One in three patients in the U.S. is referred to a specialist every year, yet only about 35% of those patients are ever seen. Referrals arrive as unstructured faxes, sit in undifferentiated work queues, get routed to the wrong specialty or simply disappear.The result is measured in lost revenue, frustrated providers and patients who never receive the care they were sent to get.
During a featured session at Becker’s 16th Annual Meeting in April, sponsored by Tennr, Beth Meese, RN, executive director of digital health and clinical applications at Cleveland Clinic, and Lisa Fort, MD, assistant chief medical information officer at Ochsner Health in New Orleans, explored what it takes to fix referral management and why intelligent triage is crucial to success.Below are four takeaways from their conversation.
1. The referral problemMeese framed the access crisis with a precise diagnosis: unstructured data arrives at the front of the referral process, generating cascading failures downstream.When Cleveland Clinic reviewed 8,000 external referrals, 19% contained diagnoses so vague the organization could not determine where to route the patient. That 19% — roughly one in five incoming referrals — represents patients who either fell out of the system entirely or consumed capacity in the wrong specialty.“We don’t even know what number it is,” Meese said of the volume of patients lost in the process.
The fix, she argued, has to start at the point of intake. That means converting unstructured referral data into structured records that can be tracked, measured and acted on before patients simply disappear.
2. The right patient at the right place
Dr. Fort illustrated the compounding cost of mismatched referrals with a scenario familiar to anyone in ambulatory care:A patient with back pain gets referred up the chain — urgent care to orthopedics to neurosurgery — waits months at each step and ultimately lands back where they started, more often than not needing only physical therapy.Each unnecessary referral consumes a specialist appointment that a genuinely high-acuity patient needs. Proper triage, she argued, doesn’t just improve patient experience, it creates capacity.“Right care, right place makes a huge difference,” Dr. Fort said. “It’s much less expensive.”The same logic applies in reverse: a new diagnosis of decompensated heart failure should jump the line ahead of a routine blood pressure check, but systems that rely on first-in, first-out scheduling can’t make that distinction without smarter intake infrastructure.
3. Closing the referral loop
Meese highlighted that 45% of Cleveland Clinic’s referrals come from external providers and historically, the system had not been closing the loop by sending structured follow-up information back to those referring physicians.The consequence created a reputation problem. Referring providers whose patients disappeared into the Cleveland Clinic system without feedback were left without the clinical information they sent the patient to obtain.The solution Meese described involves converting incoming referrals into structured Epic orders from the point of intake so the system can track each referral through to resolution and route information back to the original provider.4. Technology enables humans
Meese described a team of 80-plus FTEs managing referral workflows largely through manual processes and noted that no amount of hiring can keep pace with the volume or address the root causes.The model both panelists advocated for positions technology as the screening layer, parsing unstructured data, flagging undifferentiated referrals, surfacing payer coverage and prior authorization requirements and identifying acuity signals, while preserving human judgment for the decisions that require clinical expertise and relationship.
“Technology should get the first pass,” Dr. Fort said. “There’s a wealth of knowledge that tech can pull from all kinds of different places, digest, and then present it to be confirmed by a human.”
For Dr. Fort, the goal is letting a specialist spend an hour reviewing 10 referral assessments rather than 10 individual charts, enabling them to triage accurately and route patients to the right provider before anyone travels hours for a visit they didn’t need.
Both panelists agreed that converting unstructured referral data into structured, trackable records is the foundation on which everything else depends. “Let’s take advantage of providers doing something that a system can’t do really well,” Meese said. “That’s the human to human interaction.”
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