The Executive Suite: RTA: A metric for value-based care

When speaking with friends, family, and colleagues, the phrases “healthcare is difficult” or “healthcare is different” are often heard. There is just something about the healthcare industry that justifies these statements and rightfully so, as healthcare impacts all of us as individuals and as a society. Ensuring these critical services work across a broad spectrum of participants is notoriously complex. From federal and state government requirements and regulations to the needs of a small provider practice trying to deliver the best possible care on the free market, it is not a simple task to try to quickly explain the economics of healthcare without starting with “healthcare is difficult” or “healthcare is different.”

There is one critical metric that is the key to unlocking a myriad of mission-critical problems plaguing the healthcare industry, the “referral-to-appointment” ratio, or RTA. A new concept to healthcare, RTA is the foundation for value-based care organizations, allowing them to confidently take on more risk while at the same time empower those who are focused on the traditional fee-for-service model of healthcare delivery. A high RTA benefits everyone by scheduling patients for the healthcare they need and by supporting the current, and most importantly, future healthcare ecosystems.

What is RTA?

In simple math, RTA is the number of total referrals received in a given time period over the number of patients who actually walk through the door for an appointment. It’s a number that more than 95% of health system managers and executives struggle to measure and find impossible to manage.

How RTA supports value-based care

While the fax machine has traditionally been the standard way for medical practices to communicate on referrals, patient records, and physician progress notes, in the 21st century it is an incredibly inefficient method for managing the continuum of care from one setting to another. Faxed referrals sit in manila folders at front desks while patients get sicker. Closing the referral loop is key; both the PCP and the referred specialist need to be on the same page about where the patient is with their treatment in order to keep additional medical costs down.

Unfortunately, only 50% of paper-based referrals ever get scheduled, with no-show rates high and communication between offices low. RTA fixes this and, most importantly, gets patients scheduled for the appointments they need. RTA allows the primary care provider to know where patients were sent, if they were seen, how quickly they got in for their appointment, and what the result of that appointment was. This connection and coordination is the foundation for a successful value-based care program. Without this key metric, there’s no way to know if the system is running efficiently, and more advanced programs can’t be developed due to an unpredictable patient pipeline.
How RTA supports fee-for-service

More patients equal more procedures. It is as simple as that.

Provider organizations last year took a major financial hit—hospitals and health systems were collectively over $300 billion–due to sharp drops in patient volumes and increased operating costs relating to additional PPE and ramped up COVID-19 testing and treatment capabilities. This year appears to be more promising, with multiple vaccines rolling out and federal aid well underway, according to a report from the Kaiser Family Foundation. With this optimistic outlook, providers need to focus on recovery strategies for their volume including taking ownership of their personal RTA to make sure they are maximizing patient capture and supporting their referring providers. Whether a small provider practice or an entire health system, RTA is the true measurement of an organization’s current and future financial health and stability.

Modernizing healthcare with technology

Healthcare is one of the most innovate industries in the world. Cutting-edge science is researched and implemented in exam and operating rooms every day. Unfortunately, the administrative staff of doctors’ offices and hospitals are stuck in the 20th century of fax machines and landlines. It’s time to modernize healthcare with technology features that enable the measurement of RTA.

As medical front desk, scheduling and marketing teams realize the importance of leveraging communication and CRM tools, they will play a key role in helping the provider organizations recover revenue in 2021 and work through the critical backlog of delayed care from 2020. By digitizing workflows, cutting off referral leakage and keeping a steady stream of referred patients scheduled, there will be a significant positive impact on patients as well as organizations’ profitability and longevity.