Tag Archives: referral leakage

Revenue lost due to patient leakage in hospitals and health systems

The last few years have been a tumultuous time for hospitals and health systems due to the high patient leakage rate. Even today, patient leakage is a key concern and remains an unsolved challenge in many of the health systems. Health systems are losing more than 20% revenue due to inefficient organizational referral processes, as a result, patients are opting to different care providers for their care needs. Identifying the gaps or latitude to go out of the system, and sealing this, is the basic step that health systems need to take in solving patient leakage challenge.

What are the main causes of patient leakage?

Here are some reasons why patient leakage happens

– Referring physicians refer patients to out-of-network providers

– Patients move out of the care network due to poor care coordination

– Unavailability of a specialist within the care network

Patient Leakage and its consequences

Though in most hospitals patient leakage is contributing to significant revenue loss, this loss is ignored, and not given much importance. Health systems and hospitals need to consider this leakage extremely important. Non-coordinated or fragmented care is one of the main reasons for patient leakage. The point is to emphasize on some damaging consequences patient leakage can bring on care quality and patient health outcomes.

Understanding the actual causes of this leakage and taking tangible steps to address this challenge is vital. It is the responsibility of the health system to track and manage patient referrals in a better way with a solution for tracking leakages and referrals. Otherwise, it can damage the health system’s reputation, undermine its brand value, and even jeopardize its competitive edge.

Challenges in processes that cause patient leakage

Streamlining different processes for different aspects is required for better overall operational efficiency. One such process that needs attention to arrest leakage is the patient referral process. Health systems need to adapt to solutions that will help seal this leakage. HealthViewX helps referral coordinators in health systems to manage patient referral efficiently and improve care, performance, compliance, and reduce leakage.

The current referral process lacks certain mechanisms to make this process effective. Hospitals and health systems need a referral solution in addition to an EMR to solve their referral challenges especially referral leakage.

An ideal referral solution for hospitals should have the following features

Multi-channel referral consolidation

Health systems have multiple access points for patients and chances are that health systems may miss following-up with some referrals. The solution needs to consolidate referrals from multiple sources like fax, email, phone calls, online forms, etc. It should integrate well to bring all of these referrals into one single queue and ensure not a single referral is missed.

Secure exchange of information

A HIPAA compliant solution that supports the secure exchange of sensitive patient information among the care providers involved in patient care is a must. The provider should be able to attach documents securely at any time for one another’s reference.

Patient referral history

Both the referring physician and the receiving provider should have access to the entire referral history. All required information right from the time a referral is initiated and consequent diagnosis reports, referral status, etc. should be available at any point of care.

Scheduler Integration

Patient convenience is one of the most important factors in providing care. Scheduling appointments as per patient convenience and automated reminders for both patient and provider about the appointment is mandatory.

Dashboard and referral insights

The solution has to give complete data of the referrals flowing into the health system. The number of referrals processed, number missed and many more as per the requirement of the health system. These data analytics should give the practice a clear picture of how referrals are handled and where the leakage is happening.

Speak to HealthViewX solution experts to understand more about HealthViewX Referral Solution features that will help solve some of the challenges in the patient referral process and increase revenue through effective tracking. Schedule a demo today!

Transform Your Care Practice With A Streamlined Patient Referral Process

It is imperative to transform your care practice to deliver value-based care. Promoting and exploring technologies for streamlining various processes is the way forward for improved care quality and care coordination. One such process that requires a transformation in care practices is the patient referral process which is still a tedious, fragmented, and time-consuming task for referral coordinators in many health systems. The conventional patient referral process (both inbound and outbound) results in more stress for the referral coordinators and poor patient satisfaction. This inefficiency in the patient referral process leads to frustrated referral coordinators, physicians, specialists, patients and health systems as a whole. Patients not showing up for scheduled appointments are revenue loss for health systems that are trying to keep their patients within the network for better outcomes.

Today’s patient referral process makes it hard for patients to get the care they need, and healthcare facilities the visibility they need in the process. Additional challenges like lack of communication amongst providers, appointment delays, no-show rates, incorrect referral, etc. all have far-reaching consequences. Ineffective communication between clinical teams leads to poor health outcomes of patients and lost revenue for health systems. It is not a surprising fact, that more than half of the PCPs and Specialists are dissatisfied with the information they receive during a referral.

How to eliminate these challenges in the referral process?

A technological referral solution that offers end-to-end automation and is convenient for patients and providers is required to actively manage referrals and improve efficiency.

Healthcare providers need to adapt to an advanced technological solution that

– is patient experience focused, process-driven, and easy to use

– improves PCP, specialist experiences

– has end-to-end referral workflow automation

– intuitive dashboards with data insights and analytics

HealthViewX Patient Referral Management Solution is designed to help providers to focus on delivering high-quality coordinated care by keeping track of their patients throughout the care continuum. The solution makes the referral process efficient and simple with no burden on practice staff. It helps improve patient experience, reduces the burden on staff, improves operational efficiency, and overall benefits the health system in processing referrals.

Streamlining the patient referral process can help with

– better care for individuals and the community as a whole

– lowered cost and improved operational efficiency

– reduced paperwork for referrals

– awareness of in-network and out-of-network providers

– improved patient experience and value-based care drive

– better care coordination among providers

– visibility into real-time data to understand referral patterns, referral staff performance, patient status tracking, and gaps in care.

HealthViewX Patient Referral Management Solution helps solve challenges in all stages of the referral workflow to meet the needs of the patients, healthcare providers, and payers, and also integrates seamlessly with all EMR systems. An intelligent end-to-end automated solution is essential for better provider connectivity, reducing network leakages, improving quality care, and better health outcomes.

Schedule a demo today with our experts to understand how our solution seamlessly solves challenges in the patient referral process.

Five Ways To Reduce Patient Referral Leakage In Hospitals And Health Systems

Hospitals and health systems know that referrals are critical for their business, and failing to manage referrals efficiently can result in loss of revenue. Healthcare providers are losing more than 20% of revenue to patients going out-of-network for care. Most of these hospitals and health systems do not know why and where referral leakage occurs.

It’s only within the past few years healthcare leaders see patient referral leakage as a major issue, and fixing it is their high priority – Missed appointments alone cost the US healthcare system $150 billion annually. Healthcare organizations do not have a solution in place to monitor, track, and report patient referral leakage. They use their electronic health records to monitor and track referral leakage rather than having specific solutions, but healthcare leaders are not happy about how their EHR performs in this particular area.

Today, most hospitals and health systems leverage technology to prevent revenue leakage due to inefficient referral process. Tracking patient referral leakage through a referral solution gives them a complete view of their end-to-end referral process. Technology helps providers enhance care delivery, improve patient outcomes and use of data, and support collaborative workflows.

Here are five ways to reduce patient leakage:

Understand their referral patterns so far:

Organizations should analyze past data to understand their referral patterns. By tracking the right metrics they will not only gain valuable business acumen but also understand how the hospital is performing. Hospitals today use EHR to get this data but it is not streamlined enough to crunch all the data in a logical and meaningful way.

Improve care-coordination:

Effective and efficient communication is crucial in healthcare. Patients need to receive the right level of care from their care providers. It is important to communicate effectively with all who are actively involved in patient care.

Proceed with a data-driven approach:

A data-driven approach will have a sustainable competitive advantage over those who haven’t. The right way to make decisions is by looking at the data. Understand where the leakage is happening and if it is addressable. Health systems/ Hospitals need to use a data-driven approach to guide patient referrals to the best care option available within the network. Such an approach will help meet both the patients’ and hospital needs.

Use prognostic modeling to know the implications of future referral patterns:

Organizations need to understand how fixing referral patterns today may change future referral patterns by using predictive modeling. It’s essential to analyze how these alterations will impact patient flow, care delivery and coordination with referring providers and payers.

Include it as strategic precedence and discuss at the executive level:

Patient leakage more often gets lost among other priorities at the executive level. Organizations need to make patient referral leakage a strategic priority. Top management should drive change and ensure necessary steps are taken to address this challenge.

Tracking and understanding referral patterns will help the large hospitals streamline and manage high- overall performance referral networks, decrease patient leakage and notably impact care quality.

HealthViewX Patient Referral Management Solution smoothens the referral process and solves most operational challenges for Large Enterprise Hospitals. Do you want to know more about HealthViewX HIPAA-compliant Patient Referral Management Solution? Schedule a demo now!

How to reduce referral leakage in large hospitals?

For many large enterprise hospitals, referral leakage may amount to millions of dollars in lost revenue. Patient referrals are an important revenue generator for hospitals and losing patients to other providers can cost these hospitals upto 20 percent of their revenue. Dissatisfaction with the current referral process is widespread and every patient seeking care elsewhere is now, and potentially in the future a lost revenue opportunity for the hospitals.

Signs of an underperforming referral management system that results in referral leakage:

Inability to get complete information to process referrals at one go:

Communicating complete patient information at the time of specialty referral is crucial for high-quality consultation and coordinated patient care. The inability to get complete information leads to patient dissatisfaction, delay in processing referrals and referral leakage.

Difficulty in finding the right provider within the network:

One of the major causes of patient referral leakage is difficulty in finding the right specialist within the network. Nearly half of the physicians surveyed said they have trouble determining who is in-network. Physicians could avoid referring out-of-network if they had information about all in-network providers.

More time spent in processing each referral:

On average referral coordinators take 15-20 minutes or sometimes more to process each referral on the receiving end just for checking missing patient information. The staff time spent coordinating referrals and their visits is tedious and time-consuming.

High patient no-show rates and referral leakage:

Patient no-show rates or missed appointments cost the U.S. health systems more than $150 billion a year. Lack of quality care and coordination among care stakeholders leads to higher no-show rates or referral leakage, due to which patient experience takes a big hit.

Manual communication and tracking systems:

Manual processes like insurance preauthorization, checking for missed patient information, etc are time-consuming Such time-consuming and cumbersome manual processes may lead to patient dissatisfaction.

Lack of referral analytics for informed decision making:

Lack of data of the referrals flowing in and out of the network affects decision making. Referral analytics gives comprehensive data on the number of patients with various referral status.

The ability to significantly improve the effectiveness of the referral process lies in the referral process standardization and technological capabilities.

Here’s how to reduce referral leakage

Standardization of processes:

Inconsistency in the patient referral process between the referring provider and the receiving provider is common. Right from obtaining prior authorization, finding the right specialist for the patient, collecting the required information for the referral, coordinating for patient appointments, etc. large hospitals are often challenged throughout the process. Hospitals need to streamline their referral workflow to achieve efficiency and have standard workflows and processes to streamline the end-to-end referral process. Achieving this efficiency in the referral process requires well-defined workflows.

Technology solution and capabilities:

Despite having an approach to monitoring and managing patient referrals, existing systems are often unable to simplify referral workflows to effectively manage the end-to-end referral process. Right from tracking authorization status, scheduling appointments, calculating referral conversion rates, staff productivity, etc. all are challenging in the current referral process. A referral solution that is efficient, technologically advanced, and has the capability to automate the end-to-end referral process is the need today. Connecting the information to objectives, understanding the workflow to obtain the information, and most importantly getting the data analytics for informed decision making will be more valuable.

Referral Management Solution – A worthwhile investment

A focused referral management process has the potential to maximize utilization, standardize processes, and enable streamlined workflows. Hospitals need to invest in solutions that will reduce referral leakage and increase patient volumes.

HealthViewX Patient Referral Management solution has features that best suit a hospitals’ Referral Management System. A 30-minute demo with our team will help you understand how effective our solution can track and manage the referral life cycle.