Referral Patterns: Grow Your Clinic’s Volume Organically

Sometimes, it seems impossible to figure out how to increase patient volume.  “Advertising is too expensive.” “Referral patterns seem impossible to break.”  These are very real concerns expressed by physicians all over the country.  The reality is that advertising is very expensive and takes a lot of time to produce results.  Unfortunately, that leaves referral patterns as the best place to look to quickly and cost effectively increase patient volume.

Three Steps To Changing Referral Patters

Contrary to conventional wisdom, it is not really that difficult to change referral patterns.  Even the most long-standing relationships can be changed with the proper approach.  All physicians generally want the same things from the doctors to whom they send patients.  They want quality care, access, communication – and they want the patient back.  With this in mind, changing referral patters is a three-step process.  The beginning of the process is to define the “Value Equation” for your practice.  The second step is to implement the systems, policies and processes within your clinic to support and achieve your Value Equation. The last step is to effectively communicate your Value Equation to the right people.

Step One: Your “Value Equation”

A “Value Equation” is the value your clinic offers to a referring doctor.  In other words, “Why would a doctor want to send her patients to you versus your competitor down the street?  Your Value Equation should answer this question in a very efficient manner.  Developing your Value Equation requires you to first assess your practice’s attributes and potential selling points.  Doing this requires you to think as if you were the referring physician.  It also helps to involve staff in the process, as they see the process from different points of view.  And lets face it, the referral physicians’ staff can impact referral decisions. 

While trying to think about the subject from the referring physician’s view, use the following questions to assess your clinic’s attributes:

• What does your clinic do that is better than your competitors?
• How does access (wait time and appointment lead time) compare to your     competitors?
• How does your customer service compare to your competitors?
• Do you have better clinical outcomes or different skills than your competitors?
• Does your clinic offer more services than your competitors?
• Does your clinic provide better communication to the referring physician, then your     competitors?
• Do you have specific processes in place to make sure the patients return to the referral   source?

It might even help to develop a mini-survey for each person in your clinic based on the above questions.  The responses to these questions should not be the single source used to develop your Value Equation.  Rather, they are intended to get your team thinking about your strengths.  The next step is to go to your referral sources (even those who do not currently refer you patients) and ask them what they want and need from the physicians to whom they refer their patients.  You may think you already know the answer to this question, but most often you will learn something new.  Regardless, the important part is to ask the question, because doing so is the first step in opening the dialogue about referral patterns.  Here, the first question should be, “What do you need from the physicians to whom you refer your patients?”  If you do not get at least three specific attributes (e.g. access or communication), then you will have to probe with some of the following to draw out the information:

• Are you able to get your patients seen quickly enough when you make a referral to     (an orthpod)?
• Do you, or any of your staff, experience any hassles when referring patients?
• Do you get enough communication about the patients you refer to (ENT)?
• Do your patients return to your practice after being referred for a (cardiology)     consult?
• Are there any ideas you have, no matter how crazy, for improving the (neurology)     referral process?

Who should ask these questions?  In many cases, the best person to charge with the responsibility of asking these questions is one of the physicians.  This may be unpractical for a number of reasons.  If so, you must rely on a surrogate.  This can be a practice administrator or a nurse – but the person you chose must have the communication skills to manage the process appropriately.  If you do not have someone in your clinic with the skills to do this, then hire a consultant to do it on your behalf.  Whether it is a physician, staff person, or consultant, this step must be done and it must be done correctly. 

With the information from your own team and the referring physicians, you can now put together your Value Equation. This is where you should be as aggressive as possible, while making sure you can deliver what you promise.  Gone are the days when physicians can leave patients in their waiting rooms for an hour, or schedule surgical consults 30 days out.  Today, patients are more educated and have more choices.  They demand service and they tell their physician when they are displeased with a referral.  Some of the value equations currently being offered include:

• “Your emergent patients will be seen within 24 hours and your non-emergent patients     within 48 hours.  And, you (the referring doctor) determine emergent versus non-    emergent.”
• “If your patient has to wait more than 15 minutes in the waiting room, her visit will     be free.”
• “We have set up a separate referral number that will be answered within five rings by     a nurse who can schedule your appointment.”
• “We will send you an e-mail, letter, or fax (your choice) the same day that we see     your patient, and each day we see him thereafter.”

Developing your Value Equation should include one to three elements such as the above examples.  It should be partly based on what your referral sources want, and partly based on your strengths as a clinic.  It should blow away your competition – not just be marginally better.  A marginal improvement will not cause a physician to change a long-standing referral relationship.  Your job is to make it easy for the physician to make the decision to send you referrals.

Step Two: Systems, Policies, & Processes

Step two in the process involves developing the systems, policies, and processes to ensure the Value Equation is a reality.  The only thing worse than not having a Value Equation is communicating one that you cannot provide.  During this process, the physicians must take the leadership role and set the expectation for their staff.  They should tell their staff that they want them to meet regularly (which means paying them to do so) and provide a date certain by which a plan is due.

It is important, in this step, for the physician to recognize that his staff will provide ample reasons why the new Value Equation cannot be accomplished.  Here, the physician is charged with being the leader who sets the target and communicates to his team that he is looking for folks who can help him achieve the goal.  All pieces must be considered when developing the operational plan.  If the Value Equation is to see all emergent patients within 24 hours and all non-emergent patients within 48, then the physician must agree to make room in their schedules.  If the Value Equation is to establish a separate telephone line for referrals, then the plan must contemplate the hardware, software, and personnel needed.  These plans should be developed within two weeks, and implemented in two weeks maximum.  Short time requirements will produce better results and will begin generating desired outcomes quicker.  In most cases, these plans can be developed and implemented in under two weeks – total.

Step Three: Communication

The final step in the process is to communicate the Value Equation to current and potential referral sources.  This should be a multi-faceted, but relatively inexpensive, process.  The backbone of this process should be direct communication to those same folks with whom you met at the beginning.  Go back to those physicians and let them know that you have implemented new processes and procedures that allow you to offer a new “Value Equation.”  Let them know exactly what your new “Value Equation” is, and what you have done to make sure it is a reality.  Again, the physician is the best person for this task.  If this is not a reality, then a staff person should do it.  As was the case with the first step, the staff person needs to have the proper communication skills to present this message effectively.  If not, hire a consultant.  This has most likely been a big effort, so you want to maximize your return. 

Other parts of the communication process might include brochures, faxes, e-mails, and post cards.  All can be accomplished with relatively little effort and expense.  Also, your communication may need to be repeated a few times.  Some referral patterns have been in place for many years.  You may need to remind them, from time to time, to give you a try.  However, if your Value Equation is strong enough, it should only take one try. 

Finally, make sure you track your referrals and monitor your Value Equation.  Your practice administrator should establish an on-going process for monitoring your referrals.  You should receive a monthly report delineating how many referrals you received from each physician.  Thank those who sent you many, and contact those who just sent a few.  When you do, make sure you ask if their needs were met, and if there is anything you can do to improve the process. 

Similarly, monitor the processes associated with your Value Equation.  Check them yourself.  Make sure your clinic is doing what it says it is doing.  Bring the team together when it the process fails and look for opportunities to improve. 

By listening to your team and referring physicians, you can develop a Value Equation so strong that referring physicians will feel compelled to send you their patients.  By developing systems, processes, and policies to achieve your Value Equation – and communicating that Value Equation to those who can send you patients – your business will begin to grow.  Every day, you will be developing a steady pipeline of new patients.