What to Know about patient leakage and How to Avoid it.

What is Patient Leakage? 

Primary care physicians are noticing a shift in their patient base. With the development of urgent care centers and access to virtual on-demand care, some patients are foregoing regular primary care visits in favor of these other--often more convenient--options. Patient leakage is starting to change the patient-physician relationship.

1. There are roughly 9,000 urgent care clinics in the U.S. 
2. The number of urgent care centers is expected to increase to 15,000 by 2019
3. Urgent care revenue is expected to increase from $13.7 billion in 2011 to 17.9 billion by 2017

Leakage to Urgent Care Centers 

Old news: Urgent care centers appeal to patients who need care when their PCP office is closed, or they cannot get an immediate appointment. In some situations, they can also be less expensive and deliver care faster. 

1.  85% of urgent care centers are open 7 days a week, with 95% closing after 7 pm
2. 66% of urgent care centers have wait times of less than 20 minutes 
3.  Only 29% of primary care practices offer after-hours coverage
4. In a recent JAMA study, 74% of families surveyed first considered going to their pediatrician but chose a retail clinic because:  
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 Leakage to On-demand Telemedicine Providers 

A new trend: Many employers are now offering on-demand telemedicine for employees as a way to give access to care and lower benefits costs. However, these on-demand telemedicine services are yet another delivery channel pulling patients away from their PCP. 

• 20% of U.S. employers provide telemedicine services to employees today 
• 40% said they plan to offer access in the next year and 33% in the next 3 years. 
• Some consider that the effective use of telemedicine services could eliminate 15% of physician office visits. 

The Big 4 On-Demand Telemedicine Companies  

There are four well-funded companies in the on-demand telemedicine space. While these on-demand services can effectively keep patients out of the ED, they are also pulling patients away from their PCPs. 

Clinical Impact of Patient Leakage 

While the convenience of on-demand telemedicine and urgent care centers and is attractive, there are unintended consequences that cannot be ignored -- and more must be done to guarantee patients are not put at risk. 

• Fragmented, Non-coordinated care can result in conflicting treatments, unnecessary testing and a weakened patient-physician relationship. 
• Without access to history and medical records, urgent care centers and on-demand telemedicine providers risk misdiagnosis and dangerous medication interactions 

Financial Impact of Patient Leakage 

The economics of a practice changes when the easy, less-time consuming, and less complex cases are lost to urgent care and on-demand telemedicine providers. Clinical practices cannot survive on complex cases alone, and this is accelerating the decline in independent practices. 

1. The number of independent physicians fell from 57% in 2000 to 37% in 2013, and is predicted to fall to 33% by the end of 2016.

• 24% of physicians are considering selling their practice.

Solution: Bring Video Visits to Outpatient Clinics 

Because of the convenient access and improved continuity of care, most patients believe video visits with their PCP are a good idea. 

According to a recent recent survey from Towers Watson: 

1. 74% of consumers would use telehealth services given the opportunity.
2. 76% of patients prioritize access to care over the need for in-person interactions with healthcare providers. 
3. 70% of patients are comfortable communicating with their healthcare providers via text, email or video in lieu of seeing them in person

Major Benefits of Offering Video Visits 

Benefit #1 Increase Patient Satisfaction & Retention 

1. No need to take time off work, battle traffic, or spend time in waiting rooms—improve patient satisfaction and retention by providing convenient care. 
2. Most patients prefer to maintain the relationship with their PCP, but want easier access. 
3. Expands patient base to rural communities where 20% of Americans live but only 9% of the nation’s physicians practice. 

Benefit #2 Improve Clinical Outcomes 

1. Easier access = better compliance with treatment plans (especially important for patients with chronic conditions) 
2. Provider has access to the patient’s medical record to view history and notes from previous consults -- reducing the risk of misdiagnosis, unnecessary testing, and adverse events. 
3. Continuity of care can be assured and the physician-patient relationship is strengthened 

 Benefit #3 Generate Incremental Revenue

1. Perform lower acuity follow-up visits over telemedicine using mid-level providers, while reserving in-office appointments for new patients and higher acuity visits. 
2. Replace unpaid follow-up phone phone calls with fully billable video visits (usually at the 99213 - 99214 level).
3. Easily add a few extra visits in the evenings and on the weekends, driving incremental revenue.

The telemedicine market is expected to grow to $38.5 billion in revenue by 2018, a compound growth rate of roughly 32% per year. 

Telemedicine isn’t going away anytime soon. Any physician hoping to remain relevant and profitable will likely need to jump on the video visit bandwagon. Patient demand for access and convenience, combined with employers’ desire to reduce benefits costs is rapidly changing the healthcare delivery landscape. Urgent care centers and on-demand telemedicine options are quickly filling a void that PCPs are able to fill themselves in many cases. All it takes is a slight change in perspective and the right technology! 

Contact Zapclinica to offer Telemedicine visits in your practice today.