By Angie Franks
Preventing system and organizational leakage is a common goal across nearly every type of provider. It doesn’t matter if you run a massive integrated delivery system, a midsized ACO or a community hospital – you can’t care for your patients holistically, or as effectively, if they end up going elsewhere for care that your organization could and should have provided.
It also doesn’t matter whether you’re operating under fee-for-service or value-based care contracts, or both. Either way, there are financial repercussions from patients going somewhere else for care. This is especially true for organizations that are formally accountable for a patient’s entire care plan and outcomes.
Leakage can occur at any point in the patient’s journey, from transport to admission to discharge and beyond. Each point along the way is effectively a fork in the road – a deciding moment that determines what care they’ll receive, where they’ll receive it, and which entity will bill for and provide follow-up care.
At first glance, it might seem like this is less of a concern in the ongoing environment of consolidation. After all, if you’re the only (or one of two) health systems in the area, you can count on patients coming to you, right? Maybe.
If you can’t guide them through the journey, you can’t make best use of your resources. So in some ways it matters even more, especially if you find your ED overutilized or if you’re implementing SDoH-related programs such as new types of non-emergency medical transport.
Quick, follow that patient
Let’s look at two patient journeys as an example.
The first patient has an emergency and calls 911. The paramedics arrive and ask the patient and his family where they want to go, specifically which hospital they prefer. The family, understandably in something of a panic, doesn’t really know. The closest one? The best one? Which is even the best one?
“Where would you go?” they ask the paramedic. And of course, they take the paramedic’s advice; a deciding moment, as it means transport has determined which hospital will see that patient.
A bit later the patient arrives in the emergency room and the paramedics leave to take another call, having been unable to readily share any results of the tests they performed or the information, such as current medications, that they gathered during transport. The ER staff gets to work duplicating those efforts. The patient’s family can’t do much except hope they made the right choice.
There’s good news for the patient – he’s cleared to leave the ER, but the doctor says he should follow-up with a specialist to get a CT scan. The patient might even need surgery. But he walks out the doors with no referral, left to coordinate the next (and new-to-him) phase of his care as best he can.