Nearly 20 million misdirected physician referrals in the United States could be leading to billions of dollars in wasteful spending across the country’s healthcare system, according to a new physician survey from Kyruus, an enterprise healthcare solutions company.
Massive inefficiencies in the way referrals are currently managed in the U.S. healthcare system, including the millions of patients who are sent to providers who are not matches for their conditions, may lead to reduced health outcomes for patients, ineffective use of physician time and avoidable patient costs, researchers state.
The Kyruus Physician Referral Survey, which surveyed 100 U.S.-based specialist physicians across 11 medical specialties, found the following:
- 75 percent of specialists have received at least one clinically inappropriate referral in the past year.
- 8 percent of all referrals are considered clinically inappropriate, which equates to 42 mismatched patients to specialist per year and 19.7 million clinically inappropriate referrals annually nationwide.
- The majority of physicians attribute referral misdirection to a lack of reliable information about the specialists.
- Insufficient information is harmful to call centers (31 percent), referring offices (32 percent), or referring physicians themselves (62 percent).
- 15 percent said inappropriate referrals were a result of the referral process relying too heavily on personal relationships between physicians.
- Of the patients who are referred incorrectly, 63 percent are re-referred to more clinically suitable physicians, incurring an estimated $1.9 billion in lost wages and unnecessary co-pays annually.
- The remaining 37 percent who are not re-referred are instead managed by a clinically inappropriate physician, putting quality patient care at risk.
Source: Kryuus, November 10, 2014
Care Compacts in the Medical Neighborhood: Transforming PCP-Specialist Care Coordination underscores how care compacts, also known as care collaboration agreements or referral agreements, are helping to construct a framework for care coordination within a medical neighborhood.