December 31, 2014
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Most specialists reported at least one inappropriate referral per year

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Inappropriate referrals to specialists occur frequently, and 75% of specialists reported at least one “completely inappropriate” referral in the past year, according to a survey conducted by Kyruus.

The Boston-based health care solutions company conducted a 15-minute online survey in February that included 100 specialists across 11 specialties. They included cardiology (n=11), orthopedic surgery (n=10), gastroenterology (n=10), dermatology (n=10), ophthalmology (n=9), colorectal surgery (n=7), vascular surgery (n=5) and others. Participants were asked about referral methods and their assessment of the suitability of their referrals.

Up to 26.2% of referrals were reported as potentially inappropriate, 18.4% of referrals to specialists in the last year were considered “somewhat appropriate” while 7.8% were considered “inappropriate.”

Other findings included:

  • About 65% of clinically inappropriate referrals were sent to the wrong specialist or subspecialist (48%) or did not require a referral (17%).
  • When sent a clinically inappropriate referral 63% of respondents said they will re-refer the patient to a more suitable physician. Only 12% said they do not accept the patient but will re-refer them instead; 18% will accept the patient and do not re-refer.
  • It is estimated to cost patients $1.9 billion annually in lost wages, assuming $50 as the average copay, 4 hours away from work for an appointment and $25 average hourly earnings.
  • A lack of specialist information in physician offices contributed to misdirection, according to 32% of respondents, while 62% reported that misdirection happens because referring physicians lack reliable information about specialists. Misdirection was a result of the referral process relying too heavily on personal relationships between physicians, according to 15% of respondents.

Specialists reported that 53.8% of all referrals were referred directly from physicians, 20.2% were patient self-referrals, 12.4% were from physician offices, and 11.6% came from a centralized call center. The greatest number of patient self-referrals were to plastic surgeons at 39.1% vs. 20% on average for all.

When asked to elaborate why referrals were inappropriate, responses included:

  • “[The patient] could have been managed by a PCP,” a cardiologist said.
  • “They did not have IBD,” a gastroenterologist specializing in IBD responded.
  • “A few should have been seen by psychiatry first,” a neurologist replied.
  • “Often, patients are referred with nonoperative problems who have not had any attempt at nonoperative primary care treatment attempts,” an orthopedic surgeon said.

Dermatologists reported an average of 1,213 new patients from referrals per year; other referral-based new patients: orthopedic surgeons (705), cardiologists (508), ophthalmologists (483), gastroenterologists (280) and colorectal surgeons (236).