White Paper: Preventing Revenue Leakage by Prioritizing High-Value MSK Patients

Executive Summary
Health systems and orthopedic practices are facing increasing pressure from declining reimbursement rates, rising operational costs, and a shift toward value-based care. Yet a major source of financial leakage remains overlooked: the failure to identify, prioritize, and retain high-value musculoskeletal (MSK) patients. By focusing strategically on this patient segment, organizations can significantly boost revenue, improve outcomes, and protect against competitive attrition.

The Problem: Revenue Loss from Patient Leakage
Patient leakage—when patients seek or are referred to care outside the system—represents billions in lost annual revenue for health systems. In orthopedics, this is particularly acute due to:

• Long diagnostic cycles delaying proper referrals.

• Lack of digital engagement or navigation tools.

• Poor coordination between referring providers and specialists.

• Unfocused patient flow, consuming resources on low-acuity or misaligned cases.

Studies show that MSK patients who ultimately receive surgery can generate 5x–10x the revenue of routine consults or conservative care. Yet, many systems spend equal resources on all incoming MSK cases—resulting in wasted consults, delayed care for surgical candidates, and lost patients.

The Solution: Focus on High-Value Patient Segments
Leading systems are shifting to an ROI-driven patient engagement model—using digital triage, AI symptom checkers, and clinical risk profiling to:

1. Identify High-Value Surgical Candidates Early
   AI-powered tools can pre-screen patients, flagging those with surgical needs or advanced conditions, allowing fast-track access and tailored care plans.

2. Prevent Leakage with Digital Navigation
   Timely guidance to the right in-network specialist keeps patients engaged and loyal. Systems using patient-routing platforms see up to a 40% reduction in referral leakage.

3. Improve OR Utilization and Margin
   Focusing on “surgery-ready” patients boosts surgical volume and ensures OR capacity is used for the highest-value care opportunities.

4. Deliver Better Outcomes Through Continuity
   Lifelong patient relationships—from diagnosis to recovery and post-op follow-up—generate higher satisfaction, increased referrals, and lower readmissions.

Case in Point
A large orthopedic network in the Southeast that implemented predictive triage and referral tools saw:

• 90% decrease in wasted consults

• 30% increase in surgical volume

• $2M+ annual revenue recapture through leakage prevention

Conclusion
In an era where every patient encounter must count, health systems and orthopedic practices can no longer afford to treat all MSK cases equally. By identifying and prioritizing high-value patients early, organizations can prevent revenue decline, enhance patient outcomes, and build more resilient orthopedic service lines.

About Clinekt Health
Clinekt Health helps orthopedic practices and health systems prioritize high-value MSK patients through its AI-powered MedCheck, digital triage, and referral management platform. Our tools increase patient throughput, improve surgical conversion, and reduce leakage—delivering measurable ROI in under 90 days.