Referral to First Treatment Time
Definition, formula, a worked example, and the mistakes that make it wrong. For infusion centers.
What is referral to first treatment time?
Formula
Median and 90th percentile of (first completed infusion date - order received date), for orders received in the same week or month
What each part means
- Order received date
- The day the referral arrived. Agree whether that is when the fax came in or when the order was entered, and use the same start at every site.
- First completed infusion
- The first visit where the patient came and drug was given. A booked appointment does not stop the clock.
- Median
- The middle value when every order's days are lined up. Half of orders were faster and half slower. A few stuck orders cannot drag it the way they drag an average.
- 90th percentile
- The wait that 90% of orders beat. It shows how long your slowest patients wait.
- Stages
- The same clock split into its handoffs: incomplete order, intake queue, benefits check, prior authorization, financial clearance, scheduling, drug readiness, and the first appointment.
Worked example
Five orders arrive in March. They reach a first completed infusion in 10, 12, 15, 20, and 40 days. The median is 15 days. The average would be 19 days, pulled up by the single 40-day order, which is why the median is the number to report.
Where the numbers come from
- Orders from your infusion software: received date, referring office, drug, and payer
- Intake and authorization task dates: intake started, benefits verified, authorization submitted and decided
- Appointments and completed infusions: booked date, appointment date, status
- A simple log of stage changes, if your software overwrites the date a status changed
Mistakes that make it wrong
- Reporting the average
- A few stuck orders drag an average around. Report the median and the 90th percentile.
- Measuring only patients who started
- If you leave out open orders, the slowest cases drop out and the number improves as the backlog grows. Always show orders still waiting, by age.
- Adding up stage medians
- Stage medians do not add up to the total median, because the patient with the median authorization time is rarely the one with the median scheduling time. Report each stage on its own and the total separately.
- Starting from appointments instead of orders
- Orders with no appointment yet are the ones that are stuck. A report that starts from appointments cannot see them.
What good looks like
It depends on your payer mix and drugs, because authorization times vary widely, and we do not know of a reliable public benchmark. Measure your own median and 90th percentile for each month of referrals, then set a target and track the trend.
Common questions
How do you calculate referral to treatment time?
Count the days from order received to first completed infusion for each order, in the site's local time. Report the median and 90th percentile for orders received in the same week or month.
How do I reduce the time from referral to first infusion?
Measure each stage separately, find the one with the longest wait, and fix that first. Common fixes are better order forms, running financial counseling alongside authorization, and calling the patient as soon as benefits are verified.
Does the CMS prior authorization rule shorten drug authorizations?
CMS says its interoperability and prior authorization final rule does not apply to prior authorization decisions for drugs. Check each payer's own policy for drug timelines.
What if our software does not keep the date each status changed?
Then you cannot rebuild the stages for past orders. Start recording stage changes now, even in a simple log. You cannot measure a clock you never started.
Is a fast median enough?
No. A center can have a fast median and still lose many referrals. Read it with the referral conversion rate and the reasons referrals were lost.
Want referral to first treatment time from your own data?
We build the reports that calculate it the same way every month, from the systems you already use.