Infusion Referral Leakage and Time to First Infusion
Every referral that never becomes a treatment is a patient and a referring office you may lose. Most centers know how many patients they treated, not how many referrals never started.
The short answer
Sound familiar?
- Referring offices call every day to ask where their patient is.
- You know how many patients you treated, but not how many referrals never started.
- Orders sit with no appointment, and nobody has a list of them.
- Time to first infusion feels slow, but nobody can say which step is slow.
Why it happens
- No date is kept for each step
- Many systems store the current status of an order and overwrite the date it changed. Without a date for each step, you cannot tell how long an order spent in intake, benefits, authorization, or scheduling.
- Reports start from appointments, not orders
- Orders that have no appointment yet are the ones that are stuck. A report that begins with the schedule never shows them.
- Only finished referrals are counted
- If you only measure orders that reached treatment, slow and lost referrals drop out and the typical wait looks better than it is. Open orders belong in the count until they start or close.
How we fix it
- 1
Follow every order to its first infusion
Measure from the date the order was received to the first completed infusion. Group orders by the week or month they arrived and report the median and the 90th percentile in days.
- 2
Split the wait into nine stall points
Time each handoff: incomplete order, intake queue, benefits check, authorization pending, denial or appeal, patient financial clearance, contact and scheduling, drug readiness, and the first appointment. The slowest stage is where to start.
- 3
Count the referrals you lose
Record why each lost referral closed, such as a denied authorization, cost to the patient, or a patient you could not reach. Review a weekly list of orders with no appointment.
What you end up with
- Time to first infusion by month, as a median and 90th percentile
- Days spent at each of nine stall points
- Lost referrals counted by reason
- A weekly list of orders with no appointment
Common questions
How do we reduce the time from referral to first infusion?
Measure each stage separately, find the one with the longest median and 90th percentile, and fix that one first. Common fixes are better order forms for offices that send incomplete orders, running financial counseling alongside authorization, and contacting the patient as soon as benefits are verified.
What is a good time from referral to first infusion?
It depends on your payer mix and drugs, because authorization times vary widely. There is no reliable public benchmark we know of, so measure your own median and 90th percentile by month and track the trend.
How many referrals are we losing before treatment starts?
Divide the referrals that reached a first completed infusion by all referrals received in the same month, then count the rest by reason. Keep still-open referrals separate and report the month again later. The referral leakage calculator gives a quick estimate.
Why don't the stage times add up to the total time?
The patient with the typical authorization wait is rarely the patient with the typical scheduling wait. Report the total from each order's own start and end dates, and use the stage figures only to see which stage is slowest.
Does the CMS prior authorization rule speed up drug authorizations?
Do not count on it. CMS says its interoperability and prior authorization final rule does not apply to prior authorization decisions for drugs. Check each payer's own policy for drug authorization timelines.
Bring the numbers that don't add up
We'll trace them to the source with you and say where we'd start. No pitch deck.