Industry News

Nearly 20 Million Misdirected Physician Referrals Occur Per Year

According to a 2014 Kyruus Physician Referral Survey, each year about 19.7 million patients are inappropriately referred to a provider who is not the right match for their condition.

This survey was conducted among 100 specialists, across 11 specialties.  Besides the high total of inappropriate referrals, the survey also found that 75 percent of specialists have at least one “clinically inappropriate” referral in the past year.

It was found that 87 percent of physicians believe referral misdirection happens when there is a lack of reliable information about other specialists.
The key places where insufficient information was prevalent was in call centers, referring offices, and the referring physicians themselves.

These clinically inappropriate referrals may lead to reduced health outcomes for patients and ineffective use of physician time and avoidable patient costs.

These mistakes can amount to billions of dollars in wasteful spending across the U.S. healthcare system.
Kyruus’s calculation for lost wages and wasted copays from these referrals was found to amount to $1.9 billion per year.

Another interesting consequence of this referral mistakes is its potential effect on population health data.

For instance, Definitive Healthcare recently launched a new product feature, a population health data set.  This data set, located in each of the 7,400+ hospitals and 875+ health system profiles, of Definitive Healthcare’s hospital database follows a patient’s claim across provider and provider types.

This data aims to allow users to understand the entire costs and opportunities of providing care to these patients, by analyzing what procedures and diagnoses are being lost to other providers.

Inappropriate referrals could negatively affect this data, as users would not have a true and accurate understanding of the correct referral network and process.

These misdirected referrals have great negative implications for our healthcare system in terms of lost money, time, and accuracy of data to analyze.  In the future it is hoped that efforts will be taken to reduce this number and improve communication among physicians and specialists.

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