Building Your Referral Base with High & Low Tech
Practices are finding innovative approaches to boost their referral base, including the use of sophisticated modules within their EMR, while others are using conventional approaches like consultants and event hosting. But there are many other untapped ways that practices can employ to generate new revenue.

Using the EMR

While many cardiology practices implement an EMR in the hopes of achieving the stimulus dollars available for meeting the meaningful use criteria under the HITECH Act, referral management software also can be added to their EMR to boost revenue.

For example, tracking quality outcomes of specific conditions can help alert cardiologists to certain comorbidities like hyperlipidemia, hypertension or diabetes, which in turn leads to better patient management. Such attention to advancing the delivery of care can sucessfully build outside referrals, says Daniel J. Marino, president and CEO of consulting firm Health Directions in Chicago.

Implementing alerts can help facilitate the care continuum between the cardiologist and the referring physician through the EMR. The system can help cardiologists set up appointment reminders that are sent directly to the primary care physician. Referring doctors often don’t know if a patient has been seen or the results of an exam, says Marino. Creating these types of consultation notes within the EMR that provide a timely alert to the referring physician can help close the loop.

A good referral management program can add anywhere from 5 to 20 percent additional revenue to the practice, says Marino. However, this can be an expensive task. In fact, implementing a brand new EMR can cost upwards of $15,000 to $30,000 per physician in the first year alone.

If practices are considering using the EMR as a means of building referrals, Marino urges them to:
  • Understand what functionality exists, and how the program will fit into their business model and clinical workflow.
  • Identify key criteria and successes of the practice to help choose the best EMR to fit the practice.

Have EMR technology in place to begin tracking quality indicators. In the future, payors will begin contracting with providers on the basis of clinical outcomes data, not just the number of patients being seen or tests being performed.

Pocket marketing

Starting as an initiative to enhance patient satisfaction and a way to differentiate themselves from the competition, the 14 cardiologists at Pikes Peak Cardiology in Colorado Springs, Colo., began using the Pocket EKG clinical-based marketing program (Cardiomark) in 1997. Since then, placing a simple laminated card the size of a credit card in the wallets of patients has helped boost word-of-mouth referrals by 22 percent annually, and has decreased unnecessary hospitalizations by 45 percent.

The card, which presents patients’ baseline 12-lead ECG results on one side and vital patient information—blood type, cardiac conditions, allergies and medications—on the other, not only promotes practice loyalty, but boosts referrals, says Ronald D. Blonder, MD, DO, a cardiologist at Pikes Peak.

In addition to the laminated card, which is helpful during emergency situations when patients are out of town, the marketing program also includes Pocket EKG Patient Satisfaction Surveys, which are distributed to patients to help the practice better understand patient satisfaction and concentrate on areas in which it can improve.

The survey asks patients questions such as: How long did you wait in the waiting room? How were you treated by the front office staff or nurses? How long did you wait in the exam room and were you happy with the physician? The answers are then documented into pie charts and bar graphs by Cardiomark, which distributes results back to the practice on a quarterly basis.

“The survey gives an objective cross-section of the practice’s results so that we can identify problems early,” says Blonder, adding that the marketing program focuses on the three P’s of cardiovascular marketing: patients, payors and primary care physicians.

Hiring a welcoming committee

In 2008, Associated Cardiovascular Consultants in Cherry Hill, N.J., performed 3,433 cardiac catheterizations and 2,526 peripheral vascular interventions. For the seven-office, 31-cardiologist practice, serving five hospitals in the region, their numbers have increased steadily since 2002 when the practice hired a part-time sales consultant to visit referring doctors and inform them about the practice’s competitive edge.

The practice went the route of the consultant because of disappointing results from advertising in newspapers and on TV, according to John J. Morris, executive director of the group. “Staying ahead of the surrounding competition is integral,” says Morris, adding that it’s important to let referrers know about your experience, service lines and technology.

The sales consultant works one week per month visiting referring doctors in the community. The consultant then reports to the marketing committee about potential referrers who should be visited monthly, in addition to current referral patterns and future forecasts.

While the practice still advertises in local newspapers, it is more to create brand awareness rather than build referrals. “It’s another strategy to put ourselves, our practices and services in front of physicians and potential patients,” Morris says.

The practice also proactively calls patients to check in on them. Morris refers to this as “a patient-centered environment” and insists it is pertinent in gaining referrals and building good community relations.  

Similarly, at State of the Heart Cardiology in Grapevine, Texas, cardiologist John A. Osborne, MD, PhD, says arranging numerous speaking engagements, hiring a community liaison and allowing referring physicians to take a “test-drive” of the practice’s technology has boosted the number of referrals tremendously.

“An educated physician is going to be one of your best referral sources,” says Osborne. “The more physicians are aware of your services, the better it is for all parties involved.”

Because the current model of care is “insular,” in that primary care physicians stay in their offices rather than visit hospitals, the communication lines have become closed, making it more difficult for cardiologists to meet with referring doctors one-on-one. “The community liaison helps to break down that barrier and facilitate communication with the primary care physician,” Osborne says.

He has gained referring relationships with almost 90 percent of the physicians he has met by inviting them into the practice to observe the CT equipment and it's high-quality images.

During their visit, referring physicians are able to test for themselves how noninvasive cardiac CT equipment works. Osborne says his “Make It Real” motto gives referring physicians a chance to understand and see for themselves the care their patients will receive.
  • To gain traction with referrals, Osborne says that practices should:
  • Focus on their unique services that set them apart from their competition;
  • Make the marketing personal: meet with people and shake hands; and
  • Perform follow-up: Make sure that referring physicians are happy with your services and that the service chain has been successful for both patients and referrers.

As competition increases among practices and hospitals, each has to find the right marketing tools to attract potential referring physicians. Advanced technology, such as EMRs, can play a role, as well as some traditional tactics such as phone calls and meet-and-greets. However, in periods of economic challenges, practices should not slash their marketing budgets to zero.

Lean times are the perfect times to continue to brand yourself and as your competitors cut back their marketing efforts, it perhaps opens up space for your message to be heard by potential referrers and patients.