Medical Referrals Challenges—Does Your Process Need Improvement?

From poor patient hand-offs to lack of proper follow-up, understand what happens when the process breaks down and how to avoid common referrals challenges.
Clinical Operations

If you find the patient referral process frustrating, you’re not alone. As the number of patient referral visits in the U.S. has climbed to more than 100 million per year, the process has continued to present unwelcome challenges for both primary care providers (PCPs) and specialists. Many providers lack the staff capacity to proactively manage medical referrals while simultaneously handling front office tasks and coordinating care. So what happens when the referral loop gets disconnected? And more importantly, how can it be fixed?

Poor hand-offs

It’s not enough to hand patients a slip of paper and expect them to schedule an appointment themselves, because the truth is, many of them won’t. Research from the National Center for Biotechnology Information (NCBI) shows that one-third of patients never follow through with a referral from their PCP.

The process of self-scheduling often involves multiple calls and long lead times for appointments, which may frustrate patients to the point of giving up on the appointment altogether. As a result, they miss out on needed care, while specialty practices lose revenue because of no-shows and lose efficiency because of staff time spent coordinating referral visits.

It’s crucial that PCPs clearly explain each step of the referral process with their patients, including the reason for the referral and what to expect from the visit. Most importantly, PCPs should make sure patients receive support when scheduling appointments.

Care coordination challenges

What does that support entail? It begins with timely and accurate communication between PCPs and specialty providers, including referral orders that specify the reason for the patient’s visit, urgency of the referral and the requested service, along with insurance verification. When this information isn’t efficiently transferred, specialists have no way of knowing where referred patients are coming from and/or what types of treatment they need.

According to a study from the Journal of Internal Medicine, half of specialists are dissatisfied with the timeliness and integrity of the clinical information sent to them. “A lot of times, patients will show up for an appointment and say their doctor sent them, but we have no records or referral orders from the PCP,” says Tina Best, IT and Administrative Support at Acadian ENT in Lafayette, La.

Other times, the practice receives referral faxes from providers that don’t indicate a reason for a patient visit.

“I end up having to read nine pages of progress notes to figure out what the patient is coming in for,” says Julie Morgan, Acadian ENT’s Receptionist and Inbound Referral Coordinator.

To avoid those headaches, PCPs and specialty providers should establish care agreements that clearly define their respective roles and responsibilities and hold both sides accountable for providing relevant information to support their patients’ care.

Poor referral tracking systems

Once a referral is made, primary care providers need to be able to track the patient’s journey throughout the referral process. Otherwise, referral coordinators have no way of following the patient’s care and knowing details like which day the appointment took place, what types of tests were ordered and whether the patient showed up for the visit.

The NCBI study found that up to 50% of PCPs didn’t know whether their patients had seen the specialists to whom they were referred. That disconnect forces primary care providers’ staff to call the specialist’s office for status updates and to verify that the patient was seen. A standardized referral management system gives PCPs and specialty groups a clear picture of the entire process and allows them to analyze important trends, such as the average time to schedule an appointment. With this information, primary care teams are better able to collaborate with specialty groups to increase their availability for referrals and streamline overall organization efficiency.

Lack of follow-up

Even when a referral appointment is completed, many specialists fail to close the loop with the referring providers’ office. In the Journal of Internal Medicine survey, 40% of PCPs said they did not receive a report from the referred specialist in time for the patient’s follow-up visit. This adds to practice inefficiency since care coordinators must track down the report and spend extra time integrating the information into the patient’s electronic medical record. Performing these tasks manually also increases the likelihood of the data being lost or misinterpreted and as a result, poses a threat to patient care.

Morgan says specialists at Acadian ENT follow a standard protocol of sending an automated follow-up letter after every patient visit that is generated through the practice’s electronic medical record.

“Once the patient is seen in the office, our doctors send a referral letter and/or a progress note to the referring physician with all of the information from the visit included.”

By addressing challenges and inefficiencies within the referral management process, medical practices can reduce manual referral tracking, improve the patient experience and deliver more effective, integrated care.

Learn how Phreesia helps healthcare organizations improve the referrals process.