Revisiting the referral process and implementing a fax referral, with built-in guarantees for both patients and referring physicians, can increase satisfaction and reduce missed appointments.
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Published 8/1/2012
Meagan A. Thompson; Craig R. Mahoney, MD

Improving the Primary Care/Specialist Referral Process

Both the ease and the speed of the specialist referral process are major concerns for patients and their primary care providers. Factors that slow the process decrease the efficiency of care delivery and make future referrals less likely. Any medical specialty office should strive to coordinate referrals seamlessly, providing optimal and timely care to the patient. To facilitate this, the referral process needs to be as straightforward as possible, allowing the primary care physician and patients quick and easy access to the key people within the receiving facility.

Our experience
The Iowa Orthopaedic Center (Iowa Ortho) in Des Moines periodically reviews all processes, looking at all facets of the business of orthopaedics. During one of those reviews, it was noted that a small but vocal group of referring offices were concerned about the referral process. Their concerns focused on the effect both on the patient and on the clinic that made the referral. Given that feedback, we quickly realized that we could fine-tune how referrals are made to create a more efficient process for all parties involved, including our own staff.

Iowa Ortho is a relatively large office in central Iowa, with 22 physicians and more than 200 employees. In the past, primary care providers had two options for referring patients to our office:

  • They could call a general office number, and one of our phone room personnel would schedule the appointment.
  • They could call a specific surgeon’s nurse directly if the referral was to that physician.

Although many referring physicians had provided positive feedback on this process in the past, a recent review alerted us to possible areas of improvement.

Time and place
One of the concerns expressed by referring offices involved the time it took to complete the referral. In some situations, referring clinics didn’t want to wait or be put on hold just to speak to a staff person. Although some appreciated the personal touch, others wanted a more timely transaction.

Another concern involved the location of the appointment offered the patient. Iowa Ortho has more than 17 offices (including satellite offices) in central Iowa. The process of scheduling patients over the phone, in some instances without direct patient feedback, ended up being long and drawn out. In many cases, the appointment was scheduled for a location that was not optimal for the patient. An internal survey of patients found that close to 70 percent of patients didn’t like the time or location of the appointment that the referring office arranged.

After gaining a better understanding of the challenges, we decided to offer referring offices a third option. Our goals were to reduce the hassle of setting up a visit with our physicians, to give patients more direct contact with our staff, to familiarize the new patients to our process, and to maintain a high level of contact with referring doctors and their staffs. Our solution was to implement a fax referral line.

A fax referral line
A fax referral line is just that—a direct communication between two offices by fax that allows for referral of a patient. The fax referral process is not new to specialty care; a well-managed and functional process with built-in guarantees, however, is something few providers offer.

After speaking to multiple referral nurses, we found that they used the process with other specialty groups, but they disliked it. They never knew if the information had been received, and the referring provider never knew if an appointment had been scheduled. This created more work because referring offices had to continuously follow up with patients to ensure the system worked. By fine-tuning the fax referral process, we found our new method to be efficient for the referring clinic, patients, and our staff.

The process works in the following way:

  • Once the fax is received, our office contacts the patient and sets up the appointment. The information provided on the initial fax form allows us to plan the conversation between the patient and the scheduler. Based on the information provided, we can anticipate desirable locations and tailor the interaction to the patient.
  • We guarantee the referring offices that we will contact the patient within 24 hours to set up the appointment.
  • We also commit to providing a weekly patient status update to let referring offices know that the process is working.

A positive response
The fax referral line has been viewed as a positive by many of our referring offices. By contacting the patients ourselves, we lighten the workload for referring medical staff and doctors—and the byproduct is increased patient satisfaction. We continue to offer phone-based referrals to offices that prefer doing things that way, but we are finding that more offices are moving to the new fax referral process.

Iowa Ortho’s size and multiple locations give patients lots of options. The fax referral line enables patients to decide which physician they want to see and where they want to go for their appointment. Allowing patients—instead of the referring clinic—to decide details about the appointment has resulted in shorter waiting times for appointments and a larger percentage of initial appointments kept.

Although it took more than a year to convince referring clinics that this is a more efficient process, we have proven that we will take care of referrals quickly and that they will have more time for patient care on their end. If you wish to have the same results, the best advice we can offer is to know your referral sources, ask questions, listen to their concerns, and follow up.

We are always willing to make a change if it means better service and better outcomes for the patient. By taking time to make your referral system world-class, you too will see outstanding results and more loyal referral sources.

Meagan A. Thompson is business development manager for the Iowa Orthopaedic Center, where Craig R. Mahoney, MD, a member of the AAOS Practice Management Committee, practices.