American College of Physicians: Internal Medicine — Doctors for Adults ®

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How to increase your referrals—and your revenue

From the January 1998 ACP Observer, copyright © 1998 by the American College of Physicians.

By Jennifer Fisher Wilson

WASHINGTON, D.C.—Subspecialists should not get so caught up in patients and paperwork, that they skip the coffee talk in the doctors' lounge. According to practice consultants, socializing with peers may be the best way to increase patient loads—and revenue.

Remember that primary care physicians aren't likely to refer to subspecialists they don't know, explained Matthew E. Ward, vice president of Med Cap Resources in Richmond, Va. At the annual meeting of the Medical Group Management Association last fall, he gave tips on how subspecialists can improve their referrals business.

"Physicians like to believe that business will come to them," Mr. Ward said, "but the reality is that you have to get out there and make yourself accessible."

He pointed out that nine out of 10 referrals are made by physicians, not patients. "It's the contacts that you make complaining about the coffee in the doctors lounge that generate referrals," Mr. Ward said.

In fact, personal relationships tend to generate more referrals than professional reputation. "It's a misconception that people and their doctors look only for the best doctor for their condition, that there is any scientific basis for a referral," Mr. Ward said.

Another common misconception is that belonging to the panel of a managed care organization delivers business to subspecialists. Being in the network only gives you the ability to capture referrals, Mr. Ward said, noting that less than 10% of referrals are made using a plan directory.

To keep those referrals coming, Mr. Ward said, try developing good communications skills. When you see a patient who has been referred, for example, stick to the problem that caused your colleague to refer in the first place. The patient will think you listened well, and the primary care physician will look good for having referred the patient to a physician who was able to help. "Problems heard and fixed generate more referrals than anything," Mr. Ward said.

After the visit, report back to the referring physician in a timely manner. Take a few minutes, even while the patient is still in the room, and follow up via telephone or e-mail.

Remember to thank the referring physician. A thank-you card after the referral is a simple way to show gratitude, he said, as is a small gift at holiday time. Some subspecialists meet with primary care physicians to discuss patients they share in common.

Finally, track revenue by referral source. Increases by approximately 10% can be meaningful, Mr. Ward said. To show appreciation for a significant increase in referrals, he suggested, send lunch to the referring office. Investigate any declines in referrals with a call to the referring physician.

Subspecialists in an area with high managed care penetration might consider assigning a clerical worker to serve as a referral coordinator. This "makes a big difference with referrals," Mr. Ward said, because the referral coordinator can quickly handle any of the complex coverage situations that may arise.

If the specialist becomes involved in a dispute with the referring practice regarding reimbursement issues, the relationship with the referring physician might be jeopardized. "Don't fight the people who give you money," Mr. Ward said. Instead, he said, let someone else on your staff do that.

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