How to increase medical referral volumes

Most provider offices are really bad about getting visit notes back to the referring provider, so the bar is REALLY low. Close the referral loop with your consult notes ASAP. You will start getting all your partner’s referrals.

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In my experience, starting a new physician referral partner relationship is just the first step of the process in getting new patients. Once you have opened that relationship, here are the main things you need to take care of:

  1. Give these referred patients the fastest appointments as they report back to the referring provider. Squeeze them into your tight schedule if you need to.
  2. Always keep the referring provider staff in the loop with regular appointment updates.
  3. Send back the visit / consult notes ASAP. This alone is a game changer.
  4. Each week (or on a regular basis) touch base + thank your partners.

Why closed loop referral management?

Closed loop physician referral management is the most important part. Take care of this aspect and your referring partners will reward you with all referrals.

Most provider offices are really bad about getting these done, so the bar is REALLY low. 

Understand the following a bit further and you will know why closing the loop is so important.

  1. Each provider gets paid by payers.
  2. Each payer gets paid by members (i.e. people like you and me).
  3. Members get insurance from (mostly) their employers.
  4. Employers choose insurance plans available to their employees based on price (quoted by the insurance plans) and also based on HEDIS ratings – Employers and individuals use HEDIS to measure the quality of health plans. (see this link of NCQA)
  5. For Medicare/Medicaid, people use STAR Ratings (As an FYI, The Centers for Medicare & Medicaid Services (CMS) uses a five‐star quality rating system to measure Medicare beneficiaries’ experience with their health plans and the health care system. This rating system applies to all Medicare Advantage (MA) lines of business: Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO). It also applies to Medicare Advantage plans that cover both health services and prescription drugs (MA‐PD).)
  6. So, based on how NCQA rates plans (see this document), point #2 is for clinical measures “Rates for Clinical Measures: The proportion of eligible members who received preventive services (prevention measures) and the proportion of eligible members who received recommended care for certain conditions (treatment measures).“.
  7. How do plans prove it? By proving that members got those services. How is that proven? By documenting visit notes and closing the referral loop. 
  8. So, plans expect PCPs to refer patients out for preventive and treatment measures. PCPs are expected to prove to plans that they did send those patients out by providing visit notes. Specialists need to provide PCPs these visit notes – that’s where you have the power to help your PCPs do better with their plans. This helps the PCPs help their plans do better with NCQA. That gets them higher ratings, which in turn helps the plans be chosen by more employers.. It’s a cycle.

Once you understand the above, make sure that:

  1. You keep your referring partner office in the loop about patient no-shows.
  2. After the patient is treated, you need to send the visit notes to referring partners within 24-48 hours. 

This alone will keep you on top of mind with ALL your referring providers. (HINT – Use a healthcare referrals management software to do this better)