The $150 Billion Blind Spot in Ambulatory Care That's Hiding in Plain Sight with Michelle Skinner

On this episode of the MGMA Insights Podcast, host and senior editor Daniel Williams chats with Michelle Skinner, MBA, BSN, RN, chief clinical executive at Teletracking, about the growing complexity of ambulatory care and what it takes to keep patients connected to the right care at the right time. Their conversation explores referral leakage, scheduling inefficiencies, and provider capacity constraints — along with practical ways health systems and practices can improve visibility, streamline operations, and protect both patient access and financial performance.

Key Takeaways

• Ambulatory care now dominates the care landscape
  More than 60% of care is delivered outside hospital walls, forcing organizations to rethink how they coordinate patient movement across distributed networks.
• Referral leakage is a massive, often hidden problem
  An estimated $150 billion is lost annually due to patients leaving the network, while 38% of referrals never fully close the loop — frequently due to lack of visibility and communication gaps.
• The biggest issue isn’t staffing — it’s fragmentation
  Many practices feel “busy and full,” yet system-level data shows inefficiencies. The disconnect stems from siloed information, not necessarily insufficient effort or staffing.
• Referral coordination is overly manual and unsustainable
  Staff often juggle hundreds of referrals, relying on spreadsheets, duplicate reports, and inbox management — creating delays and increasing the risk of errors or patient drop-off.
• AI and automation can eliminate low-value administrative work
  Tools like automated duplicate cleanup and referral tracking can significantly reduce manual workload, allowing teams to focus on complex, high-touch cases.
• Scheduling inefficiencies are often hiding in plain sight
  Mismatches between supply and demand — such as unused appointment slots or rigid scheduling templates — can limit access even when capacity technically exists.
• Data transparency aligns stakeholders and drives change
  When physicians, schedulers, and administrators see the same data, it becomes easier to address bottlenecks, adjust workflows, and improve patient access collaboratively.
• Start with outcomes, not technology
  Successful transformation begins by identifying pain points (e.g., referral delays, duplicate work, lost patients) and aligning stakeholders — technology should support clearly defined goals, not lead them.

Resources

• Connect with Michelle Skinner on LinkedIn
• Teletracking
• MGMA Insights Podcast Network
• "Putting the power of scheduling into patients’ hands" (MGMA Stat Article)
• "Closed-loop referral management: Who owns each step in your practice?" (MGMA Insights Article)
• "Patient access priorities for 2026: Tackling wait times, phones, no-shows and more" (MGMA Stat Article)

Email us at dwilliams@mgma.com if you would like to appear on an episode. If you have a question about your practice that you would like us to answer, send an email to advisor@mgma.com. Don't forget to subscribe to our network wherever you get your podcasts!