What Referral Coordination May Be Telling You About Your Practice

One of the things I hear most often during vascular ultrasound exams has nothing to do with the exam itself.

It’s usually a comment from a patient.

“My cardiologist already did that test.”

Or:

“I thought that’s why my doctor sent me here.”

Sometimes the patient believes they are scheduled for one study, only to discover a different study has been ordered. Other times, they tell me a similar exam was performed recently by another provider. Occasionally, they are not entirely sure which doctor ordered what, where it was performed, or why it is being repeated.

After hearing versions of these conversations over the years, I started asking a different question.

What if clinics are measuring the wrong part of their imaging demand?

Most discussions about imaging volume focus on completed studies. How many exams were performed? How many orders were written? How many patients were scheduled?

Those are important metrics. But they may not tell the whole story.

The more interesting question may be:

What happens after the patient leaves your workflow?

The Demand You Can See

When most practices evaluate imaging demand, they look at activity that occurs inside the practice.

They see:

• Completed exams
• Scheduled appointments
• Provider orders
• Reports received
• Billable encounters

Those are the visible indicators.

If the numbers seem low, the conclusion is often simple:

“We don’t have enough volume.”

Sometimes that conclusion is correct.

Sometimes it isn’t.

The Signals That Reveal Hidden Demand

In many practices, imaging demand shows up in places that never appear on a volume report.

It appears when staff spend time:

• Identifying specialists and imaging facilities
• Verifying insurance coverage
• Confirming network participation
• Sending records and orders
• Coordinating appointments
• Following up on missing reports
• Answering patient questions
• Resolving referral issues

None of those activities are imaging studies.

But all of them exist because imaging demand already exists.

The clinic may simply be measuring that demand in staff time, delays, and operational friction rather than completed exams.

One of the strongest operational clues that a practice may have more imaging demand than it realizes is not the number of studies being performed.

It’s the amount of time staff spend coordinating referrals.

What Happens When Imaging Leaves the Workflow

When Referrals Leave the Practice

Research suggests that many specialist referrals are never completed. Imaging appointments may be delayed, cancelled, or never scheduled at all.

When a patient is referred off-site, several things can happen.

Research has shown that diagnostic test referrals are not always completed within the intended timeframe, which means the act of writing the referral does not guarantee the patient completes the imaging study.

The patient may schedule the appointment.

The patient may delay the appointment.

The patient may never schedule it at all.

The report may come back quickly.

The report may come back weeks later.

Or the patient may receive testing somewhere else entirely.

By the time the patient returns to the original practice, continuity has often become more complicated.

The clinic knows the referral was written.

What it may not know is what happened afterward.

When Referrals Expire

In many cases, depending on payer and authorization requirements, delays can push patients past the point where the original referral remains valid.

If patients delay scheduling long enough, referral authorizations or insurance requirements may expire before the exam is completed.

At that point, the patient may need:

• A new referral
• Additional documentation
• A new authorization
• Another office visit

What started as a straightforward imaging order can become another administrative process.

Some patients eventually complete the study.

Others become frustrated and postpone it further.

Some never return to the process at all.

From the clinic’s perspective, the referral was written.

From the patient’s perspective, the process became more complicated than expected.

From a continuity-of-care perspective, the disease being evaluated may simply go longer without assessment.

The Hidden Cost of Fragmented Care

One pattern I see repeatedly involves patients moving between multiple providers for related conditions.

A patient may see a primary care physician, a cardiologist, and a vascular specialist.

Each provider is acting appropriately within their own workflow.

Yet the patient often experiences the system very differently.

The patient may not remember which provider ordered which study.

The patient may not understand why one test appears similar to another.

The patient may not realize that a specialist is evaluating a different concern than the referring provider.

The result can be:

• Patient confusion
• Duplicate testing
• Delayed follow-up
• Delayed claims processing
• Expired referrals
• Additional administrative work
• Unnecessary office visits
• Disruptions in continuity of care

This is not usually the result of poor care.

It is often the predictable outcome of fragmented care pathways that lack full visibility across providers.

Research on fragmented care has linked discontinuity across care settings to increased diagnostic testing, procedures, emergency utilization, and higher costs, especially among patients with chronic conditions.

While no single factor explains rising healthcare costs, fragmented care often creates additional administrative work, duplicate services, delays, and inefficiencies that add cost for providers, patients, and the healthcare system as a whole.

Why Some Practices May Be Missing the Signal

I see this most often in internal medicine practices, but the same pattern can appear anywhere a clinic is managing chronic disease, coordinating referrals, and serving patients who require ongoing surveillance and follow-up.

That can include:

• Internal medicine
• Family medicine
• Multi-specialty practices
• Nephrology
• Wound care
• Dialysis populations

Many of these practices care for patients with:

• Diabetes
• Hypertension
• Peripheral artery disease risk factors
• Chronic kidney disease
• Smoking history
• Advanced age

These patients often require ongoing evaluation and surveillance.

The challenge is that the need may appear gradually across hundreds or thousands of patients rather than through a single large referral source.

As a result, the demand can feel invisible.

The Surveillance Opportunity

One of the biggest misconceptions in healthcare operations is that imaging demand is always tied to finding new patients.

In reality, many vascular studies are part of ongoing surveillance.

Patients with known vascular disease often require repeat imaging over time.

Carotid disease, peripheral artery disease, abdominal aortic aneurysm monitoring, dialysis access surveillance, and venous disease follow-up are rarely one-time events.

That means demand is not always a new-patient acquisition problem.

Sometimes it is a continuity-of-care opportunity.

The patients are already in the practice.

The question is whether the workflow is identifying their ongoing imaging needs.

What Is Your Workflow Telling You?

Many physicians and administrators are already operating under reimbursement pressure. At the same time, staff are managing increasing administrative burdens related to referrals, authorizations, and care coordination.

Before assuming the answer is more volume, more marketing, or a new service line, it may be worth asking a simpler question:

What is our workflow already trying to tell us?

• If staff are spending significant time coordinating external imaging referrals…
• If patients are waiting weeks for appointments…
• If surveillance patients are being tracked manually…
• If providers are frustrated by delays and missing reports…

Those may not just be operational problems. They may be signals.

If you looked back over the last 90 days, would you be able to answer a few simple questions?

• How many imaging referrals were written?
• How many patients completed them?
• How many never scheduled?
• How much staff time was spent coordinating referrals?
• How many surveillance patients are currently being tracked?
• How many reports required follow-up?
• How many patients received imaging somewhere else?

The answers may not change your workflow.

But they may change how you think about demand.

Closing Thought

The goal is not to assume every clinic has the volume—or the need—for in-house ultrasound services.

The goal is to understand what your workflow may already be telling you.

If referral coordination, surveillance tracking, delayed scheduling, and fragmented follow-up have become a routine part of your operations, it may be worth asking a simple question:

Are you seeing all of your imaging demand—or only the part that stays inside your workflow?

It may be a conversation worth having.