What is the referral process in healthcare?

Getting patients is hard for most medical practices. It requires the patient to have a degree of trust in you, and this trust is not easy to come by: especially when dealing with a patient’s health!

Referrals are the second easiest way to increase patient volumes, next to making sure that you retain existing patients. People are more likely to trust their primary care physician’s opinion over a Google search, after all.

So what makes them worth their weight in gold, and why is their importance evidence of a growing problem in healthcare?

Types of Referrals

Doctor to Patient Referrals

Most often, patients get referrals to see a specialist from their primary care physician or from a doctor at a hospital. Doctors refer patients based on what they feel is necessary for them, and this is how many specialists get the bulk of their patient base.

There’s evidence to show that this system is inefficient at best, and disastrous for both patients and specialists at worst. 46% of faxed referrals don’t result in a scheduled appointment, 50% of physicians don’t know whether the referral was acted upon, and 55% of specialist visits are completely unnecessary!

Clearly something is wrong here, yet many practices still rely on referrals from PCPs and hospital physicians.

Patient to Patient Referrals

These types of referrals are much less common, although they should still be discussed. Patients with certain health issues may talk to a friend or family member that is also experiencing a similar issue. As a result, they might recommend you to their friend or family member.

If your existing patients are able to be an ambassador for your practice, then you have a much better shot at getting more patients who trust you.

Why Referrals Are So Important

Despite alarming statistics regarding referrals, they’re still one of the most important ways that practices increase their patient volumes.

Many specialists rely entirely on referrals from other physicians because they’re unable to take more patients otherwise. This situation isn’t a good one, because it implies that a specialist has more demand than they’re able to supply. If your practice is in this position, you may want to look at scaling your operations and making sure you can take on an increased patient load.

Because many referrals don’t result in an appointment, it’s important for specialists to optimize their systems to make sure that no referrals get missed. At the same time, specialists need to make sure that the referrals they get are actually relevant to them and, if possible, pass that referral onto another specialist. Unnecessary specialist visits make it even harder for patients who actually need help.

A written order from your primary care doctor for you to see a specialist or get certain medical services. In many Health Maintenance Organizations (HMOs), you need to get a referral before you can get medical care from anyone except your primary care doctor. If you don’t get a referral first, the plan may not pay for the services.

Primary care practices refer patients to specialists, ancillary health care clinicians, labs and screening facilities, and elsewhere. Making the referral process easy for patients increases the chances that they will follow through, and that both you and the referral destination get all the information you need.

Action

Refer patients to clinicians who coordinate care with you.

• Identifying, developing, and maintaining relationships to whom you refer patients can make the referral process run smoothly.
• Try to establish formal referral agreements with key specialist groups and other clinicians.
• Don't continue to refer patients to clinicians who do not send information back to you, don't provide timely appointments for your patients, or otherwise fail to coordinate care.

• Which patients are appropriate to refer.
• What information is needed before and after a referral.
• Roles for both parties after the referral.
• Setting aside appointments for urgent care.

Don't rely on patients to relay information.

• Share important information directly with the other office, such as the reason for the referral, pertinent medical history, and test results.
• Explore making electronic referrals. Check whether your EHR has the capability to make referrals directly to other clinicians. If not, self-standing referral management systems are commercially available for purchase.
• Provide a detailed referral to the other clinician that contains all the information needed. The Improving Chronic Illness Site has a guide on Referral Management, which includes a checklist of information to provide to specialists for each referral.
• Get information sent directly back to you. Make sure you get a full report back before your patient's next visit.

Consider language barriers.

• When making referrals for patients with limited English proficiency, identify clinicians who are language concordant or have interpreter services. Go to Tool 9: Address Language Differences for more information on language assistance.
• Include information on your patient's language assistance needs when making the referral.

Make sure the patient understands the reason for the referral.

• Explain why the patient needs to be seen by someone else, and what might happen if he or she is not seen.
• In the case of tests, explain how you and the patient will use the information to diagnose, manage, or decide on treatments for health conditions.
• In the case of screenings, give a clear explanation of the risks and benefits. Ultimately, it's up to the patient as to whether or not to undergo any particular test or screening.
• Use the teach-back method (go to Tool 5: Use the Teach-Back Method) to confirm patient understanding.
• Ask about and address any concerns or fears.

Offer help with the referral.

• Ask patients if they would like your office to make the initial phone call.
• If staff members are making appointments for patients, make sure they first find out when the patients are available.
• Ask patients about transportation and other barriers to their completing the referral. Discuss how they could overcome these barriers. Use Tool 18: Link Patients to Non-medical Support to refer them to other services that could support their completion of the referral.

Provide clear instructions.

• For some referrals, patients will need to prepare in advance (e.g., fast, discontinue a medicine). Provide easy-to-understand instructions verbally and in writing.
• Explain the referral process fully (e.g., how you and the other clinician will exchange information, when the patient should return to your office).
• Give clear oral and written directions to get to the referral location.
• Use the teach-back method (Tool 5) to confirm patient understanding.

Follow up on referrals.

• Confirm and document that the patient successfully completed the referral.
• Obtain information on the result of the referral and document in the medical record.
• Make sure the patient receives the results of any tests or screenings, even normal results.
• Provide patients positive feedback for completing referrals. Let patients see how you use the information obtained from tests or specialist visits.
• If the patient has not completed the referral, reinforce that you feel the patient could benefit, and review barriers.
• Determine whether the patient needs additional referrals.
• Get feedback from patients on the quality of the care provided. Stop making referrals to places that consistently receive negative reports.

Track Your Progress

Select a sample of referrals made during a week. Examine the referral records to calculate the percentage of referrals that included all relevant information. One month later, calculate the percentage of patients whose referral results are in their medical records.

Select a sample of patients who were sent for lab tests during a week. One month later, calculate the percentage of patients who have completed the test and the percentage who have been notified of the test results.

One month after implementing this Tool, ask a sample of patients who have not completed referrals why they did not follow through. Develop and implement an improvement plan to address the reasons they give. Repeat in 2, 6, and 12 months.

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