Menu

Best way to increase referrals?

Home The Lounge Best way to increase referrals?

  • ENT Doc ENT Doc 
    Participant
    Status: Physician
    Posts: 2675
    Joined: 01/14/2017

    Aren’t gifts with the intent to reward referrals against anti-kickback statutes? Just thought it’s worth discussing the extent to which this can become illegal.

    #197302 Reply
    Liked by pulmdoc, Peds
    Avatar SValleyMD 
    Participant
    Status: Physician
    Posts: 379
    Joined: 05/12/2016

    Give and get the cell phone numbers with your referring docs.. get them by meeting in person or after you interact with their pts

    Send them a quick text.. “was nice meeting you.. feel free to call or text if there is anything I can help with or if you need a pt seen. I can get them in same day.. take care!”

    Then send texts for any major changes or surgeries with their pts

    Focus on midlevels. A lot of docs don’t treat them with much respect and they’re referring machines

    Once given pt info you take responsibility with nurse to set up appt.. not “yea just call my office and we can see her”.

    If I was desperate I would organize community talks

    I wouldn’t care about ratings personally

    Ensure your google contact info is up to date

    But if you’re in texting relationships you are golden

    Them: “Hey got a guy with knee pain. Can you get him in?”

    You: “Yep no problem, I’ll have my nurse call and set him up right away”

    #197318 Reply
    Avatar SValleyMD 
    Participant
    Status: Physician
    Posts: 379
    Joined: 05/12/2016

    Oh and offer to take extra call

    Tell er docs they can call you even if you’re not on call if they have someone that just needs follow up. They’ll do that over dealing with the cranky on call guy

    Be mindful though that when you compete with your partners it can backfire if you start growing too fast

    #197319 Reply
    Avatar beagler 
    Participant
    Status: Physician
    Posts: 237
    Joined: 07/08/2017
    Earnest refinancing bonus

    Old fashioned way… introduce yourself to PCPs, briefly and however you can.

    Mention what body part you like to work on, orthos should be specialized and we have your names segmented that way.

    Mention your outpatient ASC use and desire to keep total surgery costs low. Mention willingness to avoid unnecessary surgeries and use third-party low dose imaging centers.

    Ask if they prefer to do the preop and provide them with a concise form with clearly marked type of anesthesia.

    Solo Internist, Midwest

    #197322 Reply
    Avatar AR 
    Participant
    Status: Physician
    Posts: 626
    Joined: 03/10/2016

    Aren’t gifts with the intent to reward referrals against anti-kickback statutes? Just thought it’s worth discussing the extent to which this can become illegal.

    Click to expand…

    Yeah, I think this is correct.  But I’m guessing it’s a matter of degree. I heard of a guy who bought referring docs final four tickets.  I’ve got to imagine there has to be something wrong with that.  I don’t think anyone needs to worry about a box of chocolates, though.   I’m just guessing on all of this, though.  Perhaps someone with actual knowledge will come along.

    #197340 Reply
    Avatar RollieStrummer 
    Participant
    Status: Physician
    Posts: 7
    Joined: 11/07/2018

    Aren’t gifts with the intent to reward referrals against anti-kickback statutes? Just thought it’s worth discussing the extent to which this can become illegal.

    Click to expand…

    Yeah, I think this is correct.  But I’m guessing it’s a matter of degree. I heard of a guy who bought referring docs final four tickets.  I’ve got to imagine there has to be something wrong with that.  I don’t think anyone needs to worry about a box of chocolates, though.   I’m just guessing on all of this, though.  Perhaps someone with actual knowledge will come along.

    Click to expand…

    Non-monetary compensation is prohibited by the anti-kickback provisions in the Stark legislation.  There is a safe-harbor value ceiling, though.  It’s about $400 per physician and about $30 per staff member.  It’s indexed and goes up a little each year.  I can’t recall the exact amounts off the top of my head.

    In short, a nice box of chocolates is fine and legal, an all expenses paid trip to the Caribbean is not.

    #197550 Reply
    Avatar IntensiveCareBear 
    Participant
    Status: Physician
    Posts: 53
    Joined: 12/22/2018
    Splash Refinancing Bonus

    I am an ortho subspecialist in a large group that covers a huge geographic area. I’m fairly new in practice (1.5 years) and there are some well-established surgeons in my same subspecialty within our group that get the majority of direct referrals….

    Click to expand…

    Hmmm. You will probably have to mainly settle for the scraps until those guys in your same group and sub-specialty retire. Is it a monster size group, or is your “specialty” something like TKA or sports or something that basically every gen ortho does already?

    What is really perplexing is that I would have to assume your group would have some overflow for you if they chose to hire you, but since it seems like you have significant downtime despite being there over a year, that must not be the case. Are they actively trying to turn some existing patients over to you, esp new patients or existing ones when the senior docs are on vacation? Is one or more of them retiring soon? If not, hopefully none of them have an “unfortunate accident” (kidding). Are you peds, hand, F&A or spine? You should be real busy by the time you’re a year into practice. I still do not get why they hired you if they didn’t have overflow, weren’t cutting back on hours, opening a new office, etc… even doing all of those things. Were they advertising the job, or did you just kinda create the position by schmoozing residency attendings? That is the only plausible way I can see a group hiring a surgeon without the volume to support the hire.

    It’s cool you are hungry to help marketing, but the office manager should really be doing most of the marketing and setting up of lectures for you (or hiring or designating a marketing person). That is pretty questionable if you are doing it largely or all on your own, esp in a large group. I would try to schedule a “strategy meeting” with her before you keep working so hard on marketing yourself. As it stands, you are basically putting significant time into growing the practice when you are not a partner. There is nothing wrong with an associate helping market, but it might just be miscommunication where she doesn’t understand you’re not busy enough. Also consider talking to the PAs, sports med docs if you have them, or any non-surg orthos in your own group and explain to them that you want to bump your volume and are looking for help. Chances are, they don’t know you are so bored.

    …You, or any private prac doc/dent/etc med person, basically have 3 sources of pts these days: 1) physicians (med community), 2) online (pt finds you), and 3) existing patients.

    1) physicians: Probably the source of new patients with the most dependability and longest duration… but also probably the hardest for a young doc (esp in a saturated metro area). I agree with above posts that lunches and cold calls and office visits are a waste of your time and too low yield. Again, it is scary you have that much free time to even consider that. Friday afternoons are also a very bad time to do that… everyone just wants to finish up and start the weekend, not see solicitors. It is also quite likely that nearly all nearby referral sources (PCP groups, rheum, Urgent Cares, PT, etc) were already tapped by your group for past marketing efforts over the years. They probably send to your senior guys in the same sub-specialty or competing area groups. Some of those can probably be re-visited if it has been awhile, but probably meet with your office marketer first. Going around to docs and other med referrals one-by-one is probaby quite low yield (unless very rural, which a large ortho group is almost certainly not).

    Your best options to connect yourself with docs would probably be places with many potential referral sources in each effort: hospital meetings (general staff, doctor appreciation events, residency and award dinners, etc), giving lectures (FP, IM, ER residents, health fair, etc), make a habit of snacking in doc lounge (not surgeon lounge) every time you visit the hospital, etc. The way to make those meeting handshakes actually turn into referrals is writing down the names of docs you meet and you or your office send them a “great to meet you” one page mailed intro letter with a few of your cards within a week of the introduction. Tons of guys exchange names and handshakes and maybe biz cards at meetings, but very few of them ever remember much of that; you need to set yourself apart. Be the guy who actually follows up and who goes the extra mile, not just the 71st new young ortho who shook a hand. In line with that thinking, I would suggest mailed and hand-signed copy and progress note to the referring PCP or doc when they send you a new pt; that is much more likely to end up in the doc’s hand than a faxed or EMR note. Feel free to have your office girls drop off or mail a little box of candy or whatever and some biz cards to help retain your major referral PCP or PT offices around winter holidays (but keep it vague and avoid any religious nonsense, never know who you will offend).

    2) online: website, google page with ample keywords and good photos, 4-5 stars… every thing you have done already. This is acutally the most important of the three nowadays; it is all that younger (and most middle age) people do to find docs on their own. Phone books are dead. Direct mail and billboards and local paper and newsletters and mags and stuff like that are pretty low yield unless it is fairly rural and/or area with a lot of older people. Radio or TV or YT can be decent bang for the buck, but it is a little cheezy and time consuming for most medical outside derm or plastics. Online SEO stuff is by far the biggest bang for your buck. Even if PCP refers someone to you, they often go right to their phone to check out the doc and ratings before making an appointment. Your website is pretty secondary, but make sure the google results and google biz page and star rating is solid…. website is only where they might go after google biz page and ratings. It is good to hear your office manager/marketer are doing something right with website help, though.

    3) existing patients: basically common sense, but this one takes basically no time (improve revenues and follow-up rates of existing) yet it also takes a very long time (need to cultivate many satisfied patients to get many more patient referrals from them). For every patient you lose for any reason, you need a new one to replace them, so it helps to shut the back door a bit in addition to just trying to get more people in the front door. A lot of it is actually out of your control and more based on office staffing (friendly phone answers, call backs, greeting when they arrive to wait room, etc). No matter how good the doc, staff can make or break you. People might wait longer or deal with ruder front desk if they really like the doc… but they’ll eventually move on. Don’t hesitate to inform office manager of consistently rude or lazy employees; they will affect your own bottom line and the experience of patients who you are ultimately responsible for.

    On your end, you obviously want to be personable in the exam rooms and make the people feel like a friend or cousin who you care about… not someone who is a paycheck to you or a dunce who needs to be “educated” on their condition by a talking textbook (laugh, but many docs come across that way, esp young ones). It is straightforward, but a lot of docs don’t get it. If you get it right, they will send you their relatives, friends, talk you up at their book club, etc etc and grow your office. It is nice, but it takes serious amounts of time to build much volume this way. You can start improving satisfaction and therefore maintaining the volume you do have immeditely, though. Small gifts help, like Hershey kisses, color brochure, or logo pens or other little logo marketing things if your office has them… you can give those to new patients with their card as you finish the consults. It is important that you personally hand it to them with a handshake and a smile… med assistant doing it or just a box of brochures or cup of pens at the front desk doesn’t have the same effect.

    The last part is just to get more visits out of the existing patients. You should start doing this today. This is for you to decide what is reasonably appropriate, but are you doing as much conservative care as you can… or are you quick to operate since you like to operate, you are trained to operate, and you need cases for boards? If you do a few more visits with just education, PT Rx, refill NSAID Rx (“to check for side effects and effectiveness”), to have them bring a family member to discuss options, to do injections, etc before you board cases, those fill up your schedule. Better yet, you also build rapport greatly so that the patients might trust and refer you more… and they also probably won’t be so upset when surgery complications do occur. It’s not a race with most of the stuff you see,  I’m not recommending cashectomy procedures that some dumb dermatology, chiro, etc providers seem to specialize in. However, if you are like most young docs making the transition from resident who races through patients to get done into attending who wants to see more patients, you could probably fill up your schedule a bit more with the same number of patients you already have by altering the visit Rxs and follow-up times a bit.

    …I would still unfortunately suspect there is something really wrong if you are quite slow on volume and one or more of the “well-established surgeons in my same subspecialty within our group” isn’t on the way out the door. It was suggested in a post above to simply accept that, “enjoy,” and wait… and that is nonsense. As you clearly realize, it would help to figure out why you don’t have more on your schedule and then do the highest yield things to facilitate growth. You will get a fair amount of patients trickling from good online marketing, but the physican and patient referrals can take years and years to really bear fruit. Pick low hanging fruit first (online, local hospital meetings, talking to your staff and marketer, get more from existing pts). You can also just do more general ortho until you build your specialty cases up. They must have tons of that in your group (or they had no business hiring anyone), and that is what most tend to do. However, the sooner you take a proactive approach and enlist your office marketer’s help, the sooner you will probably see results and get more of the cases you want. Your call. “Shallow men believe in luck; strong men believe in cause and effect.” GL

    #197578 Reply
    Avatar Bonez 
    Participant
    Status: Physician
    Posts: 108
    Joined: 04/02/2016

    I do spine surgery. To give you an idea of the size of my group without giving it away, it is in the top 10 biggest in the country (>100 surgeons) and spans more than one state. The size and structure of this type of group is what makes it unique and also will ideally allow it to continue operating as a private practice well into the future while health care systems continue to swallow up small practices. I am essentially my own individual private practice working under the umbrella of an organization that grants bargaining power with insurance companies and hospitals and also has overhead efficiencies of scale. So while I do have a top-notch marketing/quality department that made me a website based on my direction and information I provided, that meets with me quarterly to review my practice for areas of opportunity and critique based on good data from 100 other successful surgeons, I am also responsible to an extent for expanding my practice by putting in some work outside of the hospital or clinic myself. My marketing manager is probably more concerned with the new MLB contract than calling a rural family practice clinic to set up a lunch date with me haha. Regardless of that however I’d say that almost all of my colleagues and my past co-residents / co-fellows do or have done something like this (i.e. cold calls, lunch/dinner meetings with docs, community talks, etc). In fact, some of the busiest at most well-established surgeons still do it in my group.

    We have multiple spine surgeons in our practice, but only three of us on “my side of town.” Historically there has been enough patient volume to support 3 busy spine surgeon practices with no problem. I took over as one of the spine surgeons was retiring. He had a well-established following of patients in the region, having worked for 3 different groups in the same metro area during his career. Currently if any of his patients while he was employed at our group call to get a follow-up appointment they will get directed to my clinic. One of the other partners who is a spine surgeon is retiring this fall as well, so I’m assuming there will be plenty of overflow then. I’m not hurting for business per se. I think my income was slightly less than average for my specialty, but I think that comes with being at the beginning of my career.  I have lots of unassigned clinic patients that come through our central scheduling, and from my partners or their PAs. But I think there is an untapped market for me right across the border in neighboring state that is probably sending patients elsewhere even when I am conveniently located close by. As my efficiency improves I find that even though I think I’m doing pretty good 1.5 years into practice, that I could always be seeing more patients. I take call frequently and fix any operative fracture that “walks” through the door in my clinic as well. I just want to make sure I don’t get complacent and I want to let the PCPs out there know that I’m available to take quality care of their patients in a timely manner.

    I just wanted to clarify the above, since I must have made it sound like all I’m doing is sitting around twiddling my fingers with no patients haha. I do appreciate all of the input in your post.

    #197598 Reply
    Avatar IntensiveCareBear 
    Participant
    Status: Physician
    Posts: 53
    Joined: 12/22/2018

    You are on the right track then. It sounds as if you are actually more of a solo within a big group than a big group, so some of it does take time. Just try to figure out what is highest yield for you for your marketing time and efforts. Like I said, almost every doc can get more out of their existing patient base right away with no additional time, though.

    It sounds like you are in a good situation, but a fairly big opportunity was missed with the retired spine surgeon not introducing you face-to-face with as many of his referral sources as possible. Although most of that guy’s referrals probably stayed in your group, some might have been lost, and it definitely helps to put a face to the name. You could visit any nearby PCPs, PT, neuro, chiro, Urgent Care or similar who you know sent to him (the departed doc) based on charts you’ve seen? Like patients, keeping or jump-starting one existing referral source is basically just as good as getting a new one. Obviously, try to be sure you don’t miss that introductions chance again with the guy who is leaving your group later this year; if he will go to a few hospital meetings and spend a half day or two driving around town to introduce you to his referral contacts, that’s beyond huge. Those are really the only office visits I feel to be generally worth the physician’s time (ones intended to maintain/increase referrals from known sources).

    The neighboring state is a good idea to explore, but you could ask your billers if they run into many payer problems with that before you devote too much effort. You will do well.

    #197608 Reply
    Avatar bonebrokemefix 
    Participant
    Status: Physician
    Posts: 35
    Joined: 04/10/2017

    Tons of good advice in here.

    However, I think one place to start your search for more patients is at their initial contact point for your group, i.e. the appointment scheduling system. I’d want to make darn sure that patients not asking specifically for a certain doc were being evenly distributed. And also that the referrals meant for you specifically were actually going to you. Getting to know the people that answer your phones, and them getting to know you, is probably way more efficient than going to see PCP offices.

    #198010 Reply
    Liked by Tim, Docbeans
    q-school q-school 
    Participant
    Status: Physician
    Posts: 2186
    Joined: 05/07/2017

    Tons of good advice in here.

    However, I think one place to start your search for more patients is at their initial contact point for your group, i.e. the appointment scheduling system. I’d want to make darn sure that patients not asking specifically for a certain doc were being evenly distributed. And also that the referrals meant for you specifically were actually going to you. Getting to know the people that answer your phones, and them getting to know you, is probably way more efficient than going to see PCP offices.

    Click to expand…

    just be careful not to ruffle any feathers.  it sounds like you are going to be busier than you want in a few years, and your ability to control the environment will increase.  things are the way they are usually for a reason, and it doesn’t always meet everyone’s definition of fair.  ideally these things would have been hammered out pre hiring, but if they weren’t some doc who is going to retire in a couple of years isn’t going to like you messing with the distribution of consults, especially if someone is ‘in charge’ of the scheduling system and reports you.  pluses and minuses to being in a big system.

    #198070 Reply
    Liked by Tim, Docbeans, Kamban
    Lordosis Lordosis 
    Participant
    Status: Physician
    Posts: 317
    Joined: 02/11/2019

    I would not bribe your scheduler because that could piss off your partners.  But it never hurts to be the friendly guy.  Also being very accommodating with your schedule makes it easier for them and might make you the go to when there is a squeeze in.

    “Never let your sense of morals prevent you from doing what is right.”

    #198076 Reply
    Liked by Kamban, Tim
    Avatar Kamban 
    Participant
    Status: Physician
    Posts: 2059
    Joined: 08/01/2016
    things are the way they are usually for a reason, and it doesn’t always meet everyone’s definition of fair. ideally these things would have been hammered out pre hiring, but if they weren’t some doc who is going to retire in a couple of years isn’t going to like you messing with the distribution of consults, especially if someone is ‘in charge’ of the scheduling system and reports you. pluses and minuses to being in a big system.

    Click to expand…

    I second this. You are most likely not a partner yet and I would not jeopardize that by antagonizing the senior partners. Just wait patiently. These old fogies will retire  / fade away and you will become a partner and also busier in a couple of years.

    #198081 Reply
    Liked by q-school, Tim, Zaphod
    Zaphod Zaphod 
    Participant
    Status: Physician, Small Business Owner
    Posts: 5396
    Joined: 01/12/2016

    I do spine surgery. To give you an idea of the size of my group without giving it away, it is in the top 10 biggest in the country (>100 surgeons) and spans more than one state. The size and structure of this type of group is what makes it unique and also will ideally allow it to continue operating as a private practice well into the future while health care systems continue to swallow up small practices. I am essentially my own individual private practice working under the umbrella of an organization that grants bargaining power with insurance companies and hospitals and also has overhead efficiencies of scale. So while I do have a top-notch marketing/quality department that made me a website based on my direction and information I provided, that meets with me quarterly to review my practice for areas of opportunity and critique based on good data from 100 other successful surgeons, I am also responsible to an extent for expanding my practice by putting in some work outside of the hospital or clinic myself. My marketing manager is probably more concerned with the new MLB contract than calling a rural family practice clinic to set up a lunch date with me haha. Regardless of that however I’d say that almost all of my colleagues and my past co-residents / co-fellows do or have done something like this (i.e. cold calls, lunch/dinner meetings with docs, community talks, etc). In fact, some of the busiest at most well-established surgeons still do it in my group.

    We have multiple spine surgeons in our practice, but only three of us on “my side of town.” Historically there has been enough patient volume to support 3 busy spine surgeon practices with no problem. I took over as one of the spine surgeons was retiring. He had a well-established following of patients in the region, having worked for 3 different groups in the same metro area during his career. Currently if any of his patients while he was employed at our group call to get a follow-up appointment they will get directed to my clinic. One of the other partners who is a spine surgeon is retiring this fall as well, so I’m assuming there will be plenty of overflow then. I’m not hurting for business per se. I think my income was slightly less than average for my specialty, but I think that comes with being at the beginning of my career.  I have lots of unassigned clinic patients that come through our central scheduling, and from my partners or their PAs. But I think there is an untapped market for me right across the border in neighboring state that is probably sending patients elsewhere even when I am conveniently located close by. As my efficiency improves I find that even though I think I’m doing pretty good 1.5 years into practice, that I could always be seeing more patients. I take call frequently and fix any operative fracture that “walks” through the door in my clinic as well. I just want to make sure I don’t get complacent and I want to let the PCPs out there know that I’m available to take quality care of their patients in a timely manner.

    I just wanted to clarify the above, since I must have made it sound like all I’m doing is sitting around twiddling my fingers with no patients haha. I do appreciate all of the input in your post.

    Click to expand…

    From what it sounds like I think you should be careful. You’re probably very soon going to be inundated with more pts than you can reasonably attend to. Take this time to learn your preferences, etc…and get things nailed down. With the rest of your attitude I think this is a little like investing, even if you’re doing everything right you need to let time do its cumulative effects on things. It seems like its slow and painful, but after a few years you’ll have amassed a ton of prior pts, interactions and good will that will start throwing off more work than you can do.

    Then there is this retirement business, you’re kinda in for it.

    #198115 Reply
    Liked by Kamban, q-school, Tim
    Zaphod Zaphod 
    Participant
    Status: Physician, Small Business Owner
    Posts: 5396
    Joined: 01/12/2016

    I would not bribe your scheduler because that could piss off your partners.  But it never hurts to be the friendly guy.  Also being very accommodating with your schedule makes it easier for them and might make you the go to when there is a squeeze in.

    Click to expand…

    Second this. If you are simply nicer and more willing, you’ll get preferential treatment without any work. People cant help but be preferential, and the above methods absolutely work.

    #198116 Reply
    Liked by Tim

Reply To: Best way to increase referrals?

In case of a glitch or error, please save your text elsewhere, clear browser cache, close browser, open browser and refresh the page.

you're currently offline

Notifications Mark all as read  |  Clear