Hospice Referral Partners Seek Stronger Interoperability

Nearly 60% of clinicians and organizations that refer patients to hospice would put increased electronic health record (EHR) interoperability on their wish list particularly the hospice’s ability to receive referrals electronically, according to a new report from Atlanta-based health care technology company Brightree. 

About 675 home health and hospices providers as well as 440 referral sources responded to a Brightree-sponsored survey conducted by Porter Research. Among the respondents, 70% of hospice and home health providers said they had seen an increase in the number of referring organizations requesting to send referrals electronically during the past two years. 

More than 60% of surveyed referral sources indicated that they would be willing to switch to a different post-acute care provider if that organization were able to accept electronic referrals, though only 4% of hospice and home health companies said they were prepared to accept referrals from an interoperable EHR system.


“There is a major gap between what post-acute care providers are doing versus what their referral sources are looking for. This gap has repercussions across the entire health care spectrum, contributing to high care delivery costs nationally, not to mention the patients that may fall through the cracks or end up back in the hospital with unnecessary readmissions as a result,” Nick Knowlton, vice president of strategic initiatives for Brightree told Hospice News. “Referral sources care about properly transitioning patients to hospice and other post-acute care settings. Now that they know it is possible, they are stating that they are willing to change alignment with hospice agencies based on their ability to interoperate.”

Definitions of interoperability can vary. For the survey, the term “interoperability” referred to the ability of different IT systems and software applications to communicate, exchange data and use the information that has been exchanged, Knowlton said.

Government stakeholders such as the U.S. Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information (ONC) have been working to promote interoperability. Both agencies in February released proposed rules designed to increase health care interoperability.


CMS proposed an Interoperability and Patient Access rule that lays out a technical path to improved care coordination and information exchange through open application programming interfaces.

The ONC proposal would establish new standards for the ways EHR systems must collect and share information.

CMS has also made interoperability a requirement for some new payment models, including the recently unveiled Primary Care First initiatives. The agency requires health care providers, including hospices and palliative care organizations, to use certified EHR technology (CEHRT).

CEHRT are IT products that comply with criteria established by CMS for certain programs, such as the Merit-Based Incentive Payment System. The Office of the National Coordinator (ONC) maintains the standards, which exist in multiple editions. Providers would have to comply with the 2015 edition for Primary Care First.

Meeting the interoperability requirements could prove challenging for hospices for whom few CEHRT systems are available.

Despite some challenges, the hospice market and health care at large is moving gradually towards greater interoperability. Among hospice and home health provider respondents to the Brightree survey, 30% said they plan to expand their interoperability efforts during 2019, and 31% said they would transition to a new EHR system for the sake of improved interoperability.

“It all starts with improving patient care transitions, especially for hospice. A proper referral empowers providers to deliver the best care from day one,” Knowlton told Hospice News. “It also ensures the best start of care for patients and their family members.”

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