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Rural referrals represent significant revenue for managed care organizations
1Marriott School, Brigham Young University, Provo, UT, USA.
Summary
Rural primary care physicians referring patients outside their county generated significant revenue for managed care organizations. This study highlights the economic impact of these referrals on healthcare providers in rural areas.
Area of Science:
- Health Economics
- Rural Healthcare Management
- Managed Care
Background:
- Managed care organizations (MCOs) face unique challenges in rural settings.
- Understanding referral patterns is crucial for MCO financial planning.
- Physician referrals outside rural areas impact healthcare economics.
Purpose of the Study:
- To assess the economic impact of referrals made by rural physicians to out-of-county providers.
- To provide data for MCOs designing services for rural populations.
Main Methods:
- Analysis of patient referral records and financial data over a three-month period.
- Focus on referrals from rural primary care physicians to external specialists.
Main Results:
- Referrals to out-of-county specialists yielded an average of $1,100 in collected revenue per episode of care.
- Hospital inpatient stays resulting from these referrals had an average expected payment exceeding $2,600.
Conclusions:
- Referrals by rural physicians to outside providers represent a significant economic factor for MCOs.
- Findings offer preliminary guidance for MCOs in structuring rural healthcare services.
- Data underscores the financial implications of healthcare access in rural communities.