[November 10, 2014]

New Report Reveals 19.7 Million Misdirected Physician Referrals in the U.S. Each Year

Nearly 20 million times a year in the U.S., patients are sent to a provider who is not the right match for their condition. This is one of many key findings in a new physician survey conducted by Kyruus, an enterprise healthcare solutions company. The report highlights massive inefficiencies in the way that referrals are currently managed in the U.S. healthcare system.

The concern is that these clinically inappropriate referrals may lead to reduced health outcomes for patients, ineffective use of physician time and avoidable patient costs, amounting to billions of dollars in wasteful spending across the entire U.S. healthcare system.

"The current process for referrals in our health ecosystem is broken," said Dr. Graham Gardner, Kyruus CEO and co-founder. "This dysfunction substantially affects patients' ability to access the care they need when they need it. Quality care starts first and foremost by ensuring patients are seen by the right providers. When we fail at this vital first step, the entire system starts to break down, compromising patient care and incurring significant avoidable costs."

The Kyruus Physician Referral Survey, which surveyed 100 U.S.-based specialist physicians across 11 medical specialties, found:

• 75 percent of specialists have received at least one "clinically inappropriate" referral in the past year.
• 7.8 percent of all referrals are considered "clinically inappropriate," which equates to 42 mismatched patients to specialist per year and 19.7 million clinically inapproprite referrals annually nationwide.
• What causes inappropriate referrals? 87 percent of physicians believe that referral misdirection happens when there is a lack of reliable information about the specialists.
• Insufficient information can be endemic to call centers (31 percent), referring offices (32 percent), or referring physicians themselves (62 percent).¹
• 15 percent said inappropriate referrals were a result of the referral process relying too heavily on personal relationships between physicians.
• Of the 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.²
• The remaining 37 percent who are not re-referred are instead managed by a clinically inappropriate physician, putting quality patient care at risk.

For a more detailed analysis of the survey findings, the Kyruus Physician Referral Report is available at http://bit.ly/1vPaI9t.

Kyruus will continue the discussion of improving operational efficiency through better patient-physician matching at the Annual Thought Leadership on Access Symposium (ATLAS) on Nov. 19, 2014, at the Ritz Carlton in Boston. Senior hospital executives who wish to learn more about the event can visit www.atlasconference.com.

About Kyruus

Kyruus is an enterprise healthcare provider solutions company that helps health systems optimize their Patient Access, Referral Management and Care Coordination operations. Leveraging the cloud and a proprietary Big Data approach, the company enables the integration of massive amounts of information to create a single source of truth of providers. Kyruus helps health systems create customizable protocols for referral and scheduling across all channels of patient engagement to improve patient access and patient experience. To find out how a Better Match = Better Care™, please visit http://www.kyruus.com.

¹ Note that respondents were allowed to select more than one response.

² Based on an average co-pay of $50 per specialist visit and the need for many patients to take a half-day (4 hours) off from work at $25 average hourly wage to visit a physician.

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