Specialist referrals: Best practices to limit liability

Physicians' referrals to specialists have at least doubled over the past decade or so, but that trend isn't necessarily problematic, according to an article from Medical Economics.

From a liability standpoint, primary care physicians (PCPs) face less risk in referring patients than they do in not sending patients to specialists when necessary, Ann Whitehead, R.N., vice president, risk management & patient safety for the Cooperative of American Physicians, Inc., a physician-owned organization offering medical professional liability protection, told the publication.

Even sending a patient to the "wrong" specialist carries little legal risk for physicians, according to Whitehead. However, a recent report from Kyruus identified high rates of misdirected patient referrals as a major problem that may lead to reduced health outcomes for patients, ineffective use of physician time and avoidable patient costs.

So while referring in itself isn't often a bad move, experts recommend the following best practices to ensure referrals benefit all involved:

  • Document in the medical record the reason for the referral. If the differential diagnosis shows it's justified, then the physician has done the right thing, according to Medical Economics.
  • If a specialist delivers poor care to your patient or fails to send you a note afterward, stop referring to that clinician and tell him or her why, Kenneth T. Hertz, principal in the Medical Group Management Association, told the publication. It is the PCP's responsibility to track and review communication received back from specialists, he added, so make sure you have an electronic health record or other reliable tracking system in place.
  • Do your homework. Sixty-two percent of specialist respondents said they believe misdirection happens because referring physicians lack reliable information about specialist physicians, according to Whitehead.
  • Appeal insurance restrictions limiting who you can refer to if no one on the approved list is right for your patient, Hertz recommended.
  • Be clear with patients that it is their responsibility to follow through with referrals and document this advice in their medical records. If a patient is noncompliant, ask why he or she didn't see the specialist and document the answer, Whitehead suggested. 

To learn more:
- read the article
- see the survey