Peer Review

Without referrals, many endocrinology practices simply would not exist. Knowing the ins and outs of navigating the referral landscape is vital to ensuring your own practice’s successful future.

Referrals from other physicians play an important part in the successful endocrinology practice. From patient recruitment through quality control, and even as a measure of prestige, they have a vital role to play.

A report in the Archives of Internal Medicine noted that between 1999 and 2009, the rate of physicians referring patients to another provider, usually a specialist, almost doubled. During the decade that figure rose from 4.8 in 1999 to 9.3% by the end of the decade.

Because of this, endocrine clinics are very busy places. Having a primary care physician (PCP) send a patient to them is an issue of efficiency and best use of both a provider’s and a patient’s time.

Referral as Triage

“In this context, referral serves as a kind of triage,” says Debra Bartel, FACMPE, clinic administrator at Portland Diabetes & Endocrinology Center in Oregon. “Since the Affordable Care Act we have been inundated in new patient referrals; some waiting as long as five months to be seen by us. We’re getting 30 to 50 requests for new patient visits.”

Many are already upset because of the wait. With the initial assessment completed by a PCP or internal medicine physician, you can avoid intensifying these feelings since you lessen the risk of them being at the wrong place for treatment.

This also means that at the first visit most of the needed tests have been completed. There is a fuller picture of the patient’s status when the specialist initially sees them.

More Efficient

“It is really an efficiency issue and most patients appreciate that we don’t have to reinvent the wheel and waste time and money,” says Tiffany Reichle, practice administrator at Texas Diabetes & Endocrinology, P.A., in Austin. “We make that first visit much more productive.”

More payers are also changing their reimbursement rules to reflect the need for patients to be worked up before being seen by a specialist. Referrals are often required for payment.

Insurers Requirement

“Insurers want the primary care folks to be the main managers of patient care,” Bartel says. “As a specialist, we will need a referral and if we don’t have it, we are treating the patient for free. Obviously, a practice can’t long survive under those circumstances so getting the required paperwork from their home doctor is vital.”

Quality Measurement

The volume of patients being sent to a practice can also be used a quality barometer.

“No provider will choose to send you patients for long if [the patients] don’t like coming here and don’t feel as if they are getting good medical care,” Bartel says. “If they send patients to an outside provider, they want to be 100% sure they will be helped by them. As a specialty office, if our daily referral counts decline suddenly, I know that something is wrong.”

This is becoming more important as payment changes from fee-for-service to quality-driven measures.

“Referrals are now based less on personality as in the past, and more on performance,” Reichle says. “It isn’t so much do I like the other doctor as it is how well do they take care of my patient.”

Measure of Prestige

Having a full practice census can be an indicator of how the practice is seen among their peers in the medical community.

“There is also a prestige factor involved with getting and maintaining a robust referral rate,” Bartel says. “We are the biggest endocrine practice in Portland and have been in business for nearly 60 years. But more importantly we have the reputation of being able to help endocrinology patients.”

Ullman, RN, MHA, is an Indiana-based freelance writer with nearly 30 years of experience. He wrote about disaster planning in the October issue.


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