Specialty Referrals: Difference between revisions

From Guide to YKHC Medical Practices

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#The provider makes a decision.   
#The provider makes a decision.   
''If they need more information, it goes back to step one and you get a message from the CM to get more information.  If you call first, you can provide the information they need and get the patient the right care faster.''
''If they need more information, it goes back to step one and you get a message from the CM to get more information.  If you call first, you can provide the information they need and get the patient the right care faster.''
===Colonoscopy===
*If the patient can be done in Bethel, order: "Refer to Adult Surgery Internal (YK Colonoscopy)"
*If the patient cannot be done in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.
===To screen for colon cancer when the patient cannot do a colonoscopy===
*The provider orders the test.
*The patient picks up the test from the YK lab or a village clinic.  If the village clinic does not have a test, the YK lab will send a test to the village clinic for the patient to pick up.
*The patient collects the sample per instructions.
*The patient brings it back to the village lab or the YK lab.
*The specimen is transported to the YK lab by policy.
*The YK lab runs and results the test.
===EGD===
*If the patient can be seen in Bethel, order: "Refer to Adult Surgery Internal - YK EGD"
*If the patient cannot be seen in Bethel, order: "Refer to Adult Surg Ext (only EGD/CS)"
*If you are not sure, contact the on-call anesthetist or Dr. Compton.
*The queue is managed by the Surgery Case Manager.


===Vasectomy or other minor procedures to be done in Bethel===
===Vasectomy or other minor procedures to be done in Bethel===

Revision as of 09:45, 4 December 2020

Introduction

For patients who need a referral to a specialist, search orders in PowerChart/FirstNet by typing "Refer to" and then select "ENTER"

  • Refer to ___ Internal means you are referring a patient within the YKHC system
  • Refer to ______ External means you are referring a patient outside the YKHC system

­INTERNAL referrals are to providers who will see patients in BETHEL, including in the Specialty Clinics.

  • Internal referrals in which a YKHC provider will see your patient can be made to Diabetes Clinic, Surgery (for colonoscopy or EGD), Sleep specialist, Dental, Optometry, OB/GYN surgery, Gynecology, and PT
  • Alaska Native Medical Center (ANMC) specialists travel to Bethel on a rotating basis. This allows some of our patients to be seen here for specialty care instead of traveling to Anchorage. These referrals are considered INTERNAL since the patients are seen here.
  • Visiting specialists will see patients in the Specialty Clinic (usually the Halibut hallway). Specialists are from the services of Surgery, Orthopedics, ENT, OB/GYN, Neurology, Rheumatology, Hepatology, Infectious Disease, Pediatric Cardiology, Pediatric Endocrinology, and Pediatric Neurology. You can find the current schedule for these providers by signing into AMION with anmc (lower case).

EXTERNAL referrals are indicated when the patient needs to travel to see the specialist.

  • External referrals are used for HIS Beneficiaries who will see a specialist at ANMC or a non-beneficiary that will be seen at a private hospital/clinic.

For all referrals, the provider documentation should:

  • Specify the reason for the referral with as much past medical information as possible
  • Include Beneficiary/Non-Beneficiary status
    • If a non-beneficiary, case management will also need the name of the provider they want to see
    • If a beneficiary and the patient wants a non-ANMC second opinion, the patient is financially responsible for whatever Medicaid does not pay for.
  • Indicate what, if any, Multimedia files are applicable to case
    • Images and/or scanned documents should be uploaded into Multimedia
    • Dermatology always wants pictures
    • Case management will need to know which Multimedia files should accompany an external referral
  • Indicate STAT status if warranted and inform case management ASAP.
  • Include current patient contact information. If a peds referral, also include escort name/DOB.

Please, do not enter multiple referrals for the same patient, same problem. This does not get them done faster; it just bogs down the queue. You can see if a pending referral is being addressed by using the Referrals/Provider Letters and Case Management filters in the Documentation section of PowerChart/FirstNet. You will not see it under orders once it has been accepted by the case management pool.

If you are referring to a non-YKHC/non-ANMC provider or practice, please document the name of the provider with the address and phone number. We ask for any outside referrals that the patients make the appointments themselves. Our case managers can assist by sending the referral orders along with all the notes, labs, media, etc.

Case Management does not make ANMC appointments. ANMC makes contact with the patient to schedule the appointment. ANMC will only attempt to contact patient three times, and then cancel the referral. If the patient still needs to be seen, a new referral will need to be entered.

Referrals from the ER

  1. Occasionally you will need to place a referral on a patient that you see in the ED. For example, a non-emergency hernia repair will need an order placed in the chart for the referral to surg.
  2. Type in the search order window the word “refer” and hit enter or the binoculars. The list of services that you can refer to come up and you will need to choose the correct service and complete the order (yellow parts are required.)
  3. Once you sign the order, it goes to a queue for the case managers to review and forward the appropriate documentation.

return to the Emergency Department Main Page

ACT/Behavioral Health

  • Be sure to include good contact numbers
  • Include a statement indicating that the patient agrees to talk to Behavioral Health.

Colonoscopies/EGDs

  • For Colonoscopy/EGD procedures to be done in Bethel,
    • Refer to Adult Surgery Internal (YK Colonoscopy)
    • Refer to Adult Surgery Internal - YK EGD
  • For Colonospcopy/EGD procedures to be done at ANMC
    • Refer to Adult Surg Ext (only EGD/CS), not Gastroenterology.
    • There is no ANMC Surgery Internal Referral.

Dental

  • All referrals are processed through YKHC Dental Department.
  • Referrals to ANMC must be processed through YKHC Dental.
  • If you have acute dental concerns, you can TigerText "Dental On Call" or send your patient to Dental for a walk in clinic appointment. It is not necessary to place a referral to dental.

General Surgery

You do not need to call the surgeons in Anchorage to order a surgery referral. That being said, it is a good idea to call them if you are not sure what the patient needs.

Anyone needing to be seen by surgery will need an accepting physician so you will have to contact the surgeon on call at ANMC (1-907-663-2662) and ask for the on call surgeon. Discuss with the surgeon whether the patient is best suited to be seen in Bethel or Anchorage. Make sure to document the name of the surgeon on the referral.

Orders Available

  • Refer to Adult Surg Ext (no EGD/CS)
  • Refer to Adult Surg Ext (only EGD/CS)
  • Refer to Adult Surgery Internal - YK EGD
  • Refer to Adult Surgery Internal - YK General
  • Refer to Adult Surgery Internal (YK Colonoscopy)

ANMC Adult Surgery Referrals

  • order: "Refer to Adult Surg Ext (no EGD/CS)"
  • Stages
  1. CM in Bethel collects information and sends it to Anchorage.
  2. CM in Anchorage reviews the information and presents it to a provider.
  3. The provider makes a decision.

If they need more information, it goes back to step one and you get a message from the CM to get more information. If you call first, you can provide the information they need and get the patient the right care faster.

Vasectomy or other minor procedures to be done in Bethel

  • Order: "Refer to Adult Surgery Internal - YK General"
  • The queue is managed by the Surgery Case Manager.

For Everything Else

  • Order: "Refer to Adult Surgery External (no EGD/CS)"
  • The surgeons will decide whether to see the patient in a Bethel field clinic or in Anchorage.

OB/GYN Referrals

Orders Available

  • Refer to OB/GYN Surgery Internal Cleared
  • Refer to Gynecology External
  • Refer to Gynecology Internal

Refer OB/GYN Surgery Internal Cleared

  • Order: Refer to OB/GYN Surgery Internal Cleared
  • This is for patients who need to have surgery and Dr. Compton has ok'd the surgery.
  • Dr. Compton uses this for patients he wants the Surgery Scheduler to put on the surgery schedule
  • If you call Dr. Compton and he says, “schedule her for surgery”, this is the order to use.
  • Use this to schedule tubal ligations of any kind. The only concern is for patients less than 25 or without children. Dr. Compton should see them in consultation first (do an internal GYN referral and please be specific that they need a personal consultation due to : under age 25, no children….etc)
  • Make sure you complete all of the information and call or message Dr. Compton if you have questions.
  • If you cannot reach Dr. Compton, contact Brenda Lamont.

Refer GYN INTERNAL

  • order: "Refer to Gynecology Internal"
  • The queue is managed by GYN Case Managers.
  • Almost all referrals should start here as most insurance will require that the patient be seen locally first.
  • for patients you want Dr. Compton to see for a consultation in the clinic
  • These should be services specific to GYN consultation only- if you have questions message or call Brenda Lamont – appts are limited.
  • Normal birth control appts are not specific to GYN-as numerous providers can do this-so patients can call the main scheduling desk for these types of appts at ext: 6442.

Refer GYN - External

  • for any referral to a Gynecologist outside of YKHC i.e. ANMC or Anchorage and beyond
  • order: "Refer to Gynecology External"
  • The queue is managed by GYN Case Managers.
  • Important things to remember or talk with patients about:
    • If we can offer the service in Bethel and the patient has no “medical” reason to be referred outside of YK, Medicaid will 99% of the time deny travel and the patient will be a self-pay. Brenda can still send the referral, but it’s always nice that patients know this ahead of time.
    • We have an ANMC GYN field clinic in Bethel every 3 months, so we may end up adding them to this list for appts if ANMC can’t schedule them prior to this, or if patient’s would prefer to wait until the next field clinic, they can.

Optometry/Ophthalmology

  • All referrals are processed through YKHC Optometry.
  • Referrals to ANMC must be processed through YKHC Optometry.

Orthopedics

Pediatric Referrals

Orders Available

  • Refer to Child Family Developmental services External (Neurodevelopmental Evaluation Services) (see Developmental Delay Section for more details)
  • Refer to Family, Infant, Toddler Program Internal (see Developmental Delay Section for more details)
  • Refer to Pediatric Clinic External (MRI/EEG/VFSS/Hip US)
  • Refer to Peds Cardiology External/Internal
  • Refer to Peds Endocrinology External/Internal
  • Refer to Peds Gastroenterology External
  • Refer to Peds Hematology/Oncology External
  • Refer to Peds Nephrology External
  • Refer to Peds Neurology External
  • Refer to Peds Neurology Internal
  • Refer to Peds Other External
  • Refer to Peds Psychiatry Internal
  • Refer to Peds Pulmonology External
  • Refer to Peds Pulmonology Internal
  • Refer to Peds Rheumatology External
  • Refer to Peds Surgery External
  • Refer to Peds Urology External
  • Refer to Chronic Peds Ophthalmology External
  • Refer to Devt/Behavioral Peds External