How to reduce referral leakage in large hospitals?

HealthViewX
3 min readJan 6, 2021

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.

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HealthViewX

A healthcare orchestration technology platform (www.healthviewx.com) that seamlessly orchestrates clinical and user experience of patients and providers.