Referral Rates Direct Indirect Costs 121713

8122019 Referral Rates Direct Indirect Costs 121713

httpslidepdfcomreaderfullreferral-rates-direct-indirect-costs-121713 114

athenahealth IncPublished October 2012

ReferralViewSM

A First Look at National Referral Patterns from

Primary Care Practices







ReferralViewSM A First Look at National Referral Patterns from Primary Care Practices

wwwathenahealthcomwwwhalleyconsultingcom4

Te providers included in this study had over 25 million patient visit s mea sured as evaluation and management (EampM)encounters Tey made more than 200000 consult reerrals andalmost 350000 diagnostic reerrals during the study period

Te dataset contained one year o data July 2011 through June 2012 All providers in this study used athenaCollectorregathenahealthrsquos cloud-based billing and practice managementsystem and the athenaClinicalsreg EHR We limited the datato those providers who were lsquoestablishedrsquo in their utilizationo these integrated services that is they had been using thesystem or at least six months prior to the start o the studyIn addition providers with reerral rates in the top and bottomtenth o the dataset were considered outliers and thus excludedrom the analysis

For each reerring specialty we calculated a reerral rate or1) specialty consult referral

s that is reerrals to specialty physicians and 2) diagnostic referrals or reerrals or testingand diagnostic services o calculate a providerrsquos reerral rate wedivided the total number o reerrals that a provider sent outthrough the athenaClinicals system by the total number o

patient EampM visits

o understand what drives a providerrsquos reerral habits we testedcorrelations between the PCP reerral rate and several key practiceactors including

bull Reerral Rate Collections wRVUbull Reerral Rate Median Patient Agebull Reerral Rate Coding Indexbull Reerral Rate Physician Productivity (wRVUs and visits)

Please see the appendix or ull definitions o terms

Pediatricians and amily practitioners both routinely madereerrals to pediatric-specific subspecialties such as pediatriccardiology and pediatric oncology In localities where specific

pediatric subspecialties are avai lable we would iner that thereerral preerence would be to the pediatric subspecialtyhowever reerring providers do not all have access to the ullcomplement o pediatric subspecialties Tereore to normalizethe data and capture the directional intent o the reerral the

pediatric subspecialty was paired with the corresponding adult

subspecialty in our tabulations Tis can yield a ldquoservice linerdquo perspective when considering the reerral rates to cardiacspecialties or example and captures the impact o the pediatricsubspecialty reerrals to that service line

Key FindingsOverall the primary care specialties included in this analysismdashamily practice internal medicine obstetrics and gynecologyand pediatricsmdashreerred at a rate o 8 or specialty consultsTere was a wide range however o reerral rates amongspecialties as seen in Figure 2

FIGURE 2 REFERRAL RATES FOR PRIMARY CARE PROVIDERS

Type ofPractice

ConsultReferralRate

DiagnosticReferralRate

TotalReferralRate

Family Practice 11 14 25

Internal Medicine 11 18 29

OBGYN 20 29 31

Pediatrics 35 22 57

Referral rate is defined as the referrals made as a percentage of total EampM visits

Family practice and internal medicine providers reerred at a rateo 25 and 29 respectively Tis underscores the large volumeo reerrals that these primary care practices must managePediatrics handled ewer reerrals most o which were or consultsand not diagnostic ser vices OBGYN reerred the most ordiagnostic services such as ultrasound and mammogram and hadthe lowest reerral rate or consults




wwwathenahealthcomwwwhalleyconsultingcom 5

FIGURE 3 CONSULT AND DIAGNOSTIC

REFERRAL RATES BY SPECIALTY

Overall the top reerred-to specialties includedbull Gastroenterologybull Orthopedic Surgery bull Physical Terapy bull Dermatology bull EN

X-rays ultrasounds and mammograms were the most requentlyreerred-out diagnostic services among the primary care specialties

Regional TrendsTere were variations in the reerral rates by region Across the

primary care specialties o amily practice internal medicineand pediatrics reerral rates were highest in the West andNortheast OBGYN a specialty with both primary care andsubspecialty characteristics had little regional difference inreerral rates Figure 4 shows the regional differences in consultreerral rates among the PCP practices we studied

FIGURE 4 REGIONAL DIFFERENCES IN CONSULT

REFERRAL RATES

RegionFamilyPractice

InternalMedicine

Pediatrics OBGYN

Midwest 95 11 25 20

South 10 10 27 29

West 13 14 30 18

Northeast 11 14 38 17

We hypothesize that a uture segmentation o OBGYN practicesinto primary care (ie those practices that are predominantlyobstetrics) and specialty care (ie those practices that are

predominantly gynecology) wou ld show a similar reerr al pattern to those seen with the other pri mar y care practices with lower reerral s in the Midwest and Sout h

FIGURE 5 OVERALL CONSULT REFERRAL RATES BY REGION

NORTHEAST MIDWEST

WEST

SOUTH

103 81

62

98

Consult Referrals

Gastroenterology

Physical Therapy

Dermatology

Ortho SurgeryGeneral

OBGYN Maternalamp Fetal Med

torhinolaryngology

Surgery General

Cardiology

Ophthalmology

Urology

Neurology

Podiatry General

130

116

55

75

00

41

42

46

42

30

35

55

0 100

F Faammiillyy PPrraaccttiiccee

162

84

67

67

00

46

48

60

55

36

39

39

0 100

IInntteerrnnaall MMeeddiicciinnee

37

36

93

86

00

126

33

41

67

35

46

15

0 100

PPeeddiiaattrriicc MMeeddiicciinnee

162

41

24

03

231

03

63

22

03

47

15

01

0 x x x x

x x x x

100

OOBBGGY YNN

Diagnostic Referrals

X-Ray

Ultrasound

Mammogram

ECG

BoneDexa

MRI

CT

Audio

Echo

StressCardiac

0 100


0 100


0 100


0 100

OOBBGGY YNN

586

118

01

48

00

31

27

100

15

00

06

449

349

06

54

05

05

00

00

00

241

123

162

163

79

50

57

04

23

18

329

135

190

71

46

67

56

04

20

13

x x x x

x x x x





We hypothesize that the regional variations observed across thespecialties o amily practice internal medicine and pediatricscan be explained by the ollowing actors

1 PREDOMINANCE OF RURAL AREAS IN THE MIDWEST

AND SOUTH Te Midwest and the South have the highest percentage o r ural residents3 We speculate that lowerreerral rates in rural areas are due primarily to the decreasedavailability o specialists (ie ewer reerral options) Tereorerural providers may practice a wider scope o medicine out onecessity Te coding levels (coding index) o providers in thosemore rural regions support this perception

2 PENETRATION OF HMOS IN THE WEST AND NORTHEAST

Research rom Kaiser shows that HMOs which typical lyrequire a direct reerral rom the primary care provider oraccess to specialty physicians have a more significant presence

in the West and Northeast

4

where reerral rates are higherIt should be noted that not all HMOs consider OBGYNto be a primary care specialty

3 HIGHER MEDIAN PATIENT AGE IN THE WEST Reerralrates in the West were the highest or both amily practiceand internal medicine As shown in Figure 6 the median ageo patients in the West was highest as well It is possible thatolder patients were driving increased reerral rates

FIGURE 6 MEDIAN PATIENT AGE FOR FAMILY PRACTICE

AND INTERNAL MEDICINE

Region FP Median Age IM Median Age

Midwest 49 62

South 49 63

West 53 65

Northeast 51 55

Detailed Findings Family PracticeSPECIALTY CONSULT REFERRALS

Family practitioners have an 11 reerral rate or specialtyconsults Gastroenterology physical therapy and orthopedicsurgery were the top reerred-to specialties

FIGURE 7 TOP REFERRED-TO SPECIALTIES BY FAMILY

PRACTITIONERS

Referred-to Specialty Per-Visit Referral Rate

Gastroenterology 16

Physical Therapist 14

Orthopedic Surgery General 09

Podiatry General 07

Dermatology 07

Cardiology 06

EndocrinologyMetabolism 05

Surgery General 05

Ophthalmology 05

Otorhinolaryngology 05

DieticianNutritionist 04

Neurology 04

Urology 04

Psychiatry General 03

Optometrist 03





CONSULT REFERRALS ndash DATA CORRELATIONS

o understand what drives a providerrsquos reerral habits we testedcorrelations between the amily practitionerrsquos reerral rate andseveral key practice actors First we examined whether or not a

providerrsquos productivity or workload impacted his or her reerral

rate In other words does a provider with a high patient load reerout at a greater rate simply because he or she does not have thetime to treat the patient For amily practitioners no significantcorrelation was ound between productivity levels and reerral rates

A slight negative correlation was observed between the providerrsquosreerral rate and hisher collections per work RVU Collectionsare generally lower in practices serving a lower socioeconomic

patient base so it would seem that lower income patients arereerred out at a higher rate than more affluent patients We alsocompared the median age o the providerrsquos patient base to thereerral rate but ound no significant correlation

FAMILY PRACTICE DIAGNOSTIC REFERRALS

Family practitioners reerred out to diagnostic services at a rateo 14 X-rays mammograms and ultrasounds were the mostcommon o these reerrals Chest x-rays were by ar the mostcommon x-rays ordered by amily practitioners

FIGURE 8 TOP DIAGNOSTIC REFERRALS BY FAMILY

PRACTITIONERS

Modality Referral Rate Visit

X-ray 45

Mammogram 26

Ultrasound 19

ECG 1

MRI 09

Detailed Findings Internal MedicineSPECIALTY CONSULT REFERRALS

Te reerral rate or internal medicine physicians in this study was 11 As with ami ly practice gastroenterology physicaltherapy and orthopedic surgery were the top reerred-to specialtiesHowever or internists ga stroenterology represents a larger

percentage o total consult reerrals at 16 compared to amily practice reerrals to gastroenterology at 13

FIGURE 9 TOP REFERRED-TO SPECIALTIES BY INTERNAL

MEDICINE PROVIDERS


Gastroenterology 11



Dermatology 04

Cardiology 04

Ophthalmology 04

Surgery General 03


Podiatry General 03

Neurology 03

Urology 02

OBGYN Gynecology (Only) 02

Anesthesiology Pain Management 02







In the case o internal medicine there was not a significantcorrelation between provider productivity level and reerralrates or between collections and the reerral rate Tere washowever a statistica lly signi icant negative correlation

between the median age o the internal medicine providerrsquos patient base and the reerral rate Tis correlation reveals thathigher reerral rates are associated with a younger patient

population an apparent contradiction to the previoussupposition about older patients driving higher reerral ratesTat overall relationship is driven by the substantially highernumber o amily practice providers within the sample set(our to one relative to internal medicine) Further a nalysiso the age group data or the internal medicine patient basereveals that there is a ldquosweet spotrdquo in the 45-65 age range orinternal medicine patients where the reerral rates are highestBeyond that age range the reerral rates decline We speculate

that this may be because older patients already have relation-ships established with certain specialists due to prior or chronicallyoccurring conditions Younger patients may be encounteringthese medical issues or the first time and consequently wouldbe in need o that initial reerral

INTERNAL MEDICINE DIAGNOSTIC REFERRALS

Diagnostic reerrals occurred at a rate o 18 o all internalmedicine visits approximately 4 higher than the reerralrate o amily practitioners As with amily practice x-ray wasthe most commonly reerred modality However as a percento total reerrals the utilization o x-rays was almost hal thato their amily practice peers Dexa scans were the fifh mostutilized diagnostic and reflect the older patient base seen bythis primary care specialty

FIGURE 10 TOP DIAGNOSTIC REFERRALS BY INTERNAL

MEDICINE

Modality Per-Visit Referral Rate

X-ray 43

ECG 29

Mammogram 29

Ultrasound 22

BoneDexa 12

Detailed Findings PediatricsSPECIALTY CONSULT REFERRALS

Pediatricians had a 35 reerral rate one o the lower per-visitconsult reerral rates Te most requent reerred-to specialtiesby pediatricians included EN dermatology and orthopedicsurgery

FIGURE 11 TOP REFERRED-TO SPECIALTIES BY PEDIATRICIANS



Dermatology 022


Ophthalmology 016

AllergyImmunology 013

Neurology 011

Cardiology 01

Audiologist 009

Gastroenterology 009

Speech Therapist 008


Urology 008

Surgery General 008


Pediatrics General 006

Tere was considerable variation in the reerral patterns o pediatricians regarding decisions to reer to the adult subspe-cialty versus reerring to the corresponding pediatric subspecialty(eg cardiology vs pediatric cardiology) As previously discussed

we suspect that the specialty selection is driven by the availabilityo the pediatric subspecialty in the market In general pediatric

patients were most ofen reerred specifically to the pediatricsubspecialist when the reerral was in the area o ophthalmologycardiology gastroenterology urology general surgery and

psychiatry Interestingly when the issue was related to ENdermatology and neurology the reerral was more ofen madeto the adult subspecialty





FIGURE 12 PEDIATRIC VS ADULT SPECIALTY REFERRALS BY

PEDIATRICIANS

Referred-toSpecialty

of ReferralsDirected toPediatricSubspecialty

of ReferralsDirectedto AdultSubspecialty

Otorhinolaryngology 19 81

Dermatology 30 70

Orthopedic SurgeryGeneral 40 60

Ophthalmology 76 24

AllergyImmunology NA NA

Neurology 27 73

Cardiology 76 25

Audiologist NA NA

Gastroenterology 79 21

Speech Therapist NA NA

Physical Therapist NA NA

Urology 75 25

Surgery General 87 13

Psychiatry General 70 30

Pediatrics General 11 99


Pediatrician reerral rates were significantly correlated with the pediatriciansrsquo collections per work RVU Te negative correlationindicated that the lower the providerrsquos collections per work RVUthe higher the reerral rate Te negative correlation or the specialtyo pediatrics was stronger than the correlation ound in amily

practice or the same two variables In pediatrics low collections

are typical in practices with high Medicaid patient populationsand Medicaid patients may be more likely to wait to access careuntil their symptoms are more serious5 We speculate that as aresult the chances that a consult reerral will be required increasedor patients in this socioeconomic group No other significantcorrelations were ound with the pediatric reerral data

PEDIATRIC DIAGNOSTIC REFERRALS

O the primary care specialties pediatricians were the least requentutilizers o diagnostic services with a reerral rate o only 22Te majority o diagnostic reerrals were or x-rays and the mostrequently ordered x-rays were or the chest oot and abdomen

en percent o all diagnostic reerrals were or audiology-relateddiagnostics such as audiometry and tympanograms

FIGURE 13 TOP DIAGNOSTIC REFERRALS BY PEDIATRICIANS


X-ray 13

Ultrasound 03

Audio 02

ECG 01

MRI 01





Detailed FindingsObstetrics amp Gynecology SPECIALTY CONSULT REFERRALS

Obstetrics and Gynecology physicians reerred out at a rate o3 notably lower than the other specialties OBGYNs reerredin the highest proportions to the obstetrical subspecialty omaternal and etal medicine Reerrals to general surgeons werealso notably high and were presumably made or surgerytreatment afer an irregular mammogram or pap smear

FIGURE 14 TOP REFERRED-TO SPECIALTIES BY OBGYNS


OBGYN Maternal amp Fetal Med 047


Surgery General 013

OBGYN Urogynecology 010

Urology 010


Surgery Breast 005

Dermatology 005

OBGYN Gynecological Oncology 005

ObstetricsGynecology General 005

Cardiology 004


OBGYN Reproductive Endocrinology 004

Neurology 003


CONSULT REFERRALS - DATA CORRELATIONS

Several statistically significant correlations were noted duringthe analysis o the OBGYN reerral and productivity data Wesaw a negative correlation between an OBGYNrsquos reerral rateand the median age o hisher patient base Tat is the youngerthe patient base the higher the reerral rate Given that themost requently reerred-to specialty was maternal and etalmedicine it stands to reason that younger patients (those ochildbearing age) might incur a higher reerral rate

We also saw a negative correlation between collections per workRVU and the reerral rate with the OBGYN dataset suggestingthat the providers serving lower income patients tended to see

patients with more acute issues that required a consult reerral

Productivity was also negatively correlated with the providerrsquosreerral rate Tat is the higher the providerrsquos productivity(both in terms o work RVUs and visits) the less l ikely he orshe was to reer out Tis may suggest that the more productive

physician practiced a wider scope o his or her specialty decreasingthe need to reer out

OBSTETRICS amp GYNECOLOGY DIAGNOSTIC REFERRALS

O the primary care specialties evaluated OBGYNs werethe highest utilizers o diagnostic services with a reerral rate o28 As expected or the patient population ser ved the va stmajority o reerrals were or ultrasounds and mammograms

FIGURE 15 TOP DIAGNOSTIC REFERRALS BY OBGYNS


Ultrasound 13

Mammogram 10

BoneDexa 16

Sonogram 02

X-ray 02

Using Referral Data to PredictPatient Volume and Revenue983121uantiying the downstream value o a specialistrsquos business

particularly a surgeonrsquos has been evaluated in previously published studies6 By incorporating the more elusive componento the equationmdashthe volume o patients that PCPs drive to thosespecialistsmdashplanners and other administrators can provide acomprehensive orecast o the direct and indirect impact o aPCP on downstream activity

Te data in this report combined with data rom a typicalbilling and clinical management system can be used to measurethe effect o a primary care provider on specialistsrsquo patient volumeand revenue o illustrate we have provided an example usingamily practice reerrals to an orthopedic surgeon

According to data presented in this paper a typical family practice provider generates referrals at a rate of 11 referrals per100 visits According to athenahealth data a typical family

practice has about 4100 patient visits annually Terefore a





typical family practice provider will generate about 451 referralsannually Using data presented in this paper we see that family

practice providers referred to orthopedic surgeons at a rate of09 Terefore we can calculate that about 37 of the 451 referrals

will be directed to orthopedic surgery

Te orthopedic practice can use its medical billing and clinicalmanagement system to calculate the yield of those referrals bylooking at the historical utilization of services by a new patientin their practice For example on average 37 referrals into the

practice might translate into

bull 74 patient visits (both new and ollow up)bull 59 in-office diagnosticsbull 21 office proceduresbull 99 outpatient proceduressurgeriesbull 33 inpatient proceduressurgeriesbull

12 reerrals out or diagnosticsbull 7 reerrals to other specialists (ie physical therapy)

While specialists obtain patients through channels other thanthrough PCP referrals this extrapolation provides service linemanagers with a methodology for forecasting three importantmetrics 1) diagnostic demand 2) OR (facility) demand and 3)specialty physician demand By determining the typical serviceline utilization (ie cases diagnostics) of a new patient we canattach market-specific per-case or per-diagnostic contributionmargins to forecast the downstream effect of the new patientreferral Monitoring the demand for physicians who support

various service lines ensures that market demand is in alignment

with the supply of those physicians and becomes a criticalcomponent of medical staff development planning

The Value of UnderstandingPatient Referral Flow Te data presented here provide a ramework or assessingthe volume and value o reerrals to various specialties rom

primary care providers It reinorces the value o primary care providers in the medical services demand chain at a time whenthere is a nationwide shortage o primary care providers In

addition findings point to the importance o having a robustreerral management system in place or medical practices andhealthcare systems

Primary care reerral rates are a undamental metric in developinghospitalsrsquo medical staff specialties A hospitalrsquos ldquoMedical StaffComplementrdquo is the mix o physician specialties and otherhealthcare proessionals required to meet patient demand andto remain technologically and operationally viable Te data

presented here can significantly inorm this planning process

Using data in this report a healthcare system can answerquestions such as

bull How much downstream business should we expect roman employed primary care physician

bull What kind o diagnostic service utilization should weexpect rom an OBGYN

bull How many patient reerrals are lsquoleakingrsquo out o ourintegrated delivery model

bull How many primary care providers are necessary in orderto support an orthopedic surgeon

In addition the data presented here provide a gauge to indicate whether or not a specialty physicianpractice is the provider oldquochoicerdquo among reerring physicians7 Tat is it is possible todetermine whether certain specialty physicians are attracting theoptimal number o reerrals rom primary care providers A recent

study

8

identifies ldquophysician communicationrdquo and patient accesscharacteristics as the most important actors afer clinical expertisein contributing to the selection o a reerred-to physician Tereorelooking at reerral rates or given providers could indicate thatmore attention might be needed to nurture reerral relationships

Te data in ReerralView can also be used by primary care providers and advocacy organizations to develop a morecomplete understanding o the downstream value o primarycare across the national health care system A survey in the

Journal o General Internal Medicine ound that 63 of PCPs

were dissatisfied with the referral process compared with

35 for specialists9 Tis study sheds additional light on the

reasons or that dissatisaction PCPs do a significant amounto work to get a reerral out the doormdashrom organizing datato selecting the appropriate provider to handling requiredinsurance paperwork New care coordination models such asathenahealthrsquos athenaCoordinatorreg service are shifing theburden or submitting and tracking reerral data rom the

provider to the receiving acility reducing the workload or PCPs

Reerral tracking can provide key insights into overall healthcare expenditure by helping researchers monitor the type and

volume o patient reerrals as medical providers implementACOs and other quality care improvements Future research

using ReerralView can also provide a more in-depth under-standing o the reerral path rom PCPs to specialties to helptrack and predict reerrals and understand care utilization withan eye toward reducing overall costs

he value o physician reerrals is tangible a nd determinableFor hospitals health systems and providers alike ReerralViewenables new insights into reerral patterns that can inorm planningand establish the transparency needed to create an equitable andsustainable market or health inormation exchange





Appendix Data DefinitionsEampM Visit Te count o visits tabulated rom the billedin-patient and out-patient Evaluation and Management CPcodes that the provider generated during the study period

Reerral A documented request that the patient see a certainspecialty or seek a specific type o diagnostic test

Reerral Rate Reerrals made as a percentage o totalEampM visits

Coding index a measure o visit acuity calculated as workRVUs divided by EampM visits

Note Full reerral data wil l be included in the appendix o asubsequent version o this whitepaperndashavailable or downloadat athenahealthcom

End Notes1 How Many Other Doctors Do Primary Care Doctors Need toCoordinate Patient Care With Ann Intern Med 17 February2009150(4)I-44 Available at httpannalsorgarticleaspxarticleid=744335

2 Michael L Barnett MD Zirui Song BA Bruce E LandonMD MBA rends in Physician Reerrals in the United States1999-2009 Arch Intern Med 2012172(2)163-170 Availableat httparchintejamanetworkcomarticleaspxarticleid=1108675

3 Modernizing Rural Health Care Coverage 983121uality andInnovation United Healthcare Group July 2011 3 Availableat HYPERLINK ldquohttpwwwunitedhealthgroupcomhrmuhn_workingpaper6pdrdquowwwunitedhealthgroupcomhrm

uhn_workingpaper6pd4 Kaiser Family Foundation State Health Facts State HMOPenetration Rate ndash July 2011 Available at httpwwwstatehealthactsorgcomparemaptablejspcat=7ampind=349

5 Sommers AS Boukus E R Carrier E Dispelling MythsAbout Emergency Department Use Majority o MedicaidVisits Are or Urgent or More Serious Symptoms Center orStudying Health System Change No 23 July 2012 Availableat httpwwwhschangeorgCONEN13021302pd

6 Merritt Hawkins 2010 Physician InpatientOutpatient

Revenue Survey Available at httpwwwmerritthawkinscom pd2010_revenuesurveypd

7 Halley Marc D ldquoTe Economics o Physician IntegrationrdquoHealthcare Executive SeptemberOctober 2012 76-79

8 Barnett et al Reasons or Choice o Reerral PhysicianAmong Primary Care and Specialist Physicians Society oGeneral Internal Medicine 2011 Available at httpchristakismedharvardedupdpublicationsarticles131pd

9 Communication Breakdown in the Outpatient ReerralProcess J Gen Intern Med 2000 September 15(9) 626ndash631

Available at httpwwwncbinlmnihgovpmcarticlesPMC1495590





athenahealth Inc | 311 Arsenal Street | Watertown MA 02472 | 8668175738

copy 2012 athenahealth Inc All rights reserved

About athenahealth At athenahealth we offer the leading

cloud-based practice management EHR and care coordination services

that help medical groups get more money and more control of patient

care To learn how our services can help your organization contact us

at 8668175738 or athenahealthcom

About Halley Consulting Group The Halley Consulting Group

is a physician practice management and consulting rm specializing in

the strategic development and performance turnaround of both hospital-

owned medical practice networks and large independent medical ofces

Contact us at 8667065373 or halleyconsultingcom























Type ofPractice

ConsultReferralRate


TotalReferralRate



OBGYN 20 29 31

Pediatrics 35 22 57














REFERRAL RATES


InternalMedicine

Pediatrics OBGYN

Midwest 95 11 25 20

South 10 10 27 29

West 13 14 30 18





NORTHEAST MIDWEST

WEST

SOUTH

103 81

62

98

Consult Referrals

Gastroenterology

Physical Therapy

Dermatology



torhinolaryngology

Surgery General

Cardiology

Ophthalmology

Urology

Neurology

Podiatry General

130

116

55

75

00

41

42

46

42

30

35

55

0 100


162

84

67

67

00

46

48

60

55

36

39

39

0 100


37

36

93

86

00

126

33

41

67

35

46

15

0 100


162

41

24

03

231

03

63

22

03

47

15

01

0 x x x x

x x x x

100

OOBBGGY YNN


X-Ray

Ultrasound

Mammogram

ECG

BoneDexa

MRI

CT

Audio

Echo

StressCardiac

0 100


0 100


0 100


0 100

OOBBGGY YNN

586

118

01

48

00

31

27

100

15

00

06

449

349

06

54

05

05

00

00

00

241

123

162

163

79

50

57

04

23

18

329

135

190

71

46

67

56

04

20

13

x x x x

x x x x











4






Midwest 49 62

South 49 63

West 53 65

Northeast 51 55




PRACTITIONERS


Gastroenterology 16



Podiatry General 07

Dermatology 07

Cardiology 06


Surgery General 05

Ophthalmology 05



Neurology 04

Urology 04


Optometrist 03














PRACTITIONERS


X-ray 45

Mammogram 26

Ultrasound 19

ECG 1

MRI 09





MEDICINE PROVIDERS


Gastroenterology 11



Dermatology 04

Cardiology 04

Ophthalmology 04

Surgery General 03


Podiatry General 03

Neurology 03

Urology 02
















MEDICINE


X-ray 43

ECG 29

Mammogram 29

Ultrasound 22

BoneDexa 12






Dermatology 022


Ophthalmology 016


Neurology 011

Cardiology 01

Audiologist 009




Urology 008

Surgery General 008












PEDIATRICIANS





Dermatology 30 70


Ophthalmology 76 24


Neurology 27 73

Cardiology 76 25

Audiologist NA NA




Urology 75 25













X-ray 13

Ultrasound 03

Audio 02

ECG 01

MRI 01











Surgery General 013


Urology 010


Surgery Breast 005

Dermatology 005



Cardiology 004



Neurology 003












Ultrasound 13

Mammogram 10

BoneDexa 16

Sonogram 02

X-ray 02































study

8




































































Type ofPractice

ConsultReferralRate


TotalReferralRate



OBGYN 20 29 31

Pediatrics 35 22 57














REFERRAL RATES


InternalMedicine

Pediatrics OBGYN

Midwest 95 11 25 20

South 10 10 27 29

West 13 14 30 18





NORTHEAST MIDWEST

WEST

SOUTH

103 81

62

98

Consult Referrals

Gastroenterology

Physical Therapy

Dermatology



torhinolaryngology

Surgery General

Cardiology

Ophthalmology

Urology

Neurology

Podiatry General

130

116

55

75

00

41

42

46

42

30

35

55

0 100


162

84

67

67

00

46

48

60

55

36

39

39

0 100


37

36

93

86

00

126

33

41

67

35

46

15

0 100


162

41

24

03

231

03

63

22

03

47

15

01

0 x x x x

x x x x

100

OOBBGGY YNN


X-Ray

Ultrasound

Mammogram

ECG

BoneDexa

MRI

CT

Audio

Echo

StressCardiac

0 100


0 100


0 100


0 100

OOBBGGY YNN

586

118

01

48

00

31

27

100

15

00

06

449

349

06

54

05

05

00

00

00

241

123

162

163

79

50

57

04

23

18

329

135

190

71

46

67

56

04

20

13

x x x x

x x x x











4






Midwest 49 62

South 49 63

West 53 65

Northeast 51 55




PRACTITIONERS


Gastroenterology 16



Podiatry General 07

Dermatology 07

Cardiology 06


Surgery General 05

Ophthalmology 05



Neurology 04

Urology 04


Optometrist 03














PRACTITIONERS


X-ray 45

Mammogram 26

Ultrasound 19

ECG 1

MRI 09





MEDICINE PROVIDERS


Gastroenterology 11



Dermatology 04

Cardiology 04

Ophthalmology 04

Surgery General 03


Podiatry General 03

Neurology 03

Urology 02
















MEDICINE


X-ray 43

ECG 29

Mammogram 29

Ultrasound 22

BoneDexa 12






Dermatology 022


Ophthalmology 016


Neurology 011

Cardiology 01

Audiologist 009




Urology 008

Surgery General 008












PEDIATRICIANS





Dermatology 30 70


Ophthalmology 76 24


Neurology 27 73

Cardiology 76 25

Audiologist NA NA




Urology 75 25













X-ray 13

Ultrasound 03

Audio 02

ECG 01

MRI 01











Surgery General 013


Urology 010


Surgery Breast 005

Dermatology 005



Cardiology 004



Neurology 003












Ultrasound 13

Mammogram 10

BoneDexa 16

Sonogram 02

X-ray 02































study

8


































































Type ofPractice

ConsultReferralRate


TotalReferralRate



OBGYN 20 29 31

Pediatrics 35 22 57














REFERRAL RATES


InternalMedicine

Pediatrics OBGYN

Midwest 95 11 25 20

South 10 10 27 29

West 13 14 30 18





NORTHEAST MIDWEST

WEST

SOUTH

103 81

62

98

Consult Referrals

Gastroenterology

Physical Therapy

Dermatology



torhinolaryngology

Surgery General

Cardiology

Ophthalmology

Urology

Neurology

Podiatry General

130

116

55

75

00

41

42

46

42

30

35

55

0 100


162

84

67

67

00

46

48

60

55

36

39

39

0 100


37

36

93

86

00

126

33

41

67

35

46

15

0 100


162

41

24

03

231

03

63

22

03

47

15

01

0 x x x x

x x x x

100

OOBBGGY YNN


X-Ray

Ultrasound

Mammogram

ECG

BoneDexa

MRI

CT

Audio

Echo

StressCardiac

0 100


0 100


0 100


0 100

OOBBGGY YNN

586

118

01

48

00

31

27

100

15

00

06

449

349

06

54

05

05

00

00

00

241

123

162

163

79

50

57

04

23

18

329

135

190

71

46

67

56

04

20

13

x x x x

x x x x











4






Midwest 49 62

South 49 63

West 53 65

Northeast 51 55




PRACTITIONERS


Gastroenterology 16



Podiatry General 07

Dermatology 07

Cardiology 06


Surgery General 05

Ophthalmology 05



Neurology 04

Urology 04


Optometrist 03














PRACTITIONERS


X-ray 45

Mammogram 26

Ultrasound 19

ECG 1

MRI 09





MEDICINE PROVIDERS


Gastroenterology 11



Dermatology 04

Cardiology 04

Ophthalmology 04

Surgery General 03


Podiatry General 03

Neurology 03

Urology 02
















MEDICINE


X-ray 43

ECG 29

Mammogram 29

Ultrasound 22

BoneDexa 12






Dermatology 022


Ophthalmology 016


Neurology 011

Cardiology 01

Audiologist 009




Urology 008

Surgery General 008












PEDIATRICIANS





Dermatology 30 70


Ophthalmology 76 24


Neurology 27 73

Cardiology 76 25

Audiologist NA NA




Urology 75 25













X-ray 13

Ultrasound 03

Audio 02

ECG 01

MRI 01











Surgery General 013


Urology 010


Surgery Breast 005

Dermatology 005



Cardiology 004



Neurology 003












Ultrasound 13

Mammogram 10

BoneDexa 16

Sonogram 02

X-ray 02































study

8



























































REFERRAL RATES


InternalMedicine

Pediatrics OBGYN

Midwest 95 11 25 20

South 10 10 27 29

West 13 14 30 18





NORTHEAST MIDWEST

WEST

SOUTH

103 81

62

98

Consult Referrals

Gastroenterology

Physical Therapy

Dermatology



torhinolaryngology

Surgery General

Cardiology

Ophthalmology

Urology

Neurology

Podiatry General

130

116

55

75

00

41

42

46

42

30

35

55

0 100


162

84

67

67

00

46

48

60

55

36

39

39

0 100


37

36

93

86

00

126

33

41

67

35

46

15

0 100


162

41

24

03

231

03

63

22

03

47

15

01

0 x x x x

x x x x

100

OOBBGGY YNN


X-Ray

Ultrasound

Mammogram

ECG

BoneDexa

MRI

CT

Audio

Echo

StressCardiac

0 100


0 100


0 100


0 100

OOBBGGY YNN

586

118

01

48

00

31

27

100

15

00

06

449

349

06

54

05

05

00

00

00

241

123

162

163

79

50

57

04

23

18

329

135

190

71

46

67

56

04

20

13

x x x x

x x x x











4






Midwest 49 62

South 49 63

West 53 65

Northeast 51 55




PRACTITIONERS


Gastroenterology 16



Podiatry General 07

Dermatology 07

Cardiology 06


Surgery General 05

Ophthalmology 05



Neurology 04

Urology 04


Optometrist 03














PRACTITIONERS


X-ray 45

Mammogram 26

Ultrasound 19

ECG 1

MRI 09





MEDICINE PROVIDERS


Gastroenterology 11



Dermatology 04

Cardiology 04

Ophthalmology 04

Surgery General 03


Podiatry General 03

Neurology 03

Urology 02
















MEDICINE


X-ray 43

ECG 29

Mammogram 29

Ultrasound 22

BoneDexa 12






Dermatology 022


Ophthalmology 016


Neurology 011

Cardiology 01

Audiologist 009




Urology 008

Surgery General 008












PEDIATRICIANS





Dermatology 30 70


Ophthalmology 76 24


Neurology 27 73

Cardiology 76 25

Audiologist NA NA




Urology 75 25













X-ray 13

Ultrasound 03

Audio 02

ECG 01

MRI 01











Surgery General 013


Urology 010


Surgery Breast 005

Dermatology 005



Cardiology 004



Neurology 003












Ultrasound 13

Mammogram 10

BoneDexa 16

Sonogram 02

X-ray 02































study

8


























































4






Midwest 49 62

South 49 63

West 53 65

Northeast 51 55




PRACTITIONERS


Gastroenterology 16



Podiatry General 07

Dermatology 07

Cardiology 06


Surgery General 05

Ophthalmology 05



Neurology 04

Urology 04


Optometrist 03














PRACTITIONERS


X-ray 45

Mammogram 26

Ultrasound 19

ECG 1

MRI 09





MEDICINE PROVIDERS


Gastroenterology 11



Dermatology 04

Cardiology 04

Ophthalmology 04

Surgery General 03


Podiatry General 03

Neurology 03

Urology 02
















MEDICINE


X-ray 43

ECG 29

Mammogram 29

Ultrasound 22

BoneDexa 12






Dermatology 022


Ophthalmology 016


Neurology 011

Cardiology 01

Audiologist 009




Urology 008

Surgery General 008












PEDIATRICIANS





Dermatology 30 70


Ophthalmology 76 24


Neurology 27 73

Cardiology 76 25

Audiologist NA NA




Urology 75 25













X-ray 13

Ultrasound 03

Audio 02

ECG 01

MRI 01











Surgery General 013


Urology 010


Surgery Breast 005

Dermatology 005



Cardiology 004



Neurology 003












Ultrasound 13

Mammogram 10

BoneDexa 16

Sonogram 02

X-ray 02































study

8





























































PRACTITIONERS


X-ray 45

Mammogram 26

Ultrasound 19

ECG 1

MRI 09





MEDICINE PROVIDERS


Gastroenterology 11



Dermatology 04

Cardiology 04

Ophthalmology 04

Surgery General 03


Podiatry General 03

Neurology 03

Urology 02
















MEDICINE


X-ray 43

ECG 29

Mammogram 29

Ultrasound 22

BoneDexa 12






Dermatology 022


Ophthalmology 016


Neurology 011

Cardiology 01

Audiologist 009




Urology 008

Surgery General 008












PEDIATRICIANS





Dermatology 30 70


Ophthalmology 76 24


Neurology 27 73

Cardiology 76 25

Audiologist NA NA




Urology 75 25













X-ray 13

Ultrasound 03

Audio 02

ECG 01

MRI 01











Surgery General 013


Urology 010


Surgery Breast 005

Dermatology 005



Cardiology 004



Neurology 003












Ultrasound 13

Mammogram 10

BoneDexa 16

Sonogram 02

X-ray 02































study

8




























































MEDICINE


X-ray 43

ECG 29

Mammogram 29

Ultrasound 22

BoneDexa 12






Dermatology 022


Ophthalmology 016


Neurology 011

Cardiology 01

Audiologist 009




Urology 008

Surgery General 008












PEDIATRICIANS





Dermatology 30 70


Ophthalmology 76 24


Neurology 27 73

Cardiology 76 25

Audiologist NA NA




Urology 75 25













X-ray 13

Ultrasound 03

Audio 02

ECG 01

MRI 01











Surgery General 013


Urology 010


Surgery Breast 005

Dermatology 005



Cardiology 004



Neurology 003












Ultrasound 13

Mammogram 10

BoneDexa 16

Sonogram 02

X-ray 02































study

8





















































PEDIATRICIANS





Dermatology 30 70


Ophthalmology 76 24


Neurology 27 73

Cardiology 76 25

Audiologist NA NA




Urology 75 25













X-ray 13

Ultrasound 03

Audio 02

ECG 01

MRI 01











Surgery General 013


Urology 010


Surgery Breast 005

Dermatology 005



Cardiology 004



Neurology 003












Ultrasound 13

Mammogram 10

BoneDexa 16

Sonogram 02

X-ray 02































study

8


























































Surgery General 013


Urology 010


Surgery Breast 005

Dermatology 005



Cardiology 004



Neurology 003












Ultrasound 13

Mammogram 10

BoneDexa 16

Sonogram 02

X-ray 02































study

8









































































study

8


















































































































Documents

Referral Rates Direct Indirect Costs 121713