Problems With Medical Referrals in the US

During the last two decades, the number of medical referrals in the US has dramatically increased. The healthcare system has more specialists and specialties than before but unfortunately, no parallel growth can be cited for general health care quality or efficiency in patient management. The purpose of medical referrals is to ensure that the patients receive the right type of care from a specialist for a specific condition.

Here are the reasons why all those referrals are going down the drain, literally.

1. Inappropriate Referrals
2. Outdated Technology
3. Insufficient Data
4. Delayed care

Inappropriate Referrals:

It is estimated that nearly 20 million referrals are made in the US every year which are considered to be clinically inappropriate (according to an article that appeared in the HIT consultant blog -“19.7M Clinically Inappropriate Physician Referrals Occur Each Year”). Clinically inappropriate referrals are those referrals which are not made to the right Specialist. PCPs make inappropriate referrals due to the physician’s lack of information about the specialist, referring to offices about the lack of information on available specialists and personal relationships between the providers.

When an inappropriate referral is made the primary provider will have to re-refer the patient to a more appropriate provider or the patient will end up receiving care from an inappropriate provider; in either of the cases, the patient will get poor outcomes and increased cost.

Outdated Technology

Referrals made by a provider to a specialist sometimes could fall through the “cracks” in the referral process. This could vary from practice to practice; some due to faults in referral procedures or ambiguity of the processes.

One recurring problem with referral procedures is with the use of technology or lack thereof. HIPAA regulations have mandated certain standards for the use of technology to transfer patient data. For example, it is against the regulations to use providers’ personal email to send or receive patient data, HIPAA has also mandated against the use of fax which is vulnerable in the case of data theft.
On top of being insecure, these technologies are not capable of supporting modern healthcare requirements including instantaneous communication, secure chat and exchanging data.

Insufficient Data

Primary care and specialist care are poorly integrated into a single system, the lead cause of this is lack of data. There are no means to transfer data between specialist or primary provider. The specialist is always making the fresh diagnosis without knowing the care history of the patient while the primary provider is unaware what kind of care his/her patient has earlier received.

Delayed Care

Referrals are (traditionally) a slow and time-consuming process. The primary care provider with limited information about the available specialists finds it hard to shortlist an appropriate specialist. The provider has to go back and forth to choose one out of the various specialists. Between the primary provider’s preference and the specialist’s availability, the patients experience long waiting hours and would finally decide to meet another provider out of the network.

The wait to see a primary care provider, the wait to get referred and the wait till specialists appointment plus the possibility that this process may have to be repeated leads to long delays to even receive most basic care.

Primary and specialist care coordination is an important aspect of the healthcare continuum. Providers should create and evaluate a referral process which would ensure maximum security of the information shared, minimum resistance to sharing patient data and possibly reduce the time delay in the referral process.

HealthViewX Referral Management Solution is a web-based, multi-channel referral management platform. Providers can send and receive a referral, share patient related information and track referral progress through one window making the referral workflow seamless and effortless.