Patient Out-Migration Review—Best Practices

If one of your community members lives in your hospital’s primary service area but leaves town for treatment elsewhere—that is an issue. Hospitals are integrating providers more tightly and preserving joint financial incentives to deliver quality care with lower costs. Reviewing your patient out-migration data can reveal the cracks in your system and address the problems directly. This guide will serve as a resource for best practices in reviewing patient out-migration.

Points of Consideration

Partner with a data firm with access to additional information for you, such as the demographic specifics of your patient population—ages, genders, referring physicians, and payer types. These extra layers of detail will contribute significantly to out-migration analyses by providing a larger picture of your client retention data. In addition, as you gain more data about your patient population, you will begin to answer important questions such as:

  • What volume of my patients is leaving by a geographic area and by service line?
  • What is the demographic make-up of these patients?
  • What hospitals are patients going to for services or procedure treatments?
  • Who are the surgeon and referring physician?
  • What is the revenue loss?

Answering these questions will enable your hospital to build a plan for targeting specific populations and categories to grow/retain market share. Continually review and consider the following points to drive your hospital’s planning efforts:

  • Geography– Pinpoint the hospital’s primary and secondary service areas. The primary service area is generally mapped to portray where 75% of the patient volume has come and show the origin of most patients. The secondary area can be overlaid to illustrate up to 90% of operations performed at your hospital. This information answers the question of where the majority of your patients originate. Review your service areas regularly, as services areas can change every time updated data is released.
  • Service Lines– Identify the number of patients who live in your catchment area but get treatment and procedures done outside your service area. From here, you can determine the actual lost market share for each treatment event. Using this information, you can narrow the calculations down to show lost volume per specific service line.
  • Revenue Loss– Each patient out-migration has a direct effect on the bottom line. Any operation performed at a facility other than your own will result in lost revenue for your hospital. Having this information readily available in a financial report with the note that the revenue loss is due to out-migration is an excellent tool for conducting out-migration analyses.

Know the Reasons

Top reasons that out-migration occurs:

  • Your hospital is not analyzing available information. Compiling information on which patients are going elsewhere for treatment and why is essential before analyzing any other existing data. Furthermore, some hospitals do not follow up with their patients after a referral is made outside their service area to determine if they attended their visit.
  • There is a lack of awareness. Providers have one of the most significant influences on where patients receive treatment and care. However, if these providers do not know which specialties are available in-network, they will continue referring patients to familiar health care providers irrespective of network affiliation.
  • There is an assumption that it is someone else’s job to determine. However, management of out-migration tracking and prevention is not usually the job of any one person. Any employed individual who comes across patients in your hospital can influence their decision to receive care at your facility.
  • Patients may choose/prefer other providers. Generally, causes of out-migration can include proximity to patient residences, family/friend recommendations, or established provider relationships. Likewise, there are cases when referring clinicians intentionally send patients to out-of-network providers. This can be due to dissatisfaction with those who work in-network.

Reducing Out-migration

There are steps you can take to address and mitigate patient out-migration directly:

  • Dissect Your Data: Your data is a valuable outlet for understanding out-migration. Work with data partners and hospital leadership to gain insight from patterns in claims data.
  • Referring to In-Network Services. By making it easy for your providers to refer to in-network services, you decrease the potential of patient out-migrations in this avenue.
    • If your facility is a member of a healthcare system (and this system employs your providers), begin by educating them about which specific services your system provides. Do not assume the system already knows what services your facility has to offer.
    • Track referrals from the electronic health records (EHRs). EHRs are not the only tool for managing referrals, but most providers have access to them. Designate a referral coordinator to help physicians track and follow-up with patients after they have been referred.
    • Collaborate with senior leadership at your provider organization or health system to maintain and support an updated provider directory with descriptions of subspecialties for specialists in your system’s network. Categorize the providers by their broad specialty or alphabetically. Make this directory available by loading it into the EHRs, where providers are generating referrals.
    • Communicate new services to providers and remind them of existing services available through your hospitals (testing and imaging).
    • Providers appreciate receiving test and imaging results through their EHRs, so streamlining the delivery of test/imaging results to referring physicians can keep as many services as possible in-network.
    • When your providers refer patients to specialists, ensure they are sharing information about patients with them. A referral coordinator should assist with these efforts.
  • Providers should explain the advantages of staying in-network. For example, the patient’s care is more closely coordinated and is generally closer to their residence when they remain in-network for care. These benefits can also improve patient satisfaction.
  • Make it easy. By making it easier for your patients to schedule in-network than out-of-network, your patients will be more likely to stay in-network. At the time of the referral, assist patients in booking their subsequent appointments.