Increasing Medical Practice Referrals

Referrals are the lifeblood of any specialty practice, but a recent study suggests that physician office visits - and thus referrals - may be in decline. According to the Kaiser Family Foundation, the number of office visits by privately insured patients under the age of 65 declined by 17 percent in 2009-2010. At the same time, the number of privately insured persons under the age of 65 declined just 2 percent.

These statistics suggest more than just job losses are driving the office visit decline. Some factors such as "down-jobbing" (the term that refers to losing one's job and then accepting a job at a lower wage and/or lesser benefits) are related to the economy. The evolving structure of health insurance toward higher copays, higher coinsurance, and high deductible health plans is another key factor: It now costs more out-of-pocket for an insured person to go to the doctor. The bottom line: Office visits by those younger than 65 have seen a dramatic decline since 2009. Though Kaiser's research does not offer detail on the decline on specialist visits relative to primary-care visits, specialist referrals may have seen a greater decline.

Fostering referrals takes on heightened importance when there are fewer referrals to go around. The following recommendations are compiled from discussions with primary-care physicians and their staff. From these discussions I learned that consistency of service is a critical differentiator; you and your staff cannot be accessible or friendly only when it is convenient.

1. Be customer-focused

Patients and referring physicians are your customers. You are not doing them a favor by seeing a patient that needs to be seen; you are doing your job. Do not make referring physicians or their staff jump through hoops or do extra work just to get you to see a patient. If you believe a referring physician does not triage patients appropriately, break the cycle and educate them on what constitutes an appropriate referral.

2. Be available by phone

Take calls from referring physicians to discuss patients or potential patients. If a referring physician is taking time to call you to discuss a patient, be responsive. If you are unable to speak with the physician when they call, make sure your staff gets a good time for you to call them back and the best contact number.

3. Work in patients

From both the patient and referring physician's perspectives, your next-available appointment may not be good enough. Find a way and a time to work in patients that need to be seen. It may require schedule juggling or longer hours occasionally, but it is one of the keys to developing and maintaining a strong referral base.

4. Turn around your recommendations - fast

When you see a patient, make sure you get your consultation report back to the referring physician quickly. Primary-care physicians shared stories of patients coming back for follow-up visits when the consultation report had not been received. It wastes their time and the patient's time, and it results in scrambling and additional work. I recommend consultation reports be turned around within three days tops. If for any reason you are delayed, get on the phone and call the referring physician with your findings.

5. Call with abnormal findings

If your consultation results in unexpected, acute, or abnormal findings, please get on the phone with the referring physician.

6. Make it easier

Make sure it is easy and efficient for referring physicians to schedule appointments with you. Make sure your reports go back to referring physicians in a format (i.e., fax, secure server, etc.) each prefers; most practice management systems/EHRs allow such customization. Make your reports clear and concise and to the point.

7. Give great service

Referring physicians rely on feedback from their patients in making referral decisions. If you or your staff treats their patient poorly, your referrals will suffer.

8. Give thanks

Thank referring physicians. Thank their employees, too. It makes a big difference. Handwritten notes never go out of style.

9. Ask for feedback

Are you sure you are giving your referring physicians what they want? Are you sure your staff is consistently friendly and helpful to referring physicians and their office staff? Don't take either for granted. Ask referring physicians and their employees what you and your team are doing well and what you can do better. Listen, and heed their advice.

In several discussions, I heard the story of how the "only game in town" specialist suddenly changed his tune - too late - when a new competitor came to town and started taking business.
The lesson: don't take your referrals for granted. Preserve the lifeblood of your practice by taking care of those that entrust their patients to you.

Lucien W. Roberts, III, MHA, FACMPE, is vice president of Pulse Systems, Inc., and a former practice administrator. For the past 20 years, he has worked in and consulted with physician practices in areas such as compliance, physician compensation, negotiations, strategic planning, and billing/collections. He can be reached at lroberts@pulseinc.com.