45 Percent of Your Referrals are Going to Another Health System

Millions of U.S. patients are referred for specialized services each year, but as many as 45 percent will never make it to the referred-to clinic or hospital.

At a time when health systems are focusing on big-ticket cuts, a few missed appointments may not seem like much to get excited about. But, the cumulative effects to the bottom line can be staggering: Health systems lose 55 to 65 percent of revenue as a result of referral leakage, or a collective $150 billion a year. Calculated on a per-provider basis, health systems are estimated to be losing nearly $1 million per year, per affiliated physician.

Where are those referrals going? Certainly, symptoms sometimes clear up and patients decide on their own that they don’t need further treatment. The majority, however, will slip through the system as a result of some degree of poor communication. It’s estimated that half of referring and specialist physicians do not communicate with each other at all, and 25 to 50 percent of referring providers never circle back to find out if their patients actually saw the specialist.

That puts the patient in the precarious position of coordinating his own care. If he’s not clear exactly why a specialist visit is necessary, or if he has difficulty scheduling an appointment with a specialist who is not expecting his call, or if he has a frustrating experience because the specialist has not been updated on his condition, he’ll self-refer out of network or even ignore the referral altogether.

An effective referral communication plan can increase follow-through and keep patients in-network. Here’s what we recommend:

• Prioritize Patient Education—Don’t let a patient leave the hospital or physician’s office without understanding why he’s being referred to a specialist. This is not a place where you want your providers to save time. Adjust discharge procedures to prompt providers to confirm that nothing has been lost in translation for the patient.
• Make the Connection—The statistics above show that it’s clearly not enough to hand a patient a phone number and send him on his way. Schedule the appointment for him, or at the very least, contact the specialist and ensure she’s expecting your patient’s call. Provide the patient’s phone number so the specialist’s office staff can reach out if they haven’t heard from the patient within a day or two.
• Track and Follow Up—Research studies revealed another alarming trend in this area: After a referral was made, physicians were often unclear about who would be responsible for which aspects of the patient’s continuing care. A well-defined process for tracking and following up on referrals will prevent patients from getting lost in the system.
• Provide the Right Tools—Today’s most advanced clinical communication technology makes it exceedingly simple for physicians to connect with each other directly over a secure texting platform. Extensive built-in directories enable clinicians to find colleagues by name or by role. Sending a quick text message to a specialist in the presence of the patient not only provides pertinent information for the consult, but it also serves to communicate clearly to the patient that this appointment should be a priority.

Managing referrals is one way to improve profitability in your health system. Download the Revenue Rescue eBook to learn more.

Tags: Improving Profitability, Optimizing Clinical Communication, Clinical Communications