Best Ways to Generate More Referrals

Jeffrey J. Denning

Disclosures

UnCommon Sense 

Introduction

We regularly remind our specialist readers that their success hinges on securing and cementing referral relationships. It's a good time to tell your referral sources how you feel about them. Uncommonly successful physicians know that there's lots more to it than sending colleagues a barrel of nacho-flavored popcorn at holiday time. Here's what we've learned.

Our clients tell us that they want the following from those they refer to:

  • Be someone they know. Less than 10% of physicians routinely refer to physicians they don't know, and about 40% say they know something specific about the specialists' outcomes or quality records.

  • Treat their patients right. PCPs are forever telling us that they take seriously patient complaints about specialists they refer to, including the level of service offered.

  • See the patients soon. PCPs are acutely aware of delays in getting their patients in to see consultants.

  • Report back fast.

Referral Reports Doctors Want

That last one is crucial: Get the results of the consult back to the referring physician fast. Fax and email are usually the most practical ways. Call if there will be any delay in the written report. If the severity of the patient's problem (or other instruction from the referral source) warrants, make the phone call. But be careful not to waste your colleagues' time. Leave a message with the nurse if it's simple: "I'm admitting [your patient] today."

The exception: Always call to acknowledge the first referral from a new source. One topic for the call: "Do you want me to call you like this? I don't want to waste your time, but I do want to give you the service your expression of confidence in me deserves." Usually, referral sources will tell you to call if it's urgent, otherwise report in writing. Still, for the second referral from that same source, call again: "I know you told me to write and I will. But I want you to know how pleased I am to be able to help you with Mrs. Glotz. Thanks again for the opportunity."

Be sure to copy the referring physician on all the tests, op notes, and discharge summaries. Offer to send the patient back for presurgical clearance, if necessary. And remember that the words consultation and referral are not synonyms. Even when the PCP is transferring the patient's care to you, include him or her in the care process. If the patient does not need your continuing care, send him back to the PCP with recommendations for future needs and the invitation to work collaboratively again when necessary. This puts the specialist in direct contrast with those who don't take pains to get patients back to their referral sources.

Take Time to Teach

Most PCPs appreciate specialists' help in keeping current with developments in their fields. That's why we think it is smart to use these phone calls and other personal contacts with referral sources to educate them in how to better handle their patients. When done with respect and in a spirit of friendly consultation, these contacts are valued.

Short newsy letters with clinical information PCPs can use are another way to satisfy this need and win points. No need to put out a slick newsletter every quarter. What is important is that you think carefully about what your constituency needs to know. Then give it to them in brief.

An otolaryngologist we know with an enviable practice did what we think is the best version of this we've seen. Norman Harris, MD, of Fullerton, California, wrote a 74-page, self-published book for his referring colleagues, Streamlined Office Otolaryngology. It's a humble 5 x 7 paperback covering common ear problems, nasal complaints, and otopharyngeal difficulties in 3 chapters. The appendices cover a list of how-to's, from removing ear wax and foreign bodies to taking care of nosebleeds and reading audiograms. There's an appendix, "What to Say About...," which covers everything from fluid in the ear, ringing, stuffy and runny noses, and how to stop smoking.

Don't most PCPs have training in these areas already? Sure, but their office personnel might really benefit from this handbook. That kind of thoughtfulness is what turns ordinary ENT practices into superstar ones. Our guess is that this started out as a training manual for Dr. Harris's staff. Providing it to his referral sources was a logical extension.

Another way surgeons can help any colleague is to get them the coding and fees fast when they assist in surgery. Their offices are unable to submit claims for these services without the information. The "special" specialists also instruct their staff to never get testy with referring physicians or their employees.

Sometimes the scheduling pressures and referral preauthorization requirements stress office workers. Managed care plans have created another potential beef: "Why do they wait so long to send me these patients?" That and the coordination of documented referrals and the preauthorization paperwork and the telephone and fax follow-up required just to see the patient. It can create a contentious environment. But the best specialists will have employees who know who the VIPs are and treat them with due deference.

So, No Gifts?

What about that popcorn? We're not suggesting that whatever you sent your referrings last year was inappropriate. But it's what specialists do every week that cements the relationship.

Is Your Consult Report a Practice Builder?

There is a marketing spin to every referral report. Instead of the usual, try these ideas to let your support base know that you are thinking of them. Try this organization next time you dictate:

1. Confirm that that the referral was made correctly.

     "Just as you suspected . . ."

     "You caught this early enough that I was able to . . ."

     "You were right to send Mrs. Flammis for an evaluation. From her complaints, I would have expected poor estrogen effect, too. What a surprise, then, to discover that it is unrelated to her hormone replacement therapy."

2. Go APE:

  • Assessment: Give your impression and working diagnosis.

  • Plan: What you intend to do and when and where you will do it.

  • Exam findings: Don't go over the stuff your colleague already knows, like height and weight, but include the patient's description of the problem and any new test information.

3. Say "thanks" and "ask for the order" again. One way to get referrals is to ask for them. Specialists can be dignified and still get the message across: "Keep sending me your cases." They let the best referral sources know that there will always be room for their patients in the practice. Here's a sample acknowledgement.

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