Why Is Your Home Health or Hospice Agency Losing Referrals Before the Start of Care?

A referral is sent to your agency.

Your intake team receives it. The patient expects services to begin soon. Somewhere in the process, the referral stalls. A document is missing. A phone call is not returned. Another agency admits the patient first.

By the time anyone realizes what happened, the opportunity is gone.

Situations like this occur more frequently than many home health and hospice agencies realize. The issue is not always marketing or referral generation. In many cases, the breakdown happens after the referral arrives but before start of care is scheduled.

*This article was written in consultation with Mariam Treystman & Austin Degenhardt.

This topic was explored during a recent conversation on The Home Health Consultant podcast with Austin Degenhardt, Managing Partner of HHA Pros Consulting. Austin focuses on helping agencies improve referral-to-admission systems in competitive markets. His experience shows that many referrals are lost because of internal operational processes rather than a lack of referral sources.

At The Home Health Consultant (THHC), we help Medicare-certified home health and hospice agencies develop practical compliance systems, improve internal workflows, and stay ready for surveys.

We’re writing this article to help agencies understand where referrals often break down inside intake and referral management systems. After reading, leadership teams can begin identifying operational gaps.

Why Do Many Home Health & Hospice Agencies Track Referrals Using Spreadsheets?

Many agencies track referrals using Google Sheets or Excel spreadsheets. This practice is extremely common across the industry.

The reason is simple. Most electronic medical record systems are designed for clinical documentation, not for early stage referral management. To create a patient chart in an EMR, agencies often need detailed information such as:

• Insurance verification
• Physician documentation
• Demographic details

Early stage referrals rarely contain all of that information.

A referral may initially include only:

• A patient name
• Phone number
• Diagnosis
• The referring provider contact info

Because of that, agencies frequently track referrals outside the EMR until they know the patient will be admitted.

While spreadsheets provide flexibility, they also create operational risks. As referral volume increases, rows grow longer, older referrals move farther down the sheet, and visibility becomes harder to maintain. In busy agencies processing dozens or even hundreds of referrals, a referral from two days earlier can quickly disappear among new entries.

This environment makes it easier for referrals to stall without anyone realizing it.

How Can Communication Breakdowns Cause Referrals to Stall?

One of the most common operational breakdowns occurs when communication between departments is not fully aligned.

Consider a simple scenario:

A physician office sends a referral that is missing a signature on the order. Intake notices the missing documentation and calls the physician office to request it. The office does not answer, so a voicemail is left.

Meanwhile, the agency marketer has a direct relationship with the physician’s medical assistant and could easily obtain the signature in minutes. However, the marketer is never informed that the referral is incomplete.

Two days later the marketer visits the physician office in person and has no idea the referral ever existed.

Situations like this create what many agencies describe as the left hand and right hand problem. One team believes it handled the issue correctly while another team never knew the issue existed.

Operationally, the referral sits unresolved while new referrals continue arriving. Over time these small breakdowns accumulate and contribute to lost admissions.

Why Is Intake One of the Most Undervalued Roles in Home Health & Hospice?

Intake teams often occupy a unique position inside home health & hospice agencies.

Intake team responsibilities include but are not limited to:

• Reviewing referrals
• Verifying documentation
• Contacting patients
• Coordinating with physicians
• Communicating with marketers and clinical leadership

Despite this responsibility, intake roles are frequently viewed as administrative rather than strategic. Meanwhile, intake teams effectively manage the entire revenue pipeline between referral and admission.

If intake systems are unclear or staff are overwhelmed, the impact spreads across the organization. Referral sources may experience delays. Patients may not receive timely follow up. Marketers may not know the status of referrals they generated.

Without clear systems and visibility, intake staff often operate in a reactive environment rather than a structured workflow.

How Does “Hero Culture” Develop Inside Home Health & Hospice Agencies?

When agencies lack clear systems for referral management, they often compensate by relying on individuals to solve problems manually.

This creates what some industry leaders call hero culture.

In this environment, specific employees repeatedly step in to rescue stalled referrals. This could look like:

• A marketer driving across town to obtain a physician signature
• A Director of Nursing reviewing referrals late in the evening
• Intake staff staying late attempting to track down missing documents

At first, these actions appear helpful because they save individual referrals. Over time, however, relying on hero behavior creates several problems:

• Staff burnout increases
• Errors become more likely
• Referral tracking remains inconsistent
• The organization becomes dependent on specific individuals

Instead of fixing the system, agencies unintentionally build workflows around emergency problem solving. This is not a sustainable practice, and how cracks in your intake system are formed.

How Can Agencies Begin Identifying Referral Workflow Problems?

Some operational signals may indicate that referrals are falling through the intake process. Here are a few things to look out for, and questions to ask your intake team routinely:

• Are we consistently waiting on missing documentation before we can move referrals forward?
• Are referral sources asking our marketers for updates that the intake team has not yet communicated internally?
• Do we clearly understand why certain referrals never convert into admissions?
• Can we easily track where each referral currently sits in the intake process?

Important Note: When the answers to these questions are unclear, it does not necessarily mean staff are underperforming. In many organizations, the real issue is that there is no consistent system for tracking the referral journey from start to finish.

Without that visibility, each department often sees only a small piece of the process. Intake sees documentation gaps. Marketers hear concerns from referral partners. Leadership sees fluctuating admissions numbers. But no one has a complete view of what is actually happening from referral to admission.

Another thing your agency leadership can start is reviewing the early stages of their referral pipeline.

Here are a few more pointed operational questions to ask, after you’ve identified where the breakdown is happening:

Where are referrals tracked before a patient chart is created?
Understanding the system used to manage incoming referrals helps reveal potential visibility gaps.

Who is responsible for resolving incomplete referrals?
If accountability is unclear, referrals may remain unresolved longer than expected.

How are marketers notified when referrals require follow up?
Direct relationships with physician offices or facilities can sometimes resolve issues faster when communication is coordinated.

If you don’t have answers to any of these questions, you need to start building systems that answer them.

Why Does Fixing Intake Workflow Improve Both Growth and Patient Care?

Improving intake systems is not only about business performance.

When referrals move efficiently through intake and start of care is scheduled quickly:

• Patients receive the clinical support they need sooner
• Referral partners gain confidence that their patients will be cared for promptly
• Staff experience less stress because they are not constantly solving emergency problems

Again, in many cases, the referrals needed for growth are already arriving at the agency. The challenge lies in ensuring that those referrals move smoothly from intake to admission.

What Should Agencies Focus On Next to Strengthen Referral Growth?

Understanding how referrals can be lost inside intake workflows is only part of the equation. Agencies also need to think about how they approach sales relationships, referral partnerships, and long term growth strategies.

If you haven’t already, you should check out our first article in this series. In it, we break down a common misconception: more referrals = more admissions. If this article left you with any questions, it’s a good idea to double back and make sure you’re starting with square one.

*Disclaimer: The content provided in this article is not intended to be, nor should it be construed as, legal, financial, or professional advice. No consultant-client relationship is established by engaging with this content. You should seek the advice of a qualified attorney, financial advisor, or other professional regarding any legal or business matters. The consultant assumes no liability for any actions taken based on the information provided.