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Standing out in the crowd: securing preferred referral status.

Banking on a sure and steady stream of referrals used to be all about connections, back when personal relationships drove the practice of medicine. It was not unusual for providers to refer to those with whom they played golf or tennis, or attended medical school.


Affability, athleticism and alma maters did more to secure referrals, and guarantee income, than most anything else--quality of care included.

But today, patient expectations for service and delivery trump provider relationships, eclipsing all other considerations to create new, or realign old, referral patterns and habits--with profound economic repercussions.

Increasingly patients are demanding same-day access, zero wait time, and the knowledge and medical coaching to participate in treatment decisions. As these and other service guarantees become more important to patients, they become equally significant to their physicians as referral determinants.

Health care organizations positioned to deliver big on service stand to gain as a preferred referral source, with a wad of steady patients and a healthy bottom line.

How can providers of all specialties stand out and corner the referral market, regardless of medical school connections, country club affiliations or shared sports interests?

There are several crucial steps medical organizations must take to secure preferred referral status, loyalty among referral sources and lucrative rewards:

* Understand what referring providers expect or desire in services, care delivery and/or clinical quality. Brainstorm a list of service expectations and standards that you perceive to be high priority in the decision process to send patients your way. Add items to the list that represent opportunities for improvement within your own physician organization.

* Create a survey tool. Using the brainstormed list, develop a survey tool to confirm with current and potential referral sources a host of expectations and guarantees. Phrase questions to verify and prioritize the importance of service requirements like same-day appointment access, immediate callbacks and patient progress updates. Ask referring colleagues to specify preferences on how to handle patients' status/next steps. Craft queries to more fully grasp competitive performance in various areas. Have survey takers rate their own experiences with your organization and identify potential issues and/or areas of improvement. Instruct respondents to rank the impact of service expectations on referral patterns to help prioritize corrective measures.

* Determine tactics for completing the survey tool. What is the best way to reach current or potential referral sources? Is there a PHO or other physician organization that can help survey its members? Is it best to speak with providers and staff directly, recording responses, or send the survey via mail or Internet to query prospective referral sources? Should a third-party administer the survey instrument in a focus group?

* Tailor the survey instrument. Sort survey respondents into three categories: high volume referrers to your medical organization, those who split referrals between you and your competitors, and those who seldom or never refer. Customize the survey for each of the three groups. Obviously, you'll have different questions for the practices that never refer to you vs. those providers who occasionally or always send patients your way.

* Execute the survey. Using the survey tools you've developed, interview identified providers. Conduct a parallel survey of staff in provider offices to understand referral/service issues from their perspective.

When you have finished interviewing, gathering and reviewing data, develop a work plan to meet the expressed needs of the providers you are currently serving and those you wish to win over.

Prioritize the action plan to address the findings. Sort "to-do" lists into immediate action for quick fixes and create timetables for longer-term improvements and upgrades.


You'll need to project the amount of potential increased volume that could result from meeting the needs of current and new referral sources. Ensure that your department or physician organization has the resources necessary to meet referral expectations.

Is there enough provider capacity to handle an influx of new patients? Is staffing adequate? Facility up to snuff? Thoroughly scrutinize existing resources to determine where you fall short and what additional investments are necessary to get the job done.

Report back to interviewees to let them know they were heard, using the communications preferences identified in interviews. Share action plans so the providers you're targeting or hoping to do (increased) business with see your responsiveness to identified issues, particularly on those quick fix items.

Continually look for ways to articulate why your department or medical organization should be the provider's preferred referral source. Use preferred communication channels to keep providers you're targeting informed of all service enhancements/improvements, including those service delivery standards developed in response to research findings, performance/progress improvements against service standards, and planned implementation dates.

Meet regularly with the providers and staff you are targeting to ensure service delivery and use your own patient satisfaction surveys to support quality claims.

Develop a communications program for consistently showcasing your own success stories. Alone or in partnership with hospitals and other community medical organizations, generate press releases, newsletters and feature articles to promote customer service accomplishments and clinical excellence. Leverage success stories into a marketing and public relations campaign that touts the good works of your medical organization.

Changes needed

Becoming a preferred referral source may require some drastic changes in how you do business, to prove to doctors you are targeting, and their consumer-savvy patients, that you can cater to their every need.

It may mean streamlining practice operations to smooth access issues in order to respond in a more timely fashion to patient and provider demands and expectations. You may need to look more closely at how your organization manages the patient visit--before, during and after the patient leaves--to boost productivity, efficiency and patient satisfaction and polish service guarantees.

With patients at the hub of care, spending out of their own health care accounts and empowered with information, consumers will have higher expectations that the service their provider recommends or performs is the best and most appropriate care. They will hold providers to a higher standard than in the past, and challenge physicians to prove that what they are recommending is indeed best practice.

Physicians will need to re-examine not only the care and services they currently provide, but their own referral patterns to be sure they are sending patients to colleagues who can consistently deliver on expectations and are like-minded in their approach to care.

Cooperation and coordination among independent providers will be key to offer value-added benefit to patients and families, and ensure financial rewards. Medical organizations that succeed will need to position themselves as a preferred referral source, catering to patients and the colleagues who send them their way.

Jayne Oliva is a principal with The Croes*Oliva Group, a team of health care consultants who work exclusively with administrative and medical leaders to improve delivery of profitable, patient focused and streamlined patient care. She can be reached at 781-272-6444 x103 or

RELATED ARTICLE: Great Expectations: What Physicians Want from Preferred Referral Sources

Building a solid referral base in any medical organization takes more perspiration, dedication and sophistication than most realize. Organizations have to earn preferred referral status with performance and response.

Relying on old ties just doesn't cut it any more, and there's more at stake financially than ever before. Referral preference drives patient volume and expanded volume builds steady revenues.

Increasingly, providers refer to health care organizations that share the same respect and concern for patient needs and preferences, and can consistently deliver on service expectations and promises.

The Croes*Oliva Group identified a number of key consumer influencers that drive referral patterns today.

Providers will refer to health care organizations that:

* Take or return calls promptly, especially when there are questions about whether or not to refer

* Listen to input, both on problem definition and on treatment options

* Brief them on patient progress using communication methodologies they prefer

* Provide detailed notes on follow-up care when applicable, and keep them informed per an agreed upon plan following acute treatment

* Know who they are when they call, and usually which patient they are calling about

* Contact them immediately if there is an unexpected problem with treatment

* Are concerned that their patient's experience is a good one

* Consider them a partner in the care of the patient

* Proactively seek information about the patient's comprehensive health care needs

* Coordinate the patient's care within the institution, rather than putting the burden on the patient or referring provider

* Facilitate the provision of coordinated ancillary support to the patient and his/her family (mental health services, home health care, etc.) and have a system in place to determine the need for such services without the patient/family having to ask

Providers will refer to health care organizations when:

* The referral process is easy and appointments are timely

* Staff gets treated well and finds it easy to schedule a patient

* The referral staff make patients feel welcome, in person or on the phone, and understand why they are calling and expect their arrival

* The patient's family feels that they are well informed of their choices and can participate in treatment decisions

* Both patient and family are satisfied with their care, their ability to get information and support during the treatment, and their relationship with all caregivers and staff


Providers will refer to health care organizations where:

* Clinical competency is high

* There is participation in the latest research and clinical trials

* The patient is assigned to the physician who is the best choice, both clinically and operationally; i.e., can see the patient most promptly

* They respect the provider's choice of physician, explaining the reasons why the patient may need to be seen by another physician, rather than the one requested by the referring provider

* The patient is initially seen by a physician, even when ongoing care will involve non-physician providers and nurses

* Everyone can articulate patient service expectations and the protocol about communication with referring providers and their offices during the entire course of the treatment and the follow-up period
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No portion of this article can be reproduced without the express written permission from the copyright holder.
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Article Details
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Title Annotation:Practice Management
Author:Oliva, Jayne
Publication:Physician Executive
Geographic Code:1USA
Date:Sep 1, 2005
Previous Article:Breaking into clinical research.
Next Article:The great sucking sound: the consumer vortex hits health care.

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