Referral leakage is on the minds of most health system executives. They wonder why their patients seek care elsewhere, especially after they have spent millions of dollars attracting them through ad campaigns, the purchase of high-profile equipment and investing in employed medical groups that lose money in operational isolation. Perhaps we should reconsider our use of the term “referral leakage.” “Referral leakage” implies that patients are somehow confined.
Confinement, however, was one of the prime reasons the public largely rejected HMOs. By contrast, to acknowledge patient consumerism and demand for choice, emerging payment models are often based on “attribution.” Attributed PPO patients may choose to vote with their feet, and they often self-refer. The concept of referral leakage implies entitlement, but a sense of entitlement may be a part of the problem.