Why PCPs and Specialists are Focusing on Automated Referral Workflow in 2017

Posted by Jeremy Guttman on 1/3/17 5:10 PM



Relationships between PCPs and specialists are sacred. On average, a single PCP is connected to 68 specialists. However, lack of electronic connectivity makes it difficult to coordinate care and manage referrals—apart from hiring additional administrative staff.

Without patient referrals from PCP to specialist, it is estimated that only half as many patients would show up to their specialty care appointment1. Furthermore, “self-referral” patients who see specialists without recommendation from a PCP are associated with higher patient dissatisfaction and poorer continuity of care with the primary care doctor2. As PCPs refer more patients to specialists each year, coordinated care and automated referral workflow become an urgent issue for both independent and hospital-based practices.

Better than printing and faxing

According to a practice management assistant in Pittsburgh, faxing consult reports “can be a daylong process.” With a referral management application, sending consult reports to PCPs is much quicker than having “to print out a thousand notes and to fax them. It's definitely more efficient in that sense," claims the Pittsburgh-based practice assistant.

“It's very simple, it's easy to use, and it makes good sense. I'd rather use an online version [of referral management] than printing any day.”

Patients no longer fall through the cracks

Under the typical manual referral system, PCPs refer their patients to specialists with pieces of paper. As a result, half of patients don’t end up making it to their recommended specialist appointments3, often due to lost paperwork and faulty communication4.

Researchers dub missed specialist referrals “the most frequent error in medicine” and missed referrals can lead to problems such as missed or delayed diagnoses.

  • With electronic referrals, a specialist practice immediately sees every referral and has the opportunity to increase patient adherence by reaching out to schedule each appointment.
  • Additionally, when you connect electronically with your referral partners, important diagnoses aren’t delayed and patients stay safer and healthier as a result of improved care transitions and reduced time-to-treatment.

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Streamlined declines for no-shows or unresponsive patients

In most cases, if a specialist practice doesn't call or fax a PCP office to notify them of no-show referrals, the PCP office assumes that the patient made it to their referred appointment. Similarly, administrative staff may think that the specialist office failed to send a consult report in time for the patient’s next appointment.

With electronic referral management, the decline process is measurable. "You hit decline on a referral if the patient didn't come in, you follow the decline options, there is an electronic form where you can submit additional information, and modifying is very simple.”

- Practice Management Assistant, Pittsburgh, PA

Eliminated wasted phone time and improved office efficiency

According to an MGMA report, medical receptionists can waste up to 30 minutes on the phone when the patient’s information is not close at hand5. In contrast, electronic referral management "makes it easier for the PCP offices to refer patients. It saves the referring
office time by eliminating phone time trying to get through to the schedulers on a very busy day," remarks a referral coordinator of an Orthopedics practice in Pittsburgh, PA.

More efficient visits and higher satisfaction

Paper referrals lead to inefficient specialty visits and poor specialist satisfaction because of inadequate workup and illegible communication between primary care physicians and specialists6.

In contrast, practices prefer electronic referral systems.

“We have a phone number, we have an address, we have what insurance they have, and why they're coming in, and it's a done deal.”

- Leslie Hastings, Practice Manager, Wexford Cardiology, Wexford PA


I love [electronic referral management], I think it's an awesome concept...it's really helpful for time management. We try to address referrals as soon as they come through.”

- Referral Coordinator, Orthopedics practice in Pittsburgh, PA

With increased collaboration, “a specialist can be more involved in explaining to a PCP what should be done to get a patient ready to see them or to prepare for a particular procedure”

[GUIDE] Care coordination automation


Enhanced collaboration between primary and specialty care

Nearly 40% of the time, PCPs don’t receive consult reports from specialists prior to a patient’s follow-up visit7. Even when consult reports are sent, they are often delinquent, eliminating the opportunity for PCPs to have important face-to-face conversations with patients.

  • E-referrals enhance shared accountability, so specialists and PCPs achieve high-quality care coordination by exchanging clinical and service-level information timely and electronically.
  • Specialists participating in value-based care models, such as ACOs and PCSP, foster an environment for increased collaboration.
  • Increased collaboration “allows for greater opportunities for specialists to engage in the premiere population-based payment model, which will likely improve the coordination of care and outcomes for their patients.”

Referral sources won’t be a mystery

Many specialists cannot easily measure which physicians refer to them and how often. Electronic referral management allows specialty care to receive real-time data from primary care groups about which of its practices and providers are sending referrals to your providers.

  • Referral source analytics from PCP practices help specialists to identify opportunities for further collaboration with additional physicians.

Don’t go unnoticed

PCPs prioritize their preferred specialists within their electronic referral management system to reflect those practices who have committed to connect electronically and become mutually accountable for improved care coordination.

Specialists who coordinate with PCP practices that prioritize value-based care and care coordination “may increase their referral base.”

Electronically connected specialty referral partners stand out in a PCP's referral decision support system. On top of that, they're prepared to connect with other regional primary care groups—just like they're all on the same EHR.

When PCPs and specialists collaborate more closely through a singular platform, their relationships between practices and their patients are strengthened. Offices run more efficiently with fewer phone calls and a better decline process, faxing gets reduced or eliminated, patient adherence improves, and specialist practices get noticed.

Download white paper - How Automation can fix your care coordination workflow


1) Milbank Quarterly | http://www.ncbi.nlm.nih.gov/pubmed/21418312

2) Journal of Family Practice | https://www.ncbi.nlm.nih.gov/pubmed/11350708

3) Archives of Internal Medicine | http://www.ncbi.nlm.nih.gov/pubmed/22271124

4) Journal of Evaluation in Clinical Practice | http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4469338/

5) Mastering Patient Flow: Using Lean Thinking to Improve Your Practice Operations. Medical Group Management Association (MGMA)

6) BMC Health Services Research | http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4684927/

7) Archives of Internal Medicine | http://www.ncbi.nlm.nih.gov/pubmed/21220662


Topics: Care Coordination, Referral Network, Referral Adherence, Referral Workflow