Referral madness? 75% of specialists get off-target referrals

Three out of four specialists received a referral in the last year they considered “completely inappropriate,” according to a survey that included cardiologists and 10 other medical specialists.

Kyruus, a company that advises health systems on referral and scheduling issues, surveyed 100 specialists online about their referral practices, experiences and possible reasons for misdirected referrals. Some questions focused on the clinical appropriateness of the referrals.

A little more than half of respondents’ referrals came from other physicians, according to the study. Subspecialists such as interventional cardiologists had a higher percentage of referrals come directly from physicians compared with nonsubspecialists, at 56.4 percent vs. 51.7 percent.

When asked about the clinical fit of referrals over the past year, 75 percent received a “completely inappropriate” referral, which Kyruus defined as unnecessary or should have gone to a different type of specialist. Choosing the wrong type of specialist or subspecialist was the most common reason for this error (48 percent) with the case better managed in primary care as the second most common (17 percent). Wrong diagnosis accounted for 3 percent of the reported misdirected referrals.

Overall, respondents deemed about 8 percent of referrals as inappropriate. Most respondents then redirected these patients to the appropriate specialist or subspecialists. Those re-referrals cost patients an estimated $1.9 billion in co-pays and lost wages, according to the analysis, as well as delayed care and possibly poorer outcomes.

Lack of reliable information about specialists and subspecialists topped the list for likely causes of misdirected referrals, but 15 percent of respondents also tagged personal relationships between physicians as a source.

Boston-based Kyruus conducted the online survey in February 2014 and released results Nov. 10.