Physician liaisons and provider relations teams are hired for market growth and trust. They're tasked with building relationships with community physicians, helping them understand your services, and making it easy to connect patients to the right specialist. But in a lot of health systems and large practice organizations, liaisons end up with a second time-consuming job:

They become a default path for referral scheduling.

When a referring physician can't get a patient scheduled, or can't get a straight answer about where a referral is sitting, they call the person they know will pick up and help — the liaison.

It's understandable. It's also a signal that scheduling processes need attention. If the fastest/easiest way to get a referral scheduled (or check on a status) is "call the liaison," then scheduling isn't operating as a reliable workflow. It's operating as a set of backchannels.

Key Takeaways

>Referral handoffs break in predictable ways, and the end result is often the same: no appointment, no visibility, and an escalation. In one large health-system study, documented "referral loop closure" was under 35%. ^[1]
>Referral completion isn't just an operational nice-to-have. CMS treats it as a quality priority, including Closing the Referral Loop: Receipt of Specialist Report as a quality measure. ^[2]
>When referral intake, triage, and scheduling are built as a single workflow, with clear status and ownership, liaisons can spend their time where it actually compounds: building relationships, service-line growth, and proactive issue prevention. ^[3]^[5]

Why liaisons get pulled into scheduling

Most escalations aren't because a scheduler is careless or a clinic is unhelpful. They happen because referral scheduling is a multi-step process, and the referring practice experiences it as a black box with your organization.

The referral is "good enough to send" but not "specific enough to schedule"

A referral is rarely just "GI" or "Cardiology." To schedule correctly, it usually needs a more precise match: the right subspecialty, visit type, visit length, location, and prerequisites (imaging, labs, outside records, insurance steps).

When those details are missing — or your systems can't interpret them consistently — schedulers end up choosing between two bad options: 1) book based on an assumption and risk rework later, or 2) pause and ask for clarification and risk delay, phone tag, and frustration. Either path is what the referring provider feels as "we can't get this scheduled."

Nobody external can see what stage the referral is in

In many organizations, the referring office can't easily tell whether the referral is received, being reviewed, missing information, ready to schedule, scheduled, or completed. Or if they can tell, it's not a real-time status indication, it's a well-after-the-fact alert. When there's no shared status, the only way to get certainty is a call.

Patients feel this too. Studies of patient experiences with delayed specialty follow-up describe how uncertainty about "who is supposed to call whom" turns into confusion and delay, especially when access channels are overloaded. ^[4]

Capacity constraints turn into relationship problems

Even when the referral is appropriate, access is often constrained. Referring clinicians still need an answer that helps them take care of their patient.

Is there an earlier location? Is there an urgent pathway? Can the case be reviewed for priority? Is there another appropriate clinician who can see the patient sooner?

If the organization doesn't have a consistent, rules-based way to respond, "operations" quickly becomes "relationship." That's when the liaison gets pulled in.

Rules live in staff knowledge and shared folders

Health systems accumulate "silent policies" over time — who sees what, where certain procedures are preferred to be done, which visit types require review first, which plans are accepted at which site. If those rules aren't captured in a governed referral and scheduling workflow, then the people who know the shortcuts become the system and gatekeepers. Often that's an experienced scheduler. Sometimes it's the liaison who has been around long enough to learn the backchannels.

Escalation becomes the default workflow

Once referring practices learn that escalation is the only predictable way to get a result, they'll use it for routine referrals. It's not because they want special treatment — it's because they want reliability for their patients.

The full cost to liaisons, beyond the phone call

Opportunity cost

Time spent tracking referral status, chasing missing documentation, or negotiating appointment exceptions is time not spent on relationship development, service-line education, market feedback, or proactive growth work.

Inconsistency

If the "squeaky wheel" gets faster access through a liaison, you can unintentionally create inequity across referring practices. Or worse, be asked to explain why some referrals are handled differently.

Slower access for everyone

The hidden work of chasing and coordinating competes directly with the work that moves the next referral forward.

The solution — make referral scheduling a workflow with shared status

The goal here is to make sure liaison help is reserved for the cases where it actually adds value. A sustainable referral scheduling model has multiple elements. At MDfit, these are the top areas we start with for new customers needing referral help:

1) Build a covered referral intake model with clear scheduling rules

A high-performing referral intake captures a few high-signal fields that drive correct scheduling:

Symptoms / reason for referral mapped to a standard taxonomy
Urgency guidance (routine, soon, urgent) with escalation criteria
Required prerequisites (imaging/labs/prior notes)
Preferred location constraints (mobility, transportation, language)
Insurance / authorization needs when relevant

By the time a scheduler sees the referral, they shouldn't have to guess or make any assumptions.

2) Create worklists and rules-aware routing

AHRQ's eReferral implementation resources describe workflows where referrals move through review and into a scheduler worklist once approved. That supports standardization and visibility. ^[5] In practice for MDfit customers, that means referrals arrive in a structured queue, clinical review can request missing info within the system, schedulers receive "schedule-ready" referrals with the correct data, and exceptions route to the right team.

3) Make referral status visible to the referring practice

A closed-loop system treats the referring practice as a stakeholder and gives them status updates ("received," "needs more info," "scheduled," "completed"), clear next steps (what's needed, who is responsible, by when), and a contact path that doesn't depend on personal relationships.

4) Use intelligent automation for repeatable work

Automation is most valuable when it enforces the rules consistently:

Automatic validation of referral completeness
Automated reminders for missing documentation
Rules-based routing to the correct specialty/location/providers
Integrated waitlist-driven backfill for cancellations to speed referrals
Templated updates back to the referrer

All of these should be executed consistently per the organization's pre-defined rules.

5) Define escalation rules, so liaisons are used strategically

Liaisons should have a role in escalation, but only for the right cases:

Service recovery for high-severity patient impact
Complex access barriers requiring cross-department coordination
Relationship-critical issues requiring communication and expectation setting
Strategic physician-to-physician alignment

The Bottom Line

If you're seeing frequent liaison involvement in referral scheduling, you need clarity on where your current system is failing most. Track liaison referral escalations for a few weeks (reason, specialty, referral source, outcome) and identify your top failure modes (missing prerequisites, unclear triage, no visibility, capacity constraints). Then fix one high-volume pathway end-to-end through clear intake fields, triage rules, schedule-ready worklist, and status visibility. Only add automation after all the rules are clear.

And if you need help with implementation or tracking, get in touch with us at MDfit and we'll get your liaisons their time back.

References

Patel MP, Schettini P, O'Leary CP, et al. "Closing the Referral Loop: an Analysis of Primary Care Referrals to Specialists in a Large Health System." Journal of General Internal Medicine (2018). pmc.ncbi.nlm.nih.gov
Centers for Medicare & Medicaid Services (CMS). "2025 MIPS CQM Measure 374: Closing the Referral Loop: Receipt of Specialist Report." qpp.cms.gov
Ramelson H, Kline K, Kuntz J, et al. "Closing the loop with an enhanced referral management system." Journal of the American Medical Informatics Association (2018). academic.oup.com
Fernández L, Amat MJ, et al. "Patient Perspectives on Delayed Specialty Follow-Up After a Primary Care Visit." Journal of the American Board of Family Medicine (2025;38(1):139–153). pmc.ncbi.nlm.nih.gov
Agency for Healthcare Research and Quality (AHRQ). "Use of an Electronic Referral System to Improve the Outpatient Referral Process (eReferral Implementation Handbook)." digital.ahrq.gov
Centers for Medicare & Medicaid Services (CMS). "Managing Referrals — Providing a Patient-Centered Referral Experience" (TCPI Change Package). cms.gov

When Referral Scheduling Breaks, Physician Liaisons Become the Scheduling Department