About 19.7 million patients are inappropriately referred to a provider who is not the right match for their condition every year, according to the 2014 Kyruus Physician Referral Survey. The survey report highlights immense inefficiencies in the way referrals are managed in the U.S. healthcare system, as well as the financial and health risks improper referrals impose on both patients and providers.
Kyruus conducted the survey among 100 specialists across 11 specialties. Findings from the survey are shown below.
- Seventy-five percent of specialists have received at least one "clinically inappropriate" referral in the past year.
- About 8 percent of all referrals are considered "clinically inappropriate," which equates to 42 incorrectly matched patients to specialists per year and 19.7 million clinically inappropriate referrals in the U.S. each year.
- Eighty-seven percent of physicians believe referral misdirection happens when there is a lack of reliable information about other specialists.
- Insufficient information is prevalent in call centers (31 percent), referring offices (32 percent) or referring physicians themselves (62 percent).
- Fifteen percent of respondents said inappropriate referrals were a result of the referral process relying too heavily on personal relationships between physicians.
- Out of 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, which could mean putting the quality of patients' care at risk.
Editor's note: Survey respondents were allowed to select more than one response.