Referral loop · cross-site conversion · Riverbend Veterinary Group

Cross-site referral loop

CHARTED referral triggers in the source PIMS reconciled against COMPLETED visits at a sister site, across PMSes. This is the leg rVetLink cannot see: referrals that should have happened, and where the loop closed.

referral candidates

107

charted triggers in the window

completed in-network

78% matched a sister-site visit ≤ 21d

silent leak

$3.3K forward value at risk (drawer)

Where the loop closes · source site → destination site

ezyvet Pittsburgh → cornerstone Columbus $21.4K 14

instinct Cleveland → avimark Akron $19.7K 12

instinct Cleveland → ezyvet Pittsburgh $18.8K 13

ezyvet Pittsburgh → instinct Cleveland $17.0K 12

instinct Cleveland → cornerstone Columbus $15.5K 11

ezyvet Pittsburgh → avimark Akron $14.1K 10

cornerstone Columbus → instinct Cleveland $6.1K 4

avimark Akron → instinct Cleveland $4.5K 3

cornerstone Columbus → avimark Akron $4.5K 3

avimark Akron → cornerstone Columbus $1.1K 1

Referral leaks · by forward value at risk

Source site	Recommended specialty	Days since	Trigger evidence	Classification	$ at risk
instinct Cleveland	internal_medicine	85	chart note: 'splenic mass, r/o hemangiosarcoma'	silent	$330
instinct Cleveland	neurology	72	IMG-501 thoracic CT ordered	silent	$330
ezyvet Pittsburgh	cardiology	57	IMG-501 thoracic CT ordered	silent	$330
instinct Cleveland	neurology	55	chart note: 'splenic mass, r/o hemangiosarcoma'	silent	$330
ezyvet Pittsburgh	internal_medicine	51	'surgical eval advised'	silent	$330
ezyvet Pittsburgh	surgery	44	IMG-501 thoracic CT ordered	silent	$330
ezyvet Pittsburgh	cardiology	41	creatinine 4.8 mg/dL (ref <1.6)	silent	$330
instinct Cleveland	oncology	39	SRG-430 ortho consult flagged	silent	$330
instinct Cleveland	cardiology	34	chart note: 'AV block, cardiology'	silent	$330
cornerstone Columbus	internal_medicine	22	chart note: 'AV block, cardiology'	silent	$330

Show all 24 leaks

ezyvet Pittsburgh	oncology	89	chart note: 'IVDD, neuro referral'	pending	—
ezyvet Pittsburgh	surgery	87	'surgical eval advised'	unknown	—
ezyvet Pittsburgh	oncology	87	chart note: 'splenic mass, r/o hemangiosarcoma'	unknown	—
ezyvet Pittsburgh	internal_medicine	79	chart note: 'splenic mass, r/o hemangiosarcoma'	pending	—
ezyvet Pittsburgh	neurology	76	SRG-430 ortho consult flagged	pending	—
instinct Cleveland	neurology	73	chart note: 'IVDD, neuro referral'	pending	—
ezyvet Pittsburgh	oncology	66	creatinine 4.8 mg/dL (ref <1.6)	declined	—
instinct Cleveland	surgery	60	platelets 38k (ref >200k)	pending	—
instinct Cleveland	oncology	53	chart note: 'AV block, cardiology'	declined	—
instinct Cleveland	oncology	45	'surgical eval advised'	unknown	—
cornerstone Columbus	surgery	44	creatinine 4.8 mg/dL (ref <1.6)	pending	—
instinct Cleveland	cardiology	43	platelets 38k (ref >200k)	pending	—
instinct Cleveland	cardiology	41	platelets 38k (ref >200k)	declined	—
ezyvet Pittsburgh	surgery	33	platelets 38k (ref >200k)	declined	—

Why this is not rVetLink. IDEXX rVetLink tracks referrals submitted through its portal.[1] It does not measure referrals that should have happened but did not (silent leakage), nor cross-site referral within a multi-site group running multiple PIMS. Central Uplift compares CHARTED referral triggers in the source PIMS against COMPLETED visits in the destination PIMS, across sites in the same group.

Named-relationship view · Westwood Animal Hospital (secondary)

Westwood Animal Hospital referrals close in-network 85% of the time; 15.5% complete somewhere else.

705 referrals in the window, 109 completed outside the network. Network baseline is 7.0%. At an estimated $1,100 per referred episode, that is $119.9K of value the network earned and did not capture. Westwood is the largest origin practice by volume, so this is a single named-relationship view — measured only. The cross-PMS join (referral at one site, completing visit at another) is what makes the number visible.

total referrals (240d)

4,144

110 active rDVM origin practices

completed elsewhere

365

8.8% of all referrals

est. value not captured

$401.5K

$1,100 × not-completed · network total

Top 30 referring practices · sorted by lost desc

Click any column header to re-sort. URL is shareable.

Practice	City	State	Referrals	Completed	Lost	Leakage %	Est. lost $
Westwood Animal Hospital 15% leakage	New Orville	PA	705	531	109	15.5% (above 12% leakage threshold)	$119.9K
Adams Lowe Animal Hospital	West Vanessacester	PA	36	23	9	25.0% (above 12% leakage threshold)	$9.9K
Goyette Bartell Animal Hospital	West Madilyn	PA	51	40	7	13.7% (above 12% leakage threshold)	$7.7K
Christiansen Stoltenberg Animal Hospital	Friesenport	OH	25	18	6	24.0% (above 12% leakage threshold)	$6.6K
WolffSchowalter Lowe and Keebler Animal Hospital	High Point	OH	29	20	6	20.7% (above 12% leakage threshold)	$6.6K
Torp Group Animal Hospital	Fort Maiyashire	OH	48	39	6	12.5% (above 12% leakage threshold)	$6.6K
Howe Muller Animal Hospital	Lake Simeon	OH	37	30	5	13.5% (above 12% leakage threshold)	$5.5K
Huel Weissnat and Kozey Animal Hospital	Lake Johan	OH	32	20	5	15.6% (above 12% leakage threshold)	$5.5K
Schmeler Larkin Animal Hospital	Stammchester	OH	36	28	5	13.9% (above 12% leakage threshold)	$5.5K
Weissnat Turner and Bartoletti Animal Hospital	West Constantin	PA	27	22	4	14.8% (above 12% leakage threshold)	$4.4K
Pagac Inc Animal Hospital	Baldwin Park	PA	35	25	4	11.4%	$4.4K
Little Thompson and Nitzsche Animal Hospital	West Jacey	PA	35	27	4	11.4%	$4.4K
Hyatt Labadie and Berge Animal Hospital	Passaic	PA	31	23	4	12.9% (above 12% leakage threshold)	$4.4K
Roob and Sons Animal Hospital	Quigleyside	PA	30	24	4	13.3% (above 12% leakage threshold)	$4.4K
Mayer Inc Animal Hospital	Patriciatown	PA	38	28	4	10.5%	$4.4K
Ankunding and Sons Animal Hospital	Millerhaven	OH	28	21	4	14.3% (above 12% leakage threshold)	$4.4K
Hagenes McLaughlin Animal Hospital	Diamond Bar	OH	31	22	4	12.9% (above 12% leakage threshold)	$4.4K
OHara Kassulke and Weissnat Animal Hospital	Concord	PA	27	21	4	14.8% (above 12% leakage threshold)	$4.4K
Howell Kunde and Jakubowski Animal Hospital	Boca Raton	PA	40	32	4	10.0%	$4.4K
Fadel Bailey and Marks Animal Hospital	North Jackelinestead	PA	38	29	4	10.5%	$4.4K
McCullough Olson Animal Hospital	Rauworth	PA	29	22	4	13.8% (above 12% leakage threshold)	$4.4K
Hand Bernier and Witting Animal Hospital	Port Louvenia	PA	31	27	3	9.7%	$3.3K
Lang Greenholt and Terry Animal Hospital	Rancho Palos Verdes	OH	28	20	3	10.7%	$3.3K
Lindgren Waters Animal Hospital	North Troystead	PA	27	22	3	11.1%	$3.3K
HintzPollich Tromp and Little Animal Hospital	Aliyaview	OH	35	25	3	8.6%	$3.3K
Huel Inc Animal Hospital	North Noetown	OH	30	23	3	10.0%	$3.3K
Yundt and Sons Animal Hospital	West Dorothy	PA	23	15	3	13.0% (above 12% leakage threshold)	$3.3K
Schultz and Sons Animal Hospital	Frankiefield	PA	28	22	3	10.7%	$3.3K
Carter Collins and Dickens Animal Hospital	Erikton	OH	27	18	3	11.1%	$3.3K
Purdy and Sons Animal Hospital	Johannaview	PA	30	24	3	10.0%	$3.3K

What this looks like in your stack today. A referral recorded at one of your sites and a completing visit at another live in two different PMS instances; no single-PMS report joins them. Instinct exposes referrers as a first-class object, so the loop is measurable where it is the receiving system; on a legacy Cornerstone/AVImark site the referral object is a free-text field and that origin leg is unmeasured (stated honestly, never over-claimed). The query in the drawer joins referrals to the originating practice and counts how each resolved. We measure the loop and recommend the discharge/scheduling step that closes it — CU contacts no referring vet and no owner.

Window: 240d · est value per referred episode = $1,100 (consult anchored to AAHA Veterinary Fee Reference 11th ed.; diagnostics/imaging a CU estimate; build in drawer) · press Q for the query

SQL · this page ran 4 queries Q to toggle

Cross-site referral funnel (candidates → completed → silent leak)

SELECT
  (SELECT COUNT(*) FROM referral_candidate WHERE recommended_at_iso >= '2025-10-04T17:44:59.528Z') AS candidates,
  (SELECT COUNT(*) FROM referral_completion rcomp JOIN referral_candidate rc ON rc.id = rcomp.referral_candidate_id WHERE rc.recommended_at_iso >= '2025-10-04T17:44:59.528Z') AS completed,
  (SELECT COUNT(*) FROM referral_leak rl JOIN referral_candidate rc ON rc.id = rl.referral_candidate_id WHERE rc.recommended_at_iso >= '2025-10-04T17:44:59.528Z' AND rl.leak_classification = 'silent') AS silent_leaks,
  (SELECT COUNT(*) FROM referral_leak rl JOIN referral_candidate rc ON rc.id = rl.referral_candidate_id WHERE rc.recommended_at_iso >= '2025-10-04T17:44:59.528Z' AND rl.leak_classification = 'declined') AS declined_leaks,
  (SELECT COALESCE(SUM(rl.estimated_dollars_lost_cents),0) FROM referral_leak rl JOIN referral_candidate rc ON rc.id = rl.referral_candidate_id WHERE rc.recommended_at_iso >= '2025-10-04T17:44:59.528Z') AS dollars_at_risk

Referral leaks by forward value at risk

SELECT rl.id, rc.source_site_id, rc.source_pims, rc.recommended_specialty, rl.days_since_recommendation,
  rc.trigger_type, rc.trigger_evidence, rl.leak_classification, rl.estimated_dollars_lost_cents, rl.expected_site_ids
FROM referral_leak rl
JOIN referral_candidate rc ON rc.id = rl.referral_candidate_id
WHERE rc.recommended_at_iso >= '2025-10-04T17:44:59.567Z'
ORDER BY COALESCE(rl.estimated_dollars_lost_cents, 0) DESC, rl.days_since_recommendation DESC
LIMIT 100

Referral candidates with completion/leak status

SELECT rc.id, rc.source_site_id, rc.source_pims, rc.recommended_specialty, rc.recommended_at_iso,
  rc.trigger_type, rc.trigger_evidence,
  rcomp.matched_site_id, rcomp.matched_pims, rcomp.days_from_recommendation, rcomp.receiving_revenue_cents, rcomp.match_confidence,
  rl.leak_classification, rl.days_since_recommendation, rl.estimated_dollars_lost_cents, rl.expected_site_ids
FROM referral_candidate rc
LEFT JOIN referral_completion rcomp ON rcomp.referral_candidate_id = rc.id
LEFT JOIN referral_leak rl ON rl.referral_candidate_id = rc.id
WHERE rc.recommended_at_iso >= '2025-10-04T17:44:59.591Z'
ORDER BY rc.recommended_at_iso DESC

Per-practice referral-loop conversion (Westwood view)

SELECT rp.id, rp.name, rp.city, rp.state,
      COUNT(r.id) AS referral_count,
      SUM(CASE WHEN r.status='completed' THEN 1 ELSE 0 END) AS completed,
      SUM(CASE WHEN r.status='lost_to_competitor' THEN 1 ELSE 0 END) AS lost,
      SUM(CASE WHEN r.status='no_show' THEN 1 ELSE 0 END) AS no_show,
      SUM(CASE WHEN r.status='patient_declined' THEN 1 ELSE 0 END) AS declined
    FROM referring_practices rp
    LEFT JOIN referrals r ON r.originating_practice_id = rp.id AND r.referred_date >= ?
    GROUP BY rp.id
    HAVING COUNT(r.id) > 0
    ORDER BY lost DESC

-- Business constant (NOT query output): REFERRED_EPISODE_VALUE = $1,100
--   = consult $385 (AAHA Veterinary Fee Reference, 11th ed.; code EXM-101)
--     + 0.70 × diagnostics (~$300)            [Central Uplift estimate]
--     + 0.55 × imaging/procedure (~$920)      [Central Uplift estimate]
-- Headline $ = (lost/recoverable count from the query above) × $1,100.

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