COVER FOCUS
INITIATING AND
MAINTAINING SUCCESSFUL
RELATIONSHIPS WITH
REFERRING PHYSICIANS
What happened when one practice adopted a program to improve its referral base.
BY JOHN D. PITCHER III, MD
Through the years, I have learned that
solid personal relationships are built
on communication, trust, and respect.
Building partnerships with referring
ophthalmologists and optometrists is not
much different, except that you do not
have to go through as much heartache, and
you do not have to do it all by yourself.
COMMUNICATION PROBLEM IDENTIFIED
AND ADDRESSED
For busy retina specialists, it is difficult to budget time in
the schedule for much more than patient care. An additional
challenge is overcoming the perception that a patient who
is referred out to another doctor will never make his or her
way back to us for comprehensive eye care and refraction.
This was especially a concern in my practice, which is made
up of multiple subspecialists and optometrists. A complaint
commonly heard was, “If I refer my patients to you, I will
never see them again.” Consequently, we were experiencing
a dwindling referral base and increasing competition from
outside groups.
In June 2008, my practice initiated an internal program
called Dr2Dr with a designated referral services manager
whose sole responsibility is to manage correspondence with
optometrists and ophthalmologists outside of our group.
The manager leads a department of three referral service
representatives who essentially function as a customer service team that handles referred patients from start to finish.
The development of this program gave us the opportunity
to facilitate better communication with outside providers.
Additionally, with the implementation of our electronic
health record (EHR) system, we became better able to efficiently identify and track referred patients.
OUR REVAMPED APPROACH
When an outside practice calls our Dr2Dr hotline about a
patient, that patient is flagged in the EHR system. Triage-related
questions are directed to a clinic technician or the retina specialist. Next, one of the referral service representatives schedules a
consult and obtains all relevant records, which are scanned into
the EHR. At each patient visit, beginning with the consultation,
a scribe composes a letter that is then reviewed by the Dr2Dr
team to confirm the referring doctor’s name, title, and address
and to look for spelling and formatting issues. In compatible
EHR systems, these letters are transmitted electronically. Some
outside providers still prefer facsimile or regular mail for delivery.
Our practice also sends correspondence after each
injection and each laser appointment to keep the primary
eye care provider fully updated. The majority of these
letters go out within 24 to 48 hours; the rest are sent
AT A GLANCE
• As with personal relationships, building partnerships
with referring ophthalmologists and optometrists
requires communication, trust, and respect.
• A common misconception among retina specialists
is that patients referred to other doctors will never
return to them for comprehensive eye care and
refraction.
• Having a dedicated team to maintain your referral
network allows a constant focus on building and
maintaining partnerships and ensures a constant
flow of patients to your practice.
SEPTEMBER 2016 | RETINA TODAY 61
COVER FOCUS
Figure 1. A referral report like the one above is generated automatically each week and distributed to doctors within the group. It provides
details including the patient’s name, the name of referring provider(s) involved in his or her care, and the patient’s appointment status.
no later than 3 days after the appointment. This commitment builds trust and transparency in the integrated
patient care process. A referral service representative can
also help schedule follow-up appointments at outside
practices for postoperative and comanaged patients,
ensuring that all relevant chart notes arrive ahead of time.
A referral report (Figure 1) is automatically generated each
week and is distributed to the doctors within our group. It
details the names of patients and of referring providers, and
it indicates when a patient is a no-show, in which case a letter
is automatically generated to the referring doctor to notify
him or her. This report allows me to quantify the volume of
consults I receive and to identify any changes in trends. When
it shows up in my inbox on Monday morning, it often reminds
me to call an optometrist about a particular patient who may
have turned into an unusual case or required special follow-up.
SUCCESS IS A GREAT REWARD
In the first year, the Dr2Dr program increased referrals by
49%. In each subsequent year, there has been an increase of
between 3% and 12% (Table). The goal of the referral service
department is continued growth, and the referral services
team works with clinics to reinforce each individual’s role in
this mission. The referral services manager also maintains close
relationships with referring doctors and their staffs by routinely visiting their practices. These visits afford face-to-face opportunities to gather feedback on obstacles in the referral process.
The referral services manager also makes sure that these practices are well stocked with clinic referral cards, which include
a map to our clinic and our contact information. We also
62 RETINA TODAY | SEPTEMBER 2016
Figure 2. Optical coherence tomography reference guide
developed as a tool to help referring eye care providers
identify pathologies.
distribute an optical coherence tomography reference guide
depicting commonly encountered macular pathologies that
could require referral to a retina specialist (Figure 2).
TABLE. REFERRAL TRENDS:
2009 THROUGH END OF 2015
Year
% Increase
2009
49%
2010
8%
2011
12%
2012
4%
2013
12%
2014
3%
2015
8%
If a new doctor were to join our practice, the referral services
manager would coordinate with him or her to create a referring
practices visitation schedule, and this manager would accompany the new associate to each appointment. I went through this
experience, and I consider it a huge advantage to be personally
introduced to referring doctors. It enabled me to immediately
start building my practice from the moment I arrived.
A COMMITMENT TO COMMUNICATION,
TRUST, AND RESPECT
As I learned on my own early in life through trial and error,
relationships are built on communication, trust, and respect.
Developing a solid relationship with referring eye care providers can come with challenges, but the process involves an
ongoing commitment to these three areas. Having a dedicated team like our Dr2Dr department to maintain the referral
network allows us to maintain a constant focus on building
and maintaining partnerships with ophthalmologists and
optometrists and ensures a constant flow of patients to our
practice—with minimal headache. n
John D. Pitcher III, MD
retina specialist, Eye Associates of New Mexico; assistant clinical
professor of ophthalmology at The University of New Mexico, both
in Albuquerque, N.M.
n financial interest: none
n [email protected]
n