7 ways doctors make decisions on patient referrals

Better information about network options could help doctors stay in the delivery system’s network.

7 ways doctors make decisions on patient referrals

As patients increasingly have more options to receive care out of network, an effective referral strategy is a must for doctors and healthcare systems hoping to keep patients within the network.

Kyruus, a software vendor that uses data to match patients to providers and reduce barriers to care, recently contracted a survey of 100 primary care providers and 100 specialists to see how they make referral decisions, facilitate appointments and track outcomes. Here are the findings.

Familiarity reigns

More than 70 percent of physician respondents refer to the same specialist because they know the clinical expertise of the specialist, although some physicians may lack awareness of other in-network options. On average, these respondents send one-quarter of their patients out of the network.

Insufficient data

Inadequate provider information could be to blame for unnecessary out of network referrals as providers referring out of network expect one-third of the referrals would be avoidable if they had better access to information on providers in their own network.

Fewer options

In general, providers referring out of network were less likely to have access to availability, location, network affiliation and insurance information. This can lead to relying on providers within a personal network who may not be the best options for a patient.

Provider directories

Three-quarters of hospital-owned practices are significantly more likely to have access to a provider directory from their health system, compared with surveyed academic medical centers at 33 percent and solo private practices at 44 percent. However, while 60 percent of surveyed clinicians have access to their delivery system provider directories, the directories are not being used because they don’t have the level of information that is needed.

Missed opportunities

The lack of information within a delivery system can result in missed opportunities to connect a patient with a provider with similar expertise who could see the patient sooner, which improves patient satisfaction, retention and care coordination.

Leaving the network

Because of the lack of information, 77 percent of survey respondents say it is important to keep patients in network to support care coordination, yet 79 percent still refer out of the delivery system. “While the occasional out of network referral is to be expected, providers who knowingly refer out of network and are aware which patients are in network still estimate they send an average of 22 percent of patients to out of network providers,” according to the Kyruus report.

Reliance on the phone

For providers who schedule an appointment for the patient, 44 percent make the appointment within a shared electronic health records system, and 60 percent schedule it by phone. Heavy use of the phone occurs as it is difficult for providers to see capacity in their network to book the next available appointment, so they bypass the network and book the appointment before the patient leaves the office.

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