Patient leakage is a rampant problem that healthcare providers are dealing with on a day-to-day basis. Hospitals/health systems rely on patients being referred by out-of-network physicians.
Poorly handled or mismanaged patient referrals are a significant problem for many health systems that can lead to patient leakage and in-turn revenue loss. Patients being referred out of network is one of the main causes of patient leakage. Health systems are said to lose up to 20% of revenue due to patient leakage.
Patient Leakage – How does this happen?
In some cases patient leakage is inevitable. For example, if a person has to be referred to any particular specialty care or treatment that is unavailable within the network then the referring provider has no choice other than referring the patient out-of-network.
Conversely, there are several other reasons where in-house providers refer patients out of their network
1. Provider Reputation
At times the provider may refer the patient out-of-network depending on the specialist availability, reputation, experience, specialist rating, and patient satisfaction. It can also be due to unavailability of that specialist within the network. Providers are responsible for their patients’ health, so they would ensure they give the best possible treatment or reference for their patients. This is the main example of how patient leakage happens.
New providers who have joined the health system may not be aware of all the specialists available within the care network. There are high chances that providers may refer patients out of network if they are unaware of specialists within the network.
3. The patient chooses the specialist he/she wants:
The provider has to accommodate patient needs and ensure the patient is satisfied with the care provided. Patients’ may choose the provider based on their convenience or preferences like distance, personal preference, specialist rating, etc. Finally, the decision of choosing the specialist completely depends on the patient’s decisions. This is one of the reasons why patient leakage happens.
4. Provider-Patient Relationship:
This is also a prime reason for patient leakage. It is important that the providers build a strong relationship with their patients through quality and value-based care models and if this lacks chances are high that patient may leave the care network.
Distance and location play a major role in patients opting/choosing their providers. If competing facilities are much closer than the location you refer, patients would prefer the location of their convenience.
Do Health systems understand the amount of revenue loss?
Health systems/ large hospitals do not realize the actual amount of missed revenue due to patient leakage and missed patient appointments. Health systems have lost millions of revenue due to patient leakage and they do not properly track patient leakage. Even though health systems leaders track these leakages it is difficult for them to have a clear understanding of how to reduce this leakage or where and why it occurs in some cases.
A lot of health systems use the EHR system to manage and track their patient referrals and EHR’s can’t show why and where the patient’s left the network. However, efficiency in tracking and managing patient referrals still remains challenging.
HealthViewX HIPAA compliant referral management solution streamlines your end-to-end referral process and manages patient referrals better, improves patient satisfaction, reduces patient referral leakage and gives you clear insights of referral analytics for informed decisions. The best way to avoid patient leakage is to elevate patient experience and ensure you track each and every referral that comes in and goes out of network.
Schedule a demo with us and our patient referral management experts will guide you through our HIPAA compliant patient referral solution.