July 1995 Bulletin

How to keep referrers happy

By Geoffrey T. Anders, JD

Geoffrey T. Anders, JD, is president of The Health Care Group and a principal attorney with Health Care Law Associates, based in Plymouth Meeting, Pa.

Orthopaedic surgeons who want to prosper in tomorrow's health care market should start keeping their referring physicians happy today. Generally, to make sure your referrals keep coming, there are two things you must do, two things you may do, and one thing you should probably not do.

Primarily, maintain good communication with each of your referring physicians, and involve each patient's primary physician in the treatment regimen you administer, at least to the extent that he or she wants to be involved.

Secondarily, you can survey your referrers to find out just how they perceive your practice and specific changes or improvements they would like to see you make. Have your office manager talk to referring physicians' office managers to see how you can make their lives easier. Often, a referring physician's manager plays an important role in determining which specialists get business.

One thing you should not do is bribe your referrers. Steer clear of even being perceived as offering bribes. Referring physicians tend to be unimpressed by giveaways, presents, invitations to dinners or luncheons, tickets to sports events, and similar items they receive—either in appreciation or in anticipation of patient referrals.

This does not mean that you should refrain from sending greeting cards or gifts to referring physicians, as appropriate. Do so in the spirit of the holiday (send a greeting card at Christmas or Hanukkah) or event (send a bottle of champagne to a primary care physician who is celebrating 25 years in practice or opening a new office), and be certain that you neither expect nor ask for anything, in return. Also be aware that some recipients may infer that you are fishing for referrals, even if that is not your intent.

The bottom line is that you must offer a "product" that is perceived as good-to-excellent not only by your primary consumers, the patients you treat, but also by your secondary consumers, the primary care physicians who steer patients your way.

Orthopaedic surgeons are increasingly more reliant on primary care physicians for their patient volumes. In a 100 percent fee-for-service environment, an orthopaedic surgeon often can function as a primary care musculoskeletal physician. When their joints refuse to function properly, their bones are broken, or they suffer low-back pain, most patients know they need orthopaedic care, and self-refer.

But, increasingly, people are joining health care plans. The typical plan is set up to pay for specialist services only if the patient who needs them is referred by his or her primary care physician who acts as one of the plan's gatekeepers.

Your referral sources want to know what is happening with their patients. Some want active knowledge of each and every step in the process, as it happens. Stay in touch with these physicians by telephone. This is true of any primary care doctor capitated for his or her own services and "at risk" for yours.

Most only want the highlights - which you can deliver by fax or letter - so they can keep their files up-to-date and have that information if they need it. Notifying a referring physician of his or her patient's visit to you and condition as the case progresses also is a common courtesy. Know what each referrer wants and deliver it.

Become an advocate for primary care providers. Help them position themselves as cost-effective gatekeepers for the managed care organizations that are rapidly gaining control of a significant portion of the American health care delivery system.

Teaching family practitioners minor orthopaedic procedures, such as how to reduce hematomas or treat minor musculoskeletal injuries in their own offices, will make them more valuable to managed care systems. Keep them up-to-date on new orthopaedic treatments and procedures that will benefit their patients and also increase the likelihood that they will refer their patients to you when necessary.

Also, after you administer necessary episodic musculoskeletal care, make sure that your patient returns to his or her referring physician. Involving the primary care physician in the patient's follow-up care also may be worthwhile.

Consider surveying your referring physicians to find out if there are ways to serve them better and having your office manager talk to his or her referring practice counterparts. In the long run, the cost-effective quality of the service you offer has far greater impact on whether you receive more or fewer referrals than these peripheral annual or semi-annual efforts, but they also emphasize to your referrers that you care, and that cannot possibly hurt your business.

It is basic good business for you, the orthopaedic surgeon, to bring each referring physician into the orthopaedic patient care process for three reasons:

By catering to your referrers now, it is more likely that they will remember your services in the future, when managed care is the rule rather than the exception, and the success of your practice may depend on their loyalty.

© 1995 The Health Care Group

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