets to your facility. Flow starts from outside the walls of a health system, and it continues after the patient leaves that acute setting.

When you start thinking about it more holistically, you do have some bottlenecks inside the walls of your health system, and we've seen hospitals focusing on those bottlenecks for quite some time. Now you accelerate what you've done there and start driving more patients in. Drive them to the appropriate setting, move patients out more efficiently and effectively to the next best care setting. Now you’ve got an engine and a machine for a truly excellent operational facility. That manifests in good outcomes for the patient, and then financially and operationally for the health system as well.

Where do you see the future of transfer growth going?

I think what's happening in our health care industry is site-of-care decisions are becoming much more complex and mission critical. The days where patients showed up at the front door, came in through the ED, or were referred from providers and the hospital acted as the hub of care are over. We have a much more distributed health care system today than we did even just a couple of years ago.

Look at the pandemic—now we have extended the acute care setting into the patient's home, and that's here to stay. Decision-making has become more complex. The implications of those decisions are also now directly tied to revenue. If you're making decisions as to appropriate setting of care, it could really impact your revenue as well. If you're putting a patient in the wrong care setting, you're going to get reimbursed much less than you would've had you aligned that patient in the appropriate setting of care.

The complexity has become greater over time. We’re shifting our economics to more population-based health care and value-based payment methods. These decisions, having somebody to help the patient and provider navigate where the appropriate setting of care is, are an important opportunity for the health system to define standards and consistency to attract more people and retain those patients in their overall network.

The economics are tied to it. The workforce demands on providers necessitate the opportunity to provide this service in health systems.

Thanks for tuning in to another episode of PopHealth Perspectives. For similar content or to join our mailing list, visit populationhealthnet.com.

This transcript has been edited for clarity.