Physician referrals are a gold mine – we all know that. There are very few industries outside of healthcare where referral networks can work so well and can be so effective in business growth.
Over time, I have noticed that the practices that grow rapidly are the ones that take physician referral networking and physician referral partnerships seriously… very seriously.
It actually is very easy to do so if you master the individual components of this growth strategy.
The things to look at:
- Marketing to physician offices near your office/practice locations
- Following up with physician offices and reminding them of your services regularly
- Taking care of patients referred by your referring physician partner by seeing them asap, treating them well and ensuring that the patients are happy
- Keeping your referring physician partner office(s) in the loop constantly about the referral they sent over
- Closing the loop with your referring physician partner by sending out consult/visit notes ASAP and transitioning care back to your partner
- Touching base with your referring physician partners regularly to ensure satisfaction, addressing any issues they might have, keeping them abreast of the latest about your practice and the co-managed patients.
How we have seen it being done
Most practices that we have worked with, make the mistake of having physician liaisons do the following:
- Market to referring physicians with/without giving them the proper tools to do their jobs
- Follow up with physicians to make sure they send referrals
- Follow up with the practice management staff to find out whether the referring physician sent any patients or not
- Follow up with the referring physician practices to update them about the referred patients’ appointment status
- Follow up with the practice management staff to find out if the consult / visit notes are ready or not
- Follow up with the referring physician practice to drop off consult notes
- Find out issues from referring physician practices and relay them back to the practice management staff internally
- Follow up with referring partner practices on whether issues have been addressed or not
This is too much for physician liaisons to handle. They simply cannot be effective if they are handling hunting, farming, customer satisfaction, practice management staff coordination etc.
How we feel it should be done and how we have succeeded
We have always had success with teams that are laser focused on a singular task. This allows us to hire, train, set proper KPIs, MBOs for, measure, learn, fine-tune better. That’s at least, our approach to running a practice management business.
Separating hunters (physician liaisons) from farmers (referral coordinators)
Personally, my first advice is to break down these functions into:
- Hunting – folks out in the field hunting down new referring partner accounts to close (or rather, “open”). You need to equip this team with the proper training, collaterals, account information (aka referring practice locations), account intelligence (aka physician specialty, clinical interests, number of procedures if possible, procedures performed, expertise, payer mix etc). These are your “field sales reps” or “physician liaisons”.
- Farming – Once the hunters have hunted and the referring partner has sent their first few patients, it’s the job of the farmers to expand that “account” into getting more referrals. The only way this is going to happen is if your farming team is “on top” of referred patients, patient satisfaction, patient coordination, keeping the referring partner up to date on patient appointment status, reverting back with consult notes and transitioning care to ensure referring partner satisfaction. This is much more of a coordinator role (aka referral coordinator).
Our earnest advice is NOT to mix these two roles as they require different personalities and have a very different focus.
What does a physician liaison need to do their job?
We have seen that for most smaller practices, IT is a challenge and physician liaisons are thrown into the field with little to no tools nor correct data to hunt.
Imagine yourself in a physician liaison’s role. What do you need to be successful? You need:
- A clearly defined territory – i.e. exact boundaries of where you should be hunting for referring physician partners
- A clearly defined list of accounts in your territory – i.e. a list of all practices, their specialties, their locations – and if a practice has multiple locations, a clear indication of this association of multiple locations to the same practice.
- A well defined list of contact information for your accounts (fax, phone numbers are a must have, websites are a nice to have)
- A clearly defined list of contacts within your accounts – i.e which physicians practice at the account, front desk person(s) name(s) (if possible), referral coordinator’s name (if possible)
- A well defined list of contact information for these contacts within your accounts (fax, phone numbers and emails if possible)
- A well defined list of availability information for these contacts if possible. Many times, liaisons waste time going to practices expecting to be seen by a doctor – only to find out that the doctor only comes in twice a week on such and such day(s) of the week
- Provider/Account intelligence – if possible, a list of information that tells you more about the practice, the kind of plans they accept, the kind of procedures they do, the number of medicare/medicaid patients they see etc.. These require a little bit more legwork by your IT staff but are well worth your time
- A complete history of contacts / touch points and activity history with that practice (e.g. rep 1 has visited 3 times, rep 2 has called 5 times, rep 1 has faxes 3 times, doctor A had sent referrals before but stopped sending 2 years ago, doctor B just sent a new referral etc)
- Training on your own practice’s strengths, weaknesses, areas of opportunities, threats to your practice
- Marketing collateral that can be used for conversation starters, drop off / leave behind material at the practices, key differentiators between you and your competitor
- Referral pads or an even easier way for these partners to refer patients to you. You cannot dictate how this referring physician would send referrals – whether they call in, send a referral via P2P or their own EMR, whether they send via fax, your referral pad or whatever fits within their workflow. You need to prepare your farmer / referral coordinator team with that information
- To be able to add account intelligence while you are out in the field and are going door to door. These could include newly discovered staff name, numbers, details on the staff .. or the same with doctors that you discovered when you visited the practice
- To be able to add reminders to yourself about following up with a practice on specific dates/times
- To be able to check in/check out of the practices you visit so that you don’t constantly have to report back to your boss manually
- To be able to define your route for the day intelligently (i.e. optimized to minimize driving times) without having to be a google maps wizard
- To be able to communicate with your practice staff instantly while you are at the practice you are visiting
- To be able to have a clear idea about the practice and the patients they have referred to your practice over the past year (at least) as soon as you enter the practice – so you are not caught off guard while you’re there
- More to be added based on your own unique ways of hunting
Targeting the right contacts at your prospect referral partners
More often than not, we see that physician liaisons are being told to “call high”.. Aka, don’t leave without meeting the doctor.
Truth is that this is not accurate, depending on the practice you are hunting into. Many times, we have noticed that doctors actually do NOT make the referral decisions. There are many times where the referral coordinator (or even the front desk that doubles as a referral coordinator) is responsible for sending referrals out and is the one that’s responsible for deciding who (which specialist) the referral is sent to.. And they do so purely based on the path of least resistance and the most responsive partners.
Understand that and let that sink in.. while you are aiming to connect only with the doctors, referral decisions are being made by front desk or referral coordinator staff that are tasked with “sending” the referrals out the door. They don’t care about the “best doctor” for the patient (they are not clinically trained to know that much).
What do they really care about?
A couple of things ..
- Which referring partner responds to me the fastest, so I can update my boss on the status?
- Which referring partner gets my patients appointments the quickest, so my patients don’t complain to my boss, the provider?
- Which referring partner keeps me updated about the appointment status – so that my patient doesn’t come back to see my provider without having completed the referral visit or the referral notes?
- Which referring partner closes the loop on the referrals I sent via a visit note, so that I can update the same on my EMR and thereafter can report back to our payers about the referral being `complete”?
- Which referral partner offers me the path of least resistance? Aka.. I just send referrals the way I used to, without having to jump through any new hoops or having to learn a new referral process/software or something else?
The underlying theme here is.. What makes the job of your referring partner’s lives easier?
Sure, in many cases, doctors themselves are responsible for the referrals. We are not saying that you shouldn’t try to see the doctor.
You should. But you should also keep in mind that you need to train your physician liaisons in a different way to be able to gain audience with the doctor.
And once they do gain an audience with the doctor, they should be able to have a powerful impact in the 5 minutes that the referring doctor gave them.
In other words, the physician liaison should be able to bring something to the physician’s table that only the physician could appreciate.. Something that the physician liaison could not leave behind or train the front desk or referral coordinator on.. Something that the doctor themselves would be able justify spending their 5 minutes on..
Keep that in mind when you are persistent about being given an audience with the “doctor”.
Don’t expect a physician liaison to be able to figure this stuff out themselves.. Train them, empower them, guide them..
And you will reap rewards..
What does a referral coordinator need to do their jobs?
Understand the critical role of the “farmer” or “referral coordinator”. Imagine yourself in a referral coordinator’s role. What do you need to be successful? You need:
- To be a true partner with your physician liaisons / hunters – you need to know which accounts they are hunting and who you are aligned with, to support them in their efforts
- To monitor all incoming channels of referrals (referral websites, faxes, emails, phone calls)
- Always accept referrals from multiple channels (whatever your referring partner prefers) but always report back on one single channel (fax or website is usually easiest to do). Do not force the referring partner to change how they send referrals, but dictate how you report back to them
- To be in sync with your appointment scheduling team (inbound or front desk) to ensure that they capture referring physician information for each patient appointment
- To be able to call patients for whom the referring physician information is not captured and ensure that you at least capture their PCP information – this will truly help your team grow the referring partner base. Trust us on this one – even if the PCP did not send you the patient, if you get back to them with the appointment visit notes, you establish a (potentially) new referral partner. This at least gives you a reason to get in touch with the provider
- To know the referring providers of each practice – to keep an eye out for any new patients referred. You need to be on high alert for this information. Keep in mind that when the inbound team / appointment scheduling team schedules a new patient, they might only get the referring provider information. You need to be able to figure out which practice this patient was sent from. Sometimes, you will find that the same provider is practicing at multiple different practices – in those cases, you would need to call the patient to find out which practice location the patient typically visits. Or, alternatively, call each such listed practice location asking about the patient – one of them will confirm that they are the custodians of that patient 🙂
- Call the referring partner upon receiving the first few referrals to cement the referral relationship. Keep them up to date on the patient appointments, no-shows or cancellations. Make sure the referring partner office hears your practice name and your name a few times. Give them your email / contact info (direct line, not the practice main phone number), your direct fax number if possible. All these little things really do end up making a big difference.
- Collaborate with your practice management team or your IT team to get a list of all referrals received in the last week and the status of each referred patient appointment. Ask your team for a spreadsheet with this information.
- On a weekly basis, call the referring provider office to “tally up referrals sent vs received vs patient appointment information”. For the first few weeks, resist the push back from the referring practice to “just fax over this information”. It takes only 10-12 mins to get this done per practice. Get into the habit of doing so. Each day, you should be able to cover 25-30 practices. Make it a habit to call at the same date/time each week so that the referring practice staff get used to hearing from you.
- As the relationship is cemented, you can even be friendly enough to pick up the phone and ask the referring partner why you haven’t received any referrals in the past week.. Whether they are happy with your practice, if they need you to do something else.
- Always keep your hunter/physician liaison team up to date on each referring partner account details.. They need details on partner satisfaction, referrals received per week, if referral volume went up or down etc.
- As you advance your relationship with the referring partner, start transitioning them to a fax based weekly update – with the same spreadsheet format that you have been sharing with them on a weekly basis. This way you can focus on the newer referral relationships that your physician liaison team has hunted down
- Send thank you notes to your referring practices during holidays and other notable days each year. You can do this more effectively if you establish a good rapport with the stakeholders on their side.. Get to know them better and get to know their birthdates / special life events.
- ALWAYS, always try to understand (probe) if the referring partner is sending referrals only to you (loyal) or whether they are a splitter (sends to multiple specialists). Try to understand why that’s the case. You might find out that several of their patients are from a certain neighborhood where you don’t have offices. You might find out that several of their patients are not in the age group that you typically treat. Always bubble up these information to your manager
- Always keep an eye out for and probe for referring partner satisfaction.. Always ask what their referred patients said about your provider and your practice. Incorporate these notes in your weekly reports to your management.
- Feel free to add your own twists to what you do and how you feel it works better for you and your practice
Over time, if you don’t see the referral volume increasing from any particular referring partner, it is time to have a meeting with the 2 practices – preferably involving physicians and key practice management staff on both sides.
How to empower your referrals team with the data and the tools they need to be effective
Let’s go through each item one by one
Basics – provider and practice data
Your physician referrals team is going to need accurate provider and practices data. There are several companies that do this for a living. Some of them are the big guys that most of us cannot afford – e.g. definitive healthcare, LexisNexis, integratedmedicaldata (more so on email lists), IQVIA etc.
OK, so you cannot afford it – now what? Keep in mind that you can always fall back to the basics and get the data from the CMS NPI database. This data is updated every month and you also get incremental data updates weekly.
However, this data is bad – REALLY bad.. We have used this before and have pretty bad luck with this. You can read more about how inaccurate this really is on Fierce Healthcare.
If you want to depend on the government provided data, do keep in mind that you have to merge / munge the following data sets
- National Plan and Provider Enumeration System (updated weekly)
- Medicare Provider of Services Files (CLIA and all other HCPs, updated quarterly)
- Physician Compare (updated annually)
- List of Excluded Individuals and Entities – LEIE (updated monthly)
- Physician Patient Demographics (updated annually)
- Dialysis clinic information (updated quarterly)
- Long-Term Care Hospital (LTCH) Quality Reporting (updated quarterly)
- Medicare data (parts A-D)
- Hospital Service Areas (updated annually)
- Hospital Consumer Assessment of Healthcare Providers and Systems – HCAHPS (updated annually)
- Hospital Compare (updated annually)
- Medicare Shared Savings Program Organizations (updated annually)
- Sunshine Act – General + Research + Hospital + Physician Payments (2013 – 2017)
Look up Carevoyance – they do this as well.
You can use Google to do the same research. E.g. you can go to google maps, search for your location (or be at one of your offices), then search for physicians, specialists (by typing each specialty) etc.. Sure you can do that – but that is also REALLY bad data.
You can also go to zocdoc.com, vitals.com, healthgrades.com and try to find providers and practices – good luck with that 🙂
Anyways – here’s something else you can do… and data you can trust. Payer provider directory. By law, payers are supposed to keep accurate provider directories (it is not updated in real time but it’s as close to real time updates as you can hope for).
Simply create a spreadsheet with all the payers you accept. Then, google payer name + provider directory to find the results
1199seiu provider directory – this gives you a link here
If you cannot purchase the data from the companies mentioned above, you can hire freelancers from upwork.com and get them to create a spreadsheet with all the provider and practice info. At a minimum, you are going to need the following information to help your physician liaisons or healthcare marketing folks
- Practice Name
- Provider names — all providers that practice there
- Provider credentials for each provider
- Specialties – e.g. Pediatrics; Emergency Medicine
Now, at least, you have started empowering your physician liaisons with data to be effective.
Your physician liaisons can surely not use any technology if you truly do not want them to. But don’t be surprised that they are spending time each day updating their notes, spreadsheets that you might be asking them for, reports you ask them for etc. Also, be fully prepared that they would be wasting valuable time printing maps, spreadsheets of information, trying to figure out how to optimize their routes, finding parking etc..
We always recommend field sales operations CRM software that allows you and your reps to:
- Upload your target accounts with full contact data and account intelligence
- Create and assign territories to your reps
- Create routes and plans for each day of the week that is optimized for driving time
- Create reminders for themselves that ties into their calendars
- Check in and check out of accounts AND the ability to not be able to check in when they are not at or near the target account location
- Take notes while they are at the prospect, to add contacts they discovered at the practice, leave notes for your inhouse sales enablement teams to help them further
- Ping anyone at the practice to help them out with specific questions while they are at the practice
- Be able to pull up account level information so that they know in as real time as possible the total referrals and names of referred patients from each practice
- Be able to see their weekly performance of new referrals they have driven to your practice, how many patients have been scheduled, not scheduled, seen, billed etc
- Be able to order referral pads or other marketing materials when the referral partner tells them that it is needed.
Let’s talk about territory – if you’ve ever run a sales or marketing team before, you know you have laser focus on your territory and the quirks of each territory. E.g. upper west manhattan – it’s a heavy Spanish neighborhood .. and a Dominican or a Hispanic liaison is going to be most effective here. Or, e.g. the Jamaica or Jackson Heights neighborhood – it’s heavy on Bangladeshi.. A Bengali speaking physician liaison is going to be more effective here.
Divide your target accounts into territories and try not to have overlapping territories and accounts. It only leads to headaches with commissions and account ownerships.
You can choose to have territories defined based on geography or based on specialities or based on specific lines of businesses you want to promote – that’s really something you need to figure out based on what makes most sense to your practice.
In general, it’s always best if you do not have multiple reps reaching out to the same practice with mixed messaging. It’s always best if you have a rep manage a relationship with a referring partner.
In general, we always advocate hunters to be hunters and for farmers to be farmers.. Keep it that way.
Account level information
You’re going to have to clearly define a list of accounts in your territory and enhance each account with account level information so that your reps can be most effective when they are knocking on doors.
We recommend that your territory have a list of all practices, their specialties, their locations (and if a practice has multiple locations, all locations should be handled by a single rep), a clear indication of this association of multiple locations to the same practice.
You will need a well defined list of contacts within your accounts – i.e which physicians practice at the account, front desk person(s) name(s) (if possible), referral coordinator’s name (if possible), how many times your reps have visited the practice etc.. On top of this, try to provide account level information that tells your reps more about the practice, the kind of plans they accept, the kind of procedures they do, the number of medicare/medicaid patients they see etc.. Gathering this kind of data does get expensive but is well worth it.
In addition to this, you are going to need to provide a well defined list of contact information for your accounts (fax, phone numbers are a must have, websites are a nice to have)
Over time, you will notice that your reps are gathering deeper information about each account.. How many times a doctor visits the offices, which days or times they come in, new contacts in a practice, who seems to be a champion in that referring practice for your own practice, who can guide them within your referring partner practice etc..
Crucial parts that your software vendor should solve for you
The following is where we have seen several practices fail. They do provide training on their own practice’s strengths, weaknesses, areas of opportunities, threats to their practices. Some of them even provide decent marketing collateral that can be used for conversation starters, drop off / leave behind material at the practices, key differentiators between their practice and their competitor’s practice etc..
However, they typically don’t provide software robust enough where their reps could spend more time in networking rather than reporting to their managers on their daily performance / activities.
Your reps should be able to create daily route maps, know which accounts haven’t been touched in a while (aging), be able to add reminders to themselves about following up with a practice on specific dates/times, be able to check in/check out of the practices they visit.
The biggest issue that most software vendors do not solve is to allow the reps the ability to have a clear idea about the target referring practice and the patients they have referred to your practice over the past year (at least) as soon as you enter the practice. Many times reps have visited a practice several times and the partner might even have sent patients over already – but the reps do not know.
Make sure that your field sales CRM software is 100% mobile and 100% integrated with your EMR (or at least someone on your IT team updates the account information with such crucial referral information)
How to empower your referral coordinators with the data and tools they need to be effective
You referral coordinators + your physician liaisons should be your A team.
While your physician liaisons go hunt every day, your referral coordinators should be taking care of the “house” per se. They are your farmers and every door your physician liaisons open, every account they “land”.. Your referral coordinators expand.
First things first – NEVER assume that you can change the way your referring partners send you referrals.
Make it the path of least resistance for referring partners to send you referrals. Whether they choose to send you referrals directly from their EMR to your fax, using your Direct address, faxing you directly, using P2P (jointhenetwork) or any other 3rd party referral software.. Accept them ALL.
The ONE thing you can control is how you report back to your referring partners on referral status, patient appointment statuses, visit notes. And we suggest that you DO control and influence this part of the game.
This allows you to centralize “closing the loop” with your referring partners, showing them historical information of all referrals sent, showing them data on referral volumes, how quickly your co managed patients are getting appointments, how many attempts you are making per patient to get those patients to come in, how you are handling no-shows, cancellations etc..
This reporting aspect tied to the fact that your referring partners can look up their patients at any point is KEY to cementing your relationship with them.
For this, you are going to need some help from your IT team or do some spreadsheet magic.
First of all, you are going to need to help your referral coordinators monitor all incoming channels of referrals – namely
- Referral websites emails
- Referral website faxes
- Referral emails
- Inbound referral phone calls
- Patients calling in to make appointments based on the referral pad your referring partner might have given their patient
- Direct faxes from EMRs
- Situations where you acquire a new patient that wasn’t a referral but you captured their PCP information – this is KEY and a GOLDEN opportunity for you to open even more doors.. DO NOT IGNORE THIS CHANNEL.
For inbound calls – you are going to enable your referral coordinators to be in sync with your appointment scheduling team (inbound or front desk) to ensure that they capture referring physician information for each patient appointment.
Even a simple spreadsheet that captures the following will help:
Facility Name — where the patient came from
Facility Location — which location the patient came from
Referring Physician with NPI — this is crucial and inbound agents should always capture this info
Facility Number — nice to have the referring location phone number
Facility Fax Number — if possible
Patient Name — of course 🙂
Patient DOB — of course 🙂
Patient Phone no. — at a minimum, this will help your call center to call patient back to find out additional information
If Referral, Call from — whether patient called after being referred or the referring physician called directly to get an appointment.
Trust us – being diligent about collecting this information really does help. This at least gives you a reason to get in touch with the provider.. Hey, open more doors !!
Maintain daily spreadsheets of this information..
The next important thing to do .. without fail…
Call the referring partner upon receiving the first few referrals to cement the referral relationship.
Keep them up to date on the patient appointments, no-shows or cancellations. Make sure the referring partner office hears your practice name and your name a few times.
We do this on a regular basis and we continue even after we keep receiving referrals from them. The policy we follow is that if we’re not calling them or calling on them, someone else is.
Each day when you wake up, know that someone is going to knock on your referring partner’s door to gain their business.
Your job is to protect what you worked so hard to get.
We recommend that you give the referring practice admin or referral coordinator your direct email / contact info (direct line, not the practice main phone number), your direct fax number if possible.
Do whatever you need to, to make it easy for them to reach you and get appointments for their patients.
You’d be surprised at how many practice staff don’t care and take referrals for granted.
Get on weekly update calls with your referral partners – even for 10 mins. Get into the habit of calling at the same time, each week. This establishes a routing and a pattern.
For this, you’ll need to collaborate with your practice management team or your IT team. Try to get a list of all referrals received in the last week and the status of each referred patient appointment. Ask your team for a spreadsheet with this information.
Next, add a few columns to your spreadsheet.. date called, remarks – that contains what transpired on the call.
On a weekly basis, we call the referring provider office to “tally up referrals sent vs received vs patient appointment information”.
We actually resist the push back from the referring practice to “just fax over this information”.
As the relationship is cemented, you can even be friendly enough to pick up the phone and ask the referring partner why you haven’t received any referrals in the past week.. Whether they are happy with your practice, if they need you to do something else. More often than not, you’ll be happily surprised that they’re quite candid with you and give you valuable feedback for the entire practice – things like “patients said it takes too long to get an appointment “ or “we don’t get visit notes back quickly” or “your staff gives up calling these patients too easily” etc
Always, always escalate this information to your management and get together as a team to figure out how you could do better together as a team.
Get into the habit or creating a cumulative summary of referrals per practice. This really does help you and your physician liaison get a better handle of your referrals portfolio.
Always keep your hunter/physician liaison team up to date on each referring partner account details.. They need details on partner satisfaction, referrals received per week, if referral volume went up or down etc.
As you advance your relationship with the referring partner, start transitioning them to a fax based weekly update – with the same spreadsheet format that you have been sharing with them on a weekly basis. In fact, right from the beginning, you could get into the habit of calling with updates, plus following up that conversation with a fax with the same info you just discussed.
It’s so easy to send a fax via the web these days… you don’t even need to walk over to the fax machine. Just “print + save to file “ the spreadsheet as a PDF and fax it over.
Once you know your top referring providers week to week, month over month … create a list for thank you notes. Send thank you notes to your referring practices during holidays and other notable days each year.
You ALWAYS, always have to try to understand (probe) if the referring partner is sending referrals only to you (loyal) or whether they are a splitter (sends to multiple specialists). Of course, you cannot ask this right from the beginning of your relationship.
First “give, give, give” and then “ask” after you’ve helped them out.. a lot..
Try to understand why that’s the case.. if they’re splitting their referrals between you and your competition.. a competitor that you might not even be aware of.
You might find out that several of their patients are from a certain neighborhood where you don’t have offices. You might find out that several of their patients are not in the age group that you typically treat.
Always keep an eye out for and probe for referring partner satisfaction.. you’re going to do that on the phone anyways, but if your referral network is as large as ours, you’ll want to systemize and formalize this a bit more.
You can very easily create satisfaction surveys using a simple combination of google forms and google sheets. This is great information to share with your manager and your practice management staff.
Always ask what their referred patients said about your provider and your practice. There are so many patient review software these days that this is really not a big deal to take on.
We recommend that you send out a patient survey after each visit. Then you ask the patient to post it on a social media channel of their choice. Simple.
Give your patients multiple options – let them post on Facebook or google or yelp or health grades etc.. whatever is convenient for them.
While you obviously don’t have access to the same kind of survey results as Press Ganey provides, whatever you can collect yourself is a great start.
You can do this in a low tech way by simply using google forms and email or SMS! Really easy to do.
Overall if you follow these strategies, you’re already way ahead of the game.. and it reaps HUGE rewards in the long run.
Try it out and let is know how this works out for you.