One problem is plaguing health systems: patients who have already been diagnosed never make it to the treatment they need. The cost lands twice, on patients who deteriorate while they wait and on health systems that lose the procedure along with the imaging and follow-up built around it.
One disease, four visits
Let’s explore how a diagnosed patient ends up untreated using one condition, aortic stenosis, a narrowing of the heart’s aortic valve, as an example.
A murmur picked up at an urgent care visit leads to an echo, and the echo shows moderate-to-severe aortic stenosis, a narrowing of the heart’s aortic valve, with preserved heart function and a normal right ventricle. That makes the patient a straightforward candidate for transcatheter aortic valve replacement (TAVR), a minimally invasive way to replace the valve. The report recommends a structural heart referral, and since the patient has no primary care physician to route it through, it goes nowhere.
Over the next eighteen months the patient comes back three times, twice to the emergency department with syncope that gets charted as dehydration and once for an overnight stay for heart failure that clears with diuresis. Each team handled the visit in front of it reasonably well. None of them had a reason to look back through the earlier encounters, where the same disease was already documented.
Why it keeps happening
When an echo clearly shows that a patient needs a procedure, that finding often never turns into a referral. Part of the problem is finding these patients at all, because the finding usually lives in free text. A sentence in an echo report carries no code, so the registries, quality flags, and population health tools that run on structured data never see it. Locating these patients by hand means care navigators reading notes one patient and one condition at a time, which covers only a handful of conditions and a fraction of the people who qualify.
The other part is follow-through. Even once a patient is flagged, a referral has no deadline attached: nothing requires the consult to be scheduled, and no one is assigned to check back if it never is. By the time many of these patients reach a structural heart team, severe pulmonary hypertension, a failing right ventricle, and frailty have set in, and the patient is judged too sick for a procedure that would have been routine two years earlier.
What it costs
A Harvard study of Medicare patients found that even provider groups with many of their own specialists saw 61% to 72% of specialist visits go outside their network.¹ In one large health system, 38.9% of referral attempts had no appointment date on record.² For a health system, the patients already in the building with a documented diagnosis are among the most accessible growth opportunities available.
Why TAVR makes this urgent
Aortic stenosis worsens over time, and TAVR works best when it happens before the strain has damaged the rest of the heart, which makes the gap between diagnosis and procedure as consequential as the diagnosis itself. For health systems the stakes are financial as well as clinical, because the intervention itself is where the margin sits.
Medicare finalized new TAVR coverage rules in September 2026 that remove the study requirement for symptomatic severe aortic stenosis, cover asymptomatic patients within approved studies, and drop hospital volume minimums.³ More patients now qualify, and many of the newly eligible are the ones most likely to sit unnoticed in an echo report. Commercial payers are tightening at the same time, with CDI leaders reporting denials on diagnoses that appear only in an answered query. Wider eligibility and stricter proof raise the cost of any finding left unread.
Reading the whole record
No hospital can staff manual chart review across its entire population and every condition hiding in free text. The technology has to read unstructured records the way a clinician would, at population scale and across many conditions at once.
Scout, Regard’s screening solution, works this way. It reads every note and report across every patient, not only those seen by a clinician using Regard, and surfaces those already eligible for procedures like TAVR and catheter ablation. Each patient comes with linked source evidence and an urgency ranking, inside the EHR workflow teams already use, and built-in tracking shows which closed gaps Scout drove. Health systems looking to find eligible patients and recover procedural volume can request a screening gap assessment at https://regard.com/screening-gap.
¹ Barnett ML, McWilliams JM. Changes in Specialty Care Use and Leakage in Medicare Accountable Care Organizations. American Journal of Managed Care. 2018;24(5):e141–e149. https://pmc.ncbi.nlm.nih.gov/articles/PMC5986093
² Patel MP, Schettini P, O’Leary CP, Bosworth HB, Anderson JB, Shah KP. Closing the Referral Loop: an Analysis of Primary Care Referrals to Specialists in a Large Health System. Journal of General Internal Medicine. 2018;33(5):715–721. https://pubmed.ncbi.nlm.nih.gov/29532299/
³ Centers for Medicare & Medicaid Services. Transcatheter Aortic Valve Replacement (TAVR) (CAG-00430R2): Final Decision Memo. September 10, 2026.
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