When Should You Eliminate a Provider from a Referral Network?

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privatepracticefinanceswebDeveloping and maintaining a strong physician referral network can lead to more patients and more revenue for your medical practice. Your practice could spend months, maybe even years, getting a solid referral structure in place. But what happens when some of those relationships start to sour?  When should you eliminate a weak referral from your network, and is there anything your practice can do to salvage that relationship? Below are the four factors that could signify that it’s time to start thinking about eliminating a provider.

Poor communications

The key to maintaining strong relationships over time is always timely communication.

“Written communication to the referring physician demonstrates strong organizational processes and good clinical care,” says Lisa Weber, outreach and referral relations director for La Rabida Children’s Hospital in Chicago, IL. “Picking up the phone—spoken communication—is also a way to strengthen the relationship with referring physicians.”

La Rabida’s pediatric practice provides primary and specialty care for medically underserved and low-incidence populations. Having a strong referral network from area pediatricians, social service agencies, FQHCs and word-of-mouth enables the practice to reach and serve these special populations that may have otherwise gone unserved.

“For children, we feel that it is important to choose a specialist who is also trained in pediatrics,” notes Weber. “For example, the treatment of diabetes in children and adolescents—either Type I or Type II—brings its own set of challenges, both clinically and socially, that are unique to children.”

Whether it’s written or spoken, having an open line of communication is also important for Brent Brandow, director of operations for Parkway SleepHealth Centers, a comprehensive sleep health center with facilities in Cary and Raleigh, NC.

“Anytime you have a relationship with a medical practice where you consider them to be your go-to facility for referrals, they are an extension of your practice,” he says.

When Parkway SleepHealth Centers refers its patients to ENTs, Brandow says it’s important for them that those physicians keep them apprised on what’s happening with their patients.

“We want to make sure that they are being taken care of and we’re sending them to place where someone is attentive to their issues and they’re going to have their problem solved.”

And vice versa, Brandow adds. When a physician refers a patient to Parkway SleepHealth Centers, they make sure to send back extensive data to the referring practice so they feel like they are part of the process.

“When a patient returns to that physician, he or she already knows what’s happening with the patient and what treatment we suggest,” Brandow says. “They’re not blindsided by a diagnosis or treatment option because we kept them informed. There’s nothing worse than sending someone out there and into a black hole. You don’t know if they were taken care of or if someone followed up with them.”

Limited personal interaction

If none of the physicians have been to your medical practice or facility, that could be a sign for your practice to cut ties with them as well. Your physicians, nurses, or referral coordinator should make every effort to visit every practice that is part of your referral network. If any practice in that network can’t make the time or makes excuses as to why you cannot step foot on their facility, you may want to reconsider that relationship.

Brandow says that they encourage their referring physicians to visit them and take a tour of the facility.

“We make sure that we do lunches with them as well,” he says. “It’s important to get to know the people you are referring patients to on a personal level. You should be able to refer a patient to someone that you can put a face to the name.”

An onsite visit will also allow a practice to examine your workflow so they can make a more informed decision on whether to include your practice as part of its referral network.

Weber agrees. Your practice can improve its interaction with referring physicians through outreach.

“One key to developing a solid referral structure is to conduct outreach,” she stresses. “This can be done with both non-clinical and clinical staff.”

For instance, at La Rabida Children’s Hospital, they have a three-tiered outreach structure:

  • Face-to-face outreach with pediatricians and family practitioners in the community and in hospital-based settings;
  • Continuing medical education offerings throughout the year to highlight its practice’s expertise;
  • A bi-annual print magazine, written by La Rabida physicians, on a specific topic that is geared to the interests of a primary care physician.

Lack of understanding how the referring practices work

Every medical practice has a different system for managing referrals. In some practices, it’s the nurses who work with the referral network. In others, it may be the physicians or a referral coordinator. Each practice also had a different way of handling referrals. Whatever your system may be, everyone in your referral network should understand your process.

“It’s important that the practices you refer patients know who is the main point of contact, how you prefer to handle referrals, and how you handle pre-authorizations,” says Brandow.

The medical practice staff or referral coordinators who make the extra effort to come and visit the referring practice’s facility is showing a genuine interest in wanting to be part of your network, and an extension of your practice.

Disappointing patient experience

Fortunately, for both La Rabida Children’s Hospital and Parkway SleepHealth Centers, they’ve had no difficulties with their referrals and have maintained a solid referral structure. One final way to know when it’s time to eliminate a practice from your referral network is feedback from your patients. Your practice should regularly evaluate your referrals by speaking with or surveying your patients.

“We have tried both electronic surveys via email and written surveys to evaluate the satisfaction level of our referrers,” says Weber. “The feedback gained from the surveys has been used to make changes in our processes.”

Brandow agrees.

“Always ask your patients how their experience was,” he says. “Surveys are the best methods. It’s important for patients to get the best care as possible. We want to work with physicians who will help take care of our patients. You want to take ownership of your patients, but it’s difficult to do that if you don’t receive any feedback from them and their experience.”