Kyruus News

System Failure: Kyruus Data Reveals the Shortcomings in the U.S. Healthcare Referral System

We are excited to announce that today we are releasing a major report that highlights the massive inefficiencies in the way that referrals are currently managed in the U.S. healthcare system. One of the key findings revealed that nearly 20 million times a year in the U.S., patients are sent to a “clinically inappropriate” provider—meaning they are not the right match to treat their condition.

Why does this matter? These clinically inappropriate referrals ultimately can lead to poorer 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.

We independently surveyed 100 U.S.-based specialist physicians across 11 medical specialties and found:

  • 75% of specialists have received at least one “clinically inappropriate” referral in the past year.
  • 7.8% of all referrals are considered “clinically inappropriate,” which equates to 42 mismatched patients per specialist per year and 19.7 million clinically inappropriate referrals annually nationwide.
  • 15% 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% are re-referred to more clinically suitable physicians, incurring an estimated $1.9 billion in lost wages and unnecessary co-pays annually.[1]

As the data illustrates, our current process is clearly broken, leading to considerable consequences for both patients and physicians.

To review the rest of our findings, you can view the full report here, or check out our infographic on the subject located here.


[1] 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.

Topics: Referral Management Analytics Patient Access Provider Networks