Every morning at Piedmont Plastic Surgery and Dermatology, staff at eleven locations would come in to find a pile of faxes waiting on the machine. No titles. No categories. No clear owner. Just paper and a growing backlog of referred patients who may or may not have been called.
This is the referral black hole. Referred patients arrive as unstructured fax documents. Staff sort them manually, route them by hand, chase down missing information, and update the EHR field by field. At a practice managing hundreds to over a thousand new referrals per location per month across eleven offices, this is not a workflow problem. It is a revenue problem.
Anabell Brown, Operations Project and Process Improvement Manager at Piedmont Plastic Surgery and Dermatology, experienced this firsthand. In a recent Stop Referral Leakage webinar, she shared what it looked like before Medsender, what changed afterward, and what the results have meant for a practice that continues to grow. Here is that story.
Piedmont is not a small practice. With 48 providers across 11 locations in dermatology, plastic surgery, Mohs surgery, and aesthetics, it manages a significant volume of faxes and referrals. Some locations receive 300 to 400 new referrals each month. Others see 900 to 1,200. Across all locations, the practice processes roughly 8,000 faxes per month, a number that has nearly tripled over the past two years.
Before Medsender, none of that volume had a consistent workflow.
"It was not standardized. Everybody was doing something a little different. We came from paper faxes. It could take up to a week just to get a full referral together — pages missing, patient information missing, fax cut off mid-transmission. And that was just getting it started, not getting anyone scheduled."
- Anabell Brown
Getting a patient from referral receipt to a scheduled appointment took more than two weeks in some cases. One to two staff members per location handled faxes every day, not as their primary job but as a shared burden on top of everything else. At peak, up to twenty people across the practice were sorting faxes in some capacity.
The problem was not a lack of effort. The staff was working hard. The problem was visibility. There was no shared view of what was pending, no accountability for work completed, and no way to redistribute the load when one location fell behind or a coordinator was out.
"If somebody was out for a week, there was no way to pick up exactly where they left off. You had no idea what attempt number you were on. Was this patient ready to be scheduled, or were we still waiting for records? There was just no way to see it."
- Anabell Brown
The practice was also losing referrals without knowing it. Spreadsheets were being accidentally edited. Paper copies were getting misplaced. And with no standardized tracking, there was no way to know how many referred patients had simply slipped away.
As referral volume grew, the answer could not keep being more staff. Anabell described the moment the practice realized it needed to solve the problem, not manage it.
"You start looking at it, and you realize: even if we came up with the best workflow, there is no system that works for us. So, we have to find something that will."
- Anabell Brown
What she was ultimately looking for was not complicated: tracking, accountability, and visibility. The ability to see every referral, know its status, and ensure nothing was missed. The ability to know, with confidence, that every referred patient had been contacted.
That is exactly what Medsender's referral management solution was built to deliver.
The results at Piedmont are specific, measurable, and immediate.
Today, two people handle fax sorting for all eleven locations. They finish by two or three o'clock in the afternoon. Before Medsender, the same work required up to twenty people across all locations, none of whom had sorting as their primary responsibility.
"Today, we have only two people sorting faxes, and they are usually done by two or three o'clock every day. That is a massive decrease in the number of people handling faxes and the hours spent on them."
- Anabell Brown
Those reclaimed hours went back to patient-facing work. Staff who had been pulled from check-in and check-out to help sort faxes are now doing what they were hired to do. And because the practice grew without backfilling positions vacated by attrition, they are doing more with fewer people.
On the referral side, 90% of new referrals now receive a call or text within hours. The standard is set, tracked, and enforced. A team of nine dedicated referral coordinators across the practice each handle multiple locations, working from a shared queue in Medsender that provides full visibility to everyone, regardless of their physical location.
"If somebody is out for a couple of days, someone can simply jump in and pick up exactly where they left off. There is no coming back to a pile. There is no playing catch-up. We all see the same thing."
- Anabell Brown
The practice also uses a pay-for-performance structure tied to referral scheduling. Each referral coordinator averages eighteen hundred scheduled patients per quarter. That metric would not have been trackable, let alone achievable, without the visibility Medsender provides.
Piedmont runs on ModMed EMA, and Medsender's integration with ModMed delivers much of the operational value. When a referral fax arrives, Medsender's AI reads it, extracts the patient name, date of birth, and insurance information, and pre-populates the relevant fields. The coordinator reviews, confirms, and syncs directly to the patient chart in ModMed without ever leaving Medsender.
Faxes are automatically titled, categorized, and tagged before anyone on the team touches them. Categories map directly to ModMed's existing structure, so routing happens automatically for anything that can be automated, and exceptions are clearly flagged for human review.
"Medsender does most of the work, including capturing the patient's name, checking whether the patient is already in the system, and retrieving the insurance information. All my coordinator has to do is sync it to the chart and give them a call. It is that simple."
- Anabell Brown
The referral management module provides coordinators with a dedicated queue organized by status, with each status fully customizable to the practice's workflow. Automation can be triggered at each status change, including outbound SMS to patients, referral replies to referring providers, and tasks in ModMed. Nothing is lost between intake and scheduling.
When asked what she no longer worries about, Anabell's answer was not what Paul Wolfe, Medsender's Sales Leader and the webinar's moderator, expected.
"I dare say the loss of a patient. Going from paper charts, where you could drop a piece of paper and there goes a brand-new patient, or forget to call them back, to now knowing that every single referral is tracked and accounted for. That security is huge."
- Anabell Brown
In dermatology, that first patient visit is rarely the last. Biopsies lead to follow-up appointments. Diagnoses lead to treatment plans. The lifetime value of a successfully converted referred patient is significant. Losing them before they are even scheduled is revenue the practice earned and then gave back without knowing it.
Anabell put it plainly: before Medsender, more referrals meant more busywork and more staffing pressure. After Medsender, more referrals mean more patients.
2.5 months to fully implement Medsender across all 11 Piedmont took about two and a half months to fully implement Medsender across all eleven locations, going live at one or two offices per week. Anabell noted that the process was deliberate, that Medsender's implementation team worked around the practice's existing workflow rather than forcing it into a predefined structure, and that the ease of training was one of the standout moments of the rollout.
"We had to replace our trained person two days before go-live due to a medical emergency. The replacement had a day and a half of training. On her first day live, she was done with the entire inbox by lunchtime."
- Anabell Brown
Her advice to any practice considering a similar change:
Watch the full webinar: Stop Referral Leakage: Closing the Black Hole in Your ModMed Workflow
If Anabell's story sounds familiar, you are likely losing referred patients the same way. The first step is knowing how much it is costing you. Answer six quick questions to see your estimate in under a minute.
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