Patients leaving Central Massachusetts for health care cost UMass Memorial Health Care a significant amount. Every 1 percent of commercial market share that heads to Boston is a $12 million hit to UMass Memorial’s operating margin, officials said.
Fixing the issue -- known as leakage and out-migration -- could have a major impact on the health care system, which came out of 2018 with an operating loss of $28 million and has lost money nine years out of its 21-year existence.
“Right now we have 30 percent out-migration to Boston in the commercial space,” UMass Memorial Health Care CEO Dr. Eric Dickson said in an interview. “We couldn’t provide all of that care, but a 1 or 2 percent swing in reduction in out-migration takes us from being unprofitable to being a profitable health care system, so we absolutely have to solve this issue or we’re not going to be a viable health care system for the long-term.”
Out-migration is when a patient from the health care system’s service area goes elsewhere for care.
Leakage is when a patient affiliated with one of a system’s primary care doctors seeks care outside of the health care system.
All leakage is out-migration, explained Dickson, but not all out-migration is leakage. UMass Memorial sees both.
Though UMass Memorial Medical Center is a highly-rated hospital, offering the only trauma center, transplant center, stroke center, LVAD center and level III NICU in Central Massachusetts, it has to compete with Boston’s network of renowned hospitals.
UMass Memorial sees patients heading east for health care, despite traffic on the Massachusetts Turnpike, having to navigate the Longwood Medical area or the streets near Massachusetts General Hospital and pricey parking in Boston.
“We’ve got to make it as easy as possible for patients to stay here,” Dickson said. “We’ve got to beat Boston on the service in terms of being able to retain patients.”
UMass Memorial is focusing on providing better customer service, improving quality at its facilities and collaborating with some of Boston’s premier health care systems, according to Dickson.
The goal is to reduce out-migration by 1 percent per year, Dickson said.
“If we don’t find a way to solve this problem together...you’re going to deflate the overall medical and educational infrastructure that exists in Worcester and that’s not a good thing for our long-term economy in this region,” Dickson said. “Out-migration has drained the resources available. That doesn’t allow us to have the cash we need to be able to build new beds to support the region.”
In general, those who can travel from Greater Worcester to Boston for medical care are people of resources. Those with a depressed socioeconomic status tend to stay in the Worcester market.
When patients head east for care, determining why can be a challenge. If the issue is that a patient was not able to make an appointment in Worcester, the system focuses on fixing that problem, Dickson explained.
For two years, David Smith, the system’s associate vice president of virtual medicine, has focused on trying to combat leakage and out-migration.
Smith said the system can’t rely on geographic boundaries anymore when it comes to keeping patients in the network.
“There’s been a general shift toward consumerism in health care and so, particularly with the younger generation that are used to doing all their transactions online, health care is no different than banking or booking travel,” Smith explained.
Providing better customer service and convenience is a key solution for UMass Memorial, and a big push has been online scheduling.
Open access clinics, like the ophthalmology walk-in clinic that’s open five days a week, are also part of the puzzle.
With today’s technology, patients more and more are utilizing telemedicine, meeting with medical professionals through means of audio or video. The system has 30 different programs and supporting services for telemedicine, one of the more robust telemedicine programs in the state, officials said.
“It’s no longer a guarantee that patients are willing to take the time to leave work and drive into the doctor’s office, pay to park, sit in the waiting room, when they can get the same service online,” Smith said. “I think it comes down to convenience and access. If we can’t provide that then patients will go to a place that does.”
With telemedicine, UMass Memorial is trying to extend its reach into the region’s rural areas.
As the only neonatal NICU in Central Massachusetts, the system is now deploying mobile video carts to delivery units at community hospitals so a neonatologist can guide other providers’ care to newborns, allowing the babies to stay in the hospital where they were born, Smith explained.
Doctors have also started using virtual medicine for post-operative follow-up visits, checking on a patient through video after a procedure.
“It’s really kind of flipping the paradigm,” Smith said. “It’s no longer the patient coming to us. We’re really looking at our providers going to where the patient lives.”
Out-migration and leakage aren’t unique to UMass Memorial.
Fibroblast, a referral management platform, contracted an independent study last year, asking more than 100 health care executives about how they perceive and address the problem of leakage.
About 87 percent of health care executives said patient leakage is a high priority, according to the study, however, 23 percent don’t track leakage.
The study also found that 40 percent say their systems are losing 10 percent or more of annual revenues, while 19 percent are losing more than 20 percent of revenues to leakage, and 23 percent don’t know how much they are losing to the problem.
In Central Massachusetts, out-migration has been amplified by Boston hospitals placing doctors in Worcester County in an effort to draw patients east for procedures, Dickson said.
Considering that competition, a strategy for UMass Memorial has been in creating partnerships with some of Boston’s top health care systems.
In 2017, UMass Memorial Medical Center became the first academic medical center to join the Dana-Farber Cancer Care Collaborative, connecting oncologists from the two hospitals and providing opportunities for UMass Memorial providers through education, training and consultation.
Dickson calls that collaboration a “key strategic partnership," allowing patients to be seen directly at Dana-Farber if they want to or if a doctor thinks the patient could benefit from it.
Another key partnership is a “tight relationship” with Boston Children’s Hospital. UMass Memorial doesn’t offer pediatric cardiac surgery, but working with Children’s, one of the system’s cardiologists goes to a clinic in Boston, Dickson said.
“Their ophthalmologists come and hold clinics in our eye centers so kids don’t have to go to Boston to see a world-class ophthalmologist," Dickson said.
The system uses a variety of market intelligence to track leakage and out-migration.
As UMass Memorial has suffered financial struggles, some centers and services have been shut down in recent years, including the end of outpatient psychiatry as well as outpatient physical therapy services at the Hahnemann Campus and at Queen Street, the end of endoscopy service on the Clinton campus of UMass Memorial Health Alliance - Clinton Hospital, the closure of the Plumley Village Health Services as well as the Burbank Urgent Care center in Fitchburg, the end of the pediatric unit at Health Alliance Hospital in Leominster and the closure of 13 psychiatric beds at UMass Memorial Medical Center.