Specialty Referrals

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Introduction

For patients who need a referral to a specialist, search orders for "Refer to ________" in PowerChart/FirstNet.

"Refer to ___ Internal" means you are referring a patient within the YKHC system. ­*This includes the Specialty Clinics (e.g., Refer to ENT Internal, Refer to Pediatric Neurology Internal, etc.). ­*ANMC (Anchorage Native Medical Center) sends some of their specialists out to Bethel on a rotating basis. This allows some of our patients to be seen here for specialty care instead of having to travel to Anchorage. These referrals would be called INTERNAL since the patients are seen here. ­*We will periodically have providers in the Specialty Clinic for Surgery, Orthopedics, ENT, OB/GYN, Neurology, Rheumatology, Hepatology, Infectious Disease, Pediatric Cardiology, Pediatric Pulmonology, Pediatric Endocrinology, and Pediatric Neurology. You can find the current schedule for these providers by signing into AMION with anmc (lower case).

"Refer to ____External" means the patient needs to be seen somewhere other than YKHC (e.g., ANMC, Providence, Anchorage, etc.) For all referrals, the provider documentation should:

  • Always be signed
  • Specify the reason for the referral
  • Include as much past medical information as possible
  • Include Beneficiary/Non-Beneficiary status
    • If non-beneficiary, case management will also need the name of the provider they want to see
    • If beneficiary and they want a non-ANMC second opinion (they must have Medicaid/Medicare coverage for this), inform the patient that they will be financially responsible for whatever Medicaid does not pay for.
  • Indicate what if any Multimedia files are applicable for the referral
    • Images and/or scanned documents should be scanned 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.

Try to be as complete as you can with the referral in giving as much past medical information as possible.

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. Outside referrals can be made, but patients must make the appointments themselves. Our case managers can assist by sending the referral orders along with all the notes, labs, media, etc.

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.

Case Management does not make ANMC appointments. ANMC will only attempt to contact the patient x3, then send a letter to the patient. A referral would need to be resent if still needed.

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.

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

  • 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 - Surgery

Orders Available

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

General Information

  • If you have talked to Dr. Compton and he says the patient needs surgery in Bethel, or the patient wants a tubal ligation, order: "Refer to OB/GYN Surgery Internal Cleared"
  • Dr. Compton is available by phone at most times (907)545-0596.
  • This puts them on the queue to be scheduled for surgery.
  • This queue is managed by the Surgery Case Manager.

GYN - Bethel

  • Almost all referrals should start here as most insurance will require that the patient be seen locally first.
  • For patients who you want to be seen in a Bethel clinic, order: "Refer to Gynecology Internal"
  • The queue is managed by GYN Case Manager.

GYN - Anchorage

  • For patients who you want seen in Anchorage, order: "Refer to Gynecology External"
  • The queue is managed by GYN Case Manager.

Optometry/Ophthalmology

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

Pediatric Referrals

Orders Available

  • 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