Patient Leakage: How To Turn Off The Tap

Kriss-BarlowIn my previous blog, I talked about “leakage,” the term used in healthcare business development to describe when primary care physicians refer patients to providers outside their system, rather than staying within their network.

This results in business “leaking” from your organization and going someplace else. To explain how this occurs, I listed six possible causes: old habits, belief in better patient care, patient’s request, easier and cheaper, “refer to where I know” and baggage from the past.

In this follow-up blog, I’d now like to turn our attention to how to prevent patient leakage from occurring in the first place, and how to stem the tide.

Stopping patient leakage in healthcare organizations

While there is no easy fix to leakage, there are some definite steps that can be taken before a business arrangement is signed between a healthcare organization and a physician’s practice—or at least in the immediate aftermath—that will help the organization earn the majority of referrals it believes it should be getting.

The old adage “haste makes waste” has real relevance in this new world of alignment with and employment by health systems. Often the attention is on the contract amount and the business terms, meaning that completing the transaction as quickly as possible becomes the focus, rather than the needs and expectations of both parties for the long-term.

Seven ways to earn those physician referrals—or at least contain their leakage:

1) Know the current patterns. Wise healthcare organizations recognize that it is very important to talk about the business relationship after the contract is signed. This includes discussions about work/life expectations, referral patterns, and the potential to earn referrals into the system if they are not currently in-network. Utilizing data that pinpoints doctors’ current outmigration patterns really helps here. Important to know: Referrals don’t just happen—doctors earn them through relationship building, demonstrated quality and improved patient experience.

2) Move fast. Once the new practice paperwork is signed, there are so many details that need to be taken care of. Sometimes this means that aggressive referral introductions take a back seat—but they just can’t. You must charge ahead right away with a formal process of earning referrals. It’s worth the effort, you’ll see.

3) Select the right approach. Choose those processes and services that have the greatest likelihood of impact. This is true for new practices as well as those that have been part of the system but continue to refer out. How do you decide? Think about:

  • Quality differences: If you have no quality data on your program, better get some.
  • Use education as your tool.
  • Differentiation is a must-have: You must be able to show a patient advantage for switching to your system.
  • Remove barriers: Why refer to a new place that makes it harder?

4) Effecting change requires a full set of tools. Just saying, “We’re all part of the same family…” will not get the job done. Make sure to track and then acknowledge when the leaker makes a change, then give them feedback right away. This is a crucial process, and one that requires significant nurturing. But it yields great results.

5) Financial transparency. Open discussions with doctors about referral impact can enhance their involvement at a system level. Urge doctors to share their perspectives on pricing and their preferences. And also share yours. For them, seeing the flow of dollars out of the system will get them to understand the problem and hopefully buy into solutions. In their minds, it’s just one hip patient, for example, but to the organization, it’s that one patient times 40 doctors, twice a month. Big difference.

6) Care coordination. A formal approach to care coordination has proven effective for many organizations that are working to ensure the right patient receives the right level of care with the right type of facility or care provider.

7) Bring office staff into the process. Physicians rely on their staff to facilitate a great deal of the referral process, so take the time to thoroughly immerse them in your model. Remember, they are the gatekeepers so make sure you give them the respect and attention they deserve.

No magic for physician referrals that keep patients in-network—just smart, consistent physician engagement

Looking at the above list, you might say, “This is all just common sense, we’re already doing most of this.”

The questions then are: Do you do it consistently, do you start and finish the steps, do you get feedback about your effectiveness, and do the physicians feel engaged and involved in your healthcare business development process? If not, start by studying the issue from all sides using the data, set your priorities for maximum impact, determine the actions you will take, and then communicate with strong, consistent messaging.

Once you’ve covered all of these bases, odds are that your patient leakage to other healthcare organizations will dwindle down to a trickle, and hopefully, will stop altogether. And that’s success!

Kriss Barlow RN, MBA is principal with Barlow/McCarthy a physician relationship consulting firm. She can be reached at