There are currently two problems that are severely affecting the health of referral flow in hospitals across the country. If you work in physician relations, it is critical that you become very familiar with both of them—as when it comes to physician relations and referral flow, few things can cause more long-term damage to your growth strategy and ROI. Those problems are leakage and splitter behavior. Every professional in physician relations and hospital administration should know these terms inside and out, including the differences between them, how to properly diagnose them, and what solutions are available to help keep these destructive maladies from festering within your organization.
Leakage occurs when an employed or affiliated physician refers a patient to a non-partner hospital or specialist. Since 2/3 of all referrals are made based on physician preference, there are a number of reasons why a physician would refer a patient to a facility that is not within the same health system. Some of these reasons include
They personally know the specialist they are referring to, have a long-standing relationship, etc.
Distance and location of competing facilities
The specialist used to work within a partner facility but no longer does
The referring physician is unaware what is and what isn’t within their own medical network
The partner network has an inefficient referral system
Leakage is a rampant problem. Studies show that only 35-45% of referrals for adult inpatient care, (as measured by revenue) go to a partner hospital. Much like a leaky boat, the leaks in a healthcare organization must be diagnosed and addressed proactively, or the boat will eventually begin to sink below the waterline.
Splitter behavior is demonstrated when an independent physician refers his or her patients to a variety of different specialists. Some of these referrals may be within your network, while others will not be. A hospital or specialist views this as a problem since every patient that isn’t being seen by one of their own employed or affiliated physicians is lost volume and revenue. Specifically, a splitter generates only between 20% and 80% of their non-office revenue at your facility. While leakage can be illustrated by a leaking boat, splitter behavior looks more like a road that branches off into a number of different trails. Since independent physicians that are not employed directly by a particular hospital will naturally refer their patients to a number of different providers, splitter behavior is somewhat common. However, hospitals should be engaged in a constant effort to encourage splitters to direct as much of their referral volume toward their organization as possible.
While these two problems pose major risks to the health of any healthcare organization, there is a cure. Just as in medicine, the key is to leverage expertise and modern technology to quickly diagnose the onset of these problems and attack them at their roots. In order to achieve this in a comprehensive way, Marketware has developed two applications that when used together, offer an effective solution for leakage and splitter behavior.
Scout is a data-driven business intelligence platform that takes a close look at referral behavior among physicians and identifies trends and issues like leakage and splitter behavior. By importing external claims data and transforming it into visible and actionable information, a physician relations team can develop tasks and initiatives that will stop leakage and increase referral volume.
Once you have data on what your market share looks like, it’s time to target individual practices and physicians to find out why they aren’t sending more of their referrals to your hospital. Ascend is a state-of-the-art physician relationship management (PRM) tool that enables you to develop physician profiles and track outreach efforts. This includes issue tracking and management, initiative planning, onboarding procedures, task assignment, and growth analysis that fits your needs and your goals.