Three Simple Truths About Referral Management

The importance of referral coordination cannot be overstated. Patients who do not receive the care they are referred to often experience worsened conditions leading to negative health outcomes. Additionally, physician satisfaction and revenue can both be impacted by a lack of effective referral management. In order to illustrate the importance of improving referral management, let’s consider a few simple truths…

It’s highly likely that patients will not follow through with your referrals.

Studies show approximately one-third of patients don’t follow up with the specialist they are referred to, and 40% of patients that do never follow up with the referring physician after the care is provided. You need good communication, reminders, and follow-up to ensure patients will stick to their care plan.

Poor referral management puts physicians at risk.

63% of physicians report being dissatisfied with the referral process at their organization. Furthermore, as many as 50% cannot tell you if their patients followed through with the referral they made— opening them up to failures in care or worse, possible malpractice suits. 20% of malpractice claims are due to missed or delayed diagnosis from failures in handoffs between providers.

Hundreds of billions are lost annually to failures in referral management.

Aside from the cost of missed appointments, adding up to an estimated $150 billion in losses for the industry annually, we also see the cost of referrals in the form of avoidable readmissions and non-adherence, together adding up to as much as $325 billion a year.

For many organizations, these realities come as no surprise. Becker’s reported 92% of physicians know that they need to improve their referral management practices. Since referral coordination is so essential to providing quality patient care and system continuity, process improvement should be a top priority but in today’s challenging labor market it can be difficult to simply staff to the levels needed for basic scheduling. A year-long study involving a large primary care network found that less than 35% of approximately 100,000 referral scheduling attempts resulted in documented complete appointments.

In consideration of process inefficiencies and general difficulties coordinating with specialty practices, the root challenge of referral management is the increased workload and time burden they create. Care coordination is a heavy load for PSR staff and physicians bogged down with tracking the status of patient referrals must do so at the expense of other important tasks. Studies have illustrated that organizations with dedicated coordination teams fair better in terms of patient experience, service quality, and perhaps most importantly, timeliness of care— resulting in more favorable health outcomes.

Practices simply require more hands-on-deck to ensure effective referral processes. Engaging with a third-party partner (like Envera) can streamline the process and reduce the burden on staff and physicians. Together we can improve patient satisfaction and ensure that everyone involved in the process is working as efficiently as possible.

Contact us for a consultation today.