Patient Leakage 101: Why Are Hospitals Losing MSK Patients?

With approximately 1.71 billion people worldwide currently living with musculoskeletal (MSK) conditions,¹ the need for high-quality, cost-effective MSK care has never been higher. But despite this growing need, some concerning trends are emerging around access and continuity of care. 

According to the latest National Hospital Flash Report,² hospitals are seeing a drop in both patient volume and revenue:

• Outpatient revenue fell 8 percent
• Inpatient revenue dropped 3 percent
• Fewer patients appear to be undergoing surgical procedures. Operating room minutes declined 13 percent
• Adjusted discharges per calendar day fell 7 percent

This drop in volume and retention is referred to as ‘patient leakage,’ also known as referral leakage and patient referral leakage, and it’s when a patient receives care outside of the hospital network they started within. Depending on where they receive care, this can cause significant problems, including:

– Care continuity: Bouncing between providers who don’t coordinate well can negatively affect both outcomes and patient experience

– Revenue Loss: Keeping patients within the providers sphere of care is critical for capturing and retaining revenue

– Lack of visibility for providers: The ability to track patient progress is lost, and any out-of-network specialist won’t have full access to the patient’s medical records.

But there’s another issue coming that will only exacerbate this leakage issue: By 2030, nearly 73 million Americans will be eligible for Medicare—the entire baby boomer generation—and with them will come a corresponding rise in MSK treatments and surgeries. So, how do you prevent patient leakage and get hospitals back on track to effectively treat the influx of MSK patients coming in down the line? First, we need to look at where they are leaking to, and why.

Patients Are Leaking—Where Are They Going?

Sadly, a large proportion of patient leakage numbers are patients that are postponing treatment or not seeking care at all! They’re choosing to either try to live with the pain, or find alternative means to manage without physical therapy. Those means can include turning to Google or popular apps like YouTube, Instagram, and TikTok to find information on how to treat their condition. And while there are reputable accounts on those platforms, there’s also a lot of unvetted information, or worse—intentionally malicious disinformation.

Patients are also turning to alternative care options, like wellness apps, or alternative medicine. The problem again is that these options exist in a fairly unregulated space, and the scientific rigor applied to the training that therapy providers receive in order to get licensed (and keep it up to date) doesn’t always apply to these apps. It’s difficult to know which information to trust, and that’s why it’s so valuable to have a licensed professional to guide patients along their care journey.

Some new technologically-enabled service companies are also offering to fill the care gap by offering digital-only physical therapy services. These allow patients to use virtual visits within a captive virtual provider network. But while these options might seem viable at face value, they only serve to disintermediate the provider’s office entirely—then where does that leave the high acuity patients who need that hands-on care? And because patients are disintermediated from the system, care continuity suffers.

Why Are Patients Leaking?

Chief among the many reasons why patients are leaving is lack of access to care and long wait times.

There’s nothing more frustrating than seeking out care, only to be told that you need to wait weeks or even months just to get a consultation! During the wait, it’s common for patients to convince themselves that they can live with it. They survived this long without treatment—maybe it will get better on its own? Or they pursue alternative care options that aren’t as effective as therapy, and when these don’t work, they often give up on treatment entirely.

This is exacerbated in rural or underserved areas, where limited access already impacts long wait times. According to an internal study,³ one hospital system reported that MSK patients took up to 14 days to reach therapy and ~40 percent of referrals never engaged and got the care they needed, likely costing the system more down the line. 

One way to address this is to provide an independent experience to low acuity patients, so you can open up space for higher acuity patients. This way, all patients can get the right level of care, and providers can see more patients faster. If you can make care easier to access and fit within their lives, then patients don’t have to miss work or arrange childcare to come into a clinic.

Then there’s the overall patient experience. 

A poor patient experience can result from negative interactions with providers stemming from insufficient communication, feeling like they’re being rushed, or perceived lack of empathy while trying to recover from their injury.

One way to overcome this is by offering personalized experiences with appropriate care for their needs, and making yourself available between visits—and this is where technology helps. You don’t have to be on-call 24/7, but offering a ‘digital front door’ that gives patients a way to reach out between visits if they’re having trouble can go a long way toward making patients feel like they’re being heard and boosting their overall experience. If you aren’t offering this and other providers are, patients will go where they can get the type of personalized care that they prefer.

Another common complaint is how patients perceive the efficacy of their treatment.

Some patients may feel that traditional MSK treatments are “too slow,” and that seeing their provider once a month may not feel sufficient. They might be under the impression that if they just were treated more often, they’d get better faster. Now, we know that treating MSK conditions takes time and a critical part of the process is rest, and that’s why better patient education is so crucial. You can set appropriate expectations to help patients understand their condition and the timeline of effective care. And by incorporating virtual touchpoints between in-person visits, you can help patients feel like they are progressing rather than stagnating between sessions.

These benefits aren’t just to the patient experience—studies have shown that adhering to a therapy-based conservative MSK care program can result in ^4,5:

• 50 percent lower emergency room utilization for acute low back pain
• 58 percent reduction in imaging utilization
• 10 percent reduction in long-term opioid usage

Many patients profess a preference for holistic or integrated care. Just as the muscles and joints of the body are all interconnected, so are patients’ bodies and minds! Systems that do not take these perspectives into account will lose patients to those that do. We need to provide support for the whole person—not just the body, but also the mind and spirit to help patients recover faster and live better. By offering patients a treatment program that automatically takes all their needs into account, you can attract these patients to your system—and keep them there.

Plus, our health insurance and billing system often doesn’t make things any easier!

It can already be difficult for patients to seek out and stick with therapeutic care, but denied claims, unexpected out-of-pocket costs, and confusing billing statements can easily make patients feel frustrated and alienated.

While we can’t solve the entire system on a provider level, we can look for solutions that take these issues into account to streamline care and make it easier for patients to navigate. We can start by eliminating excess treatments, unnecessary referrals, and added costs with appropriate triage to conservative MSK care. This helps low- to mid-acuity patients avoid specialist referrals, surgery, and imaging that aren’t appropriate for the level of care that they need.

This reduces costs for patients by reducing in-person visits that aren’t necessary to progress their care plan, along with the accompanying co-pays that add up quickly. It’s a patient-friendly solution that also helps cut costs while improving outcomes—an added bonus to those under value-based purchasing agreements.

Finally, there’s care continuity.

Are patients seeing different providers at every visit? Is anyone following up with them? If there is no clear, consistent treatment plan, then the patient experience (and outcomes) will suffer. For one, without clear care continuity, the patient’s medical history can be overlooked. This can lead to patients being re-examined or retreading over treatment they have already received, or worse—lapses or gaps in treatment that can lead to serious consequences.

One of the best ways to avoid any issues is using an EMR-integrated treatment program to ensure that everything is connected, everyone knows the treatment plan, and collaborative care is being practiced every step of the way. For example, if a patient drops off, there might not be a way for a provider to know or keep track. But with an EMR-integrated hybrid MSK care platform, better follow-up adherence, and accountability can occur. By monitoring and checking in with the patient, providers can ensure that the patient knows that they care, keeping them engaged in their care and coming back.

Finding a Solution for Patient Leakage and the Coming MSK Care Crisis

With more care options available than ever before and greater consumer autonomy than ever, patients will gravitate toward the option that will best suit their needs for convenience, access, and costs. For health systems to remain profitable, they need to encourage patients to come back—or prevent them from leaving in the first place—by offering them what they are looking for. 

And what patients are looking for is a holistic, personalized, and flexible care experience—and that’s MedBridge Pathways. Our new hybrid MSK care platform supplements existing in-person programs with a variety of digital care pathways based on patient acuity to help MSK patients get the right level of care faster.

These standardized pathways are designed to take into account a patient’s pain, goals, and activity levels, guiding them through exercises by evidence-based progression criteria in multiple phases. For patients that need more hands-on care, there are hybrid-care pathways that seamlessly blend these digital touchpoints with in-person care. No matter what level of care they need, patients can receive an efficient yet personalized experience that allows for the flexibility that patients need to receive MSK care while navigating modern life.

And best of all, Pathways won’t disrupt the clinician-patient relationship; instead, it empowers providers to keep patients in their ecosystem for a lifetime of care. That’s because we believe that conservative care should be the first option for most MSK care patients, and that care is best delivered by expert provider staff. With Pathways, providers can boost the patient experience, stop patient leakage in its tracks, and stay prepared for the future of MSK care.