Prevent Patient Leakage With In-Network Referrals

Healthcare leaders must reduce patient leakage by improving clinical communication throughout the referral process to support value-based care and drive better patient and population health outcomes.

Large healthcare networks were created to broaden patient access to connected providers and facilities. In-network referrals are a key aspect of maintaining continuity of care across hospitals, primary care facilities, outpatient facilities, and ancillary services to support better patient outcomes.

What is patient leakage?

Patient leakage, also known as referral leakage and patient referral leakage, describes when a patient seeks or obtains healthcare services outside the hospital network. Unfortunately, when patients go outside the network for care, significant problems can occur.

Problems Caused by Patient Leakage

1. The patient loses care continuity, often resulting in a frustrating patient experience and suboptimal patient health outcomes.
2. The health system loses revenue and visibility into the patient’s healthcare journey, which is essential for tracking patient progress and administering future treatment.
3. The out-of-network specialist may not have full access to the patient’s medical records and history to support proper treatment.
4. With out-of-network referrals, inefficiencies in the referral process can result in denied referrals, delays in patient diagnosis or care, duplicate testing, and reduced continuity of care.¹

One study found that approximately 70% of primary care providers (PCPs) report sending patient history and reason for referral, but less than 35% of specialists report receiving that information.²

The Cost of Patient Leakage

Every year, more than a third of patients in the US are referred to a specialist. Healthcare executives report the following:

• 43% are losing 10% or more of annual revenue to patient leakage.
• 19% are losing up to 20% of annual revenue.
• 20% don’t understand where or why patient leakage occurs.³

20% percent of malpractice claims for missed or delayed diagnoses involved communication deficits in handoffs.³

What causes patient leakage?

Patient leakage occurs for a variety of reasons, but it happens most frequently when physicians issue out-of-network referrals. A survey of 200 physicians across the US revealed that a significant contributor to out-of-network referrals is the lack of access to detailed information about in-network providers.

91-96% of physicians say details including a provider’s general specialty, subspecialty, specific area of clinical focus, and availability to see a patient in a timely manner are highly important to inform referrals. But only 57-63% of respondents report having access to these details.⁴

Healthcare organizations can reduce business losses from out-of-network referrals and improve care outcomes by making it easier to find and hand off care to in-network care providers.

Patient Satisfaction Contributes to Patient Leakage

Another cause of patient leakage is a patient’s choice to go outside the healthcare network, which could be caused by a lack of information about in-network options or problems with the patient experience. A patient may leave with an in-network referral, but choose a competing facility instead.

Why? Sometimes, the patient is dissatisfied with their care. Other times, patients conduct their own research and choose a competing facility without knowing how the choice might impact the coordination of their care.

How to Reduce Patient Leakage

To reduce patient leakage, healthcare organizations need to support in-network referrals by enhancing transparency and simplifying the referral process. Make sure the right information is accessible to physicians looking for an in-network specialist for a patient referral. Use a system that delivers the referral to the right provider at the right time, with built-in escalation to ensure a timely response.

A clinical communication and collaboration (CC&C) solution can help if it offers:

Clinician Collaboration

• Unified Directory: Referring physicians can easily look up any in-network clinician by name, role, or specialty. Search “cardiologist” to see a list of in-network cardiologists and further refine the list by hospital or healthcare facility to best support patients.
• Safe Patient Handoff: Referring PCPs or hospital physicians can perform a safe handoff to seamlessly share patient history and clinical notes with the specialist.
• Care Coordination: Support ongoing communication among the complete care team—including the referring physician and the specialist—with HIPAA-compliant messaging to foster team-based decision making and close the loop on patient care.

Patient Communication

• Patient Education: Ongoing communication with patients and their family members can be automated and delivered via text message to boost engagement and help patients understand the importance of in-network referrals.
• Patient Referral Follow-Up: Help increase the completion rate of referrals by sending a text to the patient after treatment or discharge to connect them with an in-network provider so they can schedule an appointment.
• Patient Satisfaction Surveys: Sending links to satisfaction surveys after each healthcare encounter can help you spot and potentially resolve issues that would otherwise impact patient loyalty and HCAHPS scores.

Streamline Patient Referrals to Reduce Patient Leakage

Healthcare networks can propel value-based care and reduce patient leakage with effective clinical collaboration and patient engagement solutions. To learn more about how patient and family engagement supports value-based care initiatives, read the white paper.

Sources:

1. Dropping the Baton: Specialty Referrals in the United States, The Milbank Quarterly, Mehrotra et al., 2011: ncbi.nlm.nih.gov/pmc/articles/PMC3160594/
2. Referral and Consultation Communication Between Primary Care and Specialist Physicians, Finding Common Ground, JAMA Network, O’Malley, Reschovsky, Jan. 10, 2011: jamanetwork.com/journals/jamainternalmedicine/fullarticle/226367
3. Patient Leakage: A new survey highlights high costs, limited control, Fibroblast, Oct. 2018: fibroblast.com/wp-content/uploads/2018/10/Patient-Leakage-A-new-survey-highlights-high-costs-limited-control-October-2018-1.pdf
4. Docs Could Avoid 34% of Out-of-Network Patient Referrals with Data, Xtelligent Healthcare Media, LaPointe, J., Aug.31, 2018: revcycleintelligence.com/news/docs-could-avoid-34-of-out-of-network-patient-referrals-with-data