Physician Referral and Appointment Setting

By Sue Altman

Spring, 2004

Even though the call center industry has been performing Physician Referral for nearly 20 years, the name of the service is misleading.  We say "referral," but in truth, our actual goal is new patient acquisition - that is, physician appointments.  Senior management is rarely interested in how many physician names were given out in the course of a month.  They'd much prefer to know bottom line figures such as "new patients connected with our physicians," or "kept appointments."  The truth about physician referral services and how often they result in kept appointments is demonstrated in research gathered in 2001 by Expert Knowledge Network:

Service Description                                           Percentage of Kept Appointments

Physician referral alone (caller was given names)                       18-20%

Appointment was scheduled at time of call                                52-65%

Appointment scheduled plus reminder call                                 73-86%

         (including rescheduling if needed)

So, it is obvious that evolving from referral-based services to appointment-setting is the faster track to achieving your goal of patient acquisition.  Converting this number to a net revenue figure is even better!  The value of your service, often referred to as your value proposition, can be calculated in a variety of ways.  These fall into three categories: direct revenues, indirect revenues, and savings.  There are also less tangible measures that can also be tracked and reported, but they are generally of less interest to senior management. 

Direct revenues are dollars that come directly to your call center, organization, or affiliate because of the services you provide.  Indirect or "downstream" revenues are from subsequent actions to the initial appointment.  Savings through automation also deserve mention, but the focus should center on the patients and revenues that new technology may attract.  The following is a brief primer describing decision points that will help prove your contribution.  Direct revenues can be realized by sales and kept appointments, as covered below:

Direct Revenues from Sales: If your call center sells the physician referral service for a fee, be sure the fee you charge is greater than your cost per call.  You may also consider charging extra for scheduling appointments, since this step takes your staff additional time and delivers greater value to your customer.

Direct Revenues from Kept Appointments.  Kept appointments equate to office visit revenues for physicians.  If the practices are owned or affiliated with your organization, then this qualifies as direct revenue resulting from call center activity.  Since kept appointments are always the goal, you should optimize the current activity so that "converting referrals to appointments" is a primary objective of your staff. 

• Create an easy-flowing script for referral representatives' use that will encourage callers to allow your staff to schedule appointments more effectively.

• Your marketing message must prepare callers to expect the complete service, matching them with a physician that meets their needs and references and a scheduled appointment.  Consider stating "same day appointments," "one call for an appointment," or "one call does all," as a benefit of the service.

• Set up processes that enable easy scheduling, such as: 

• Direct access to schedules

• Reserved "slots" in the physicians' schedules for appointment-seeking callers.

• Back door lines into the physician practices to reduce on-hold delays.

Quantifying the financial value of new patient visits can be done as follows:

• Through the revenue reconciliation process, in the case that the owned physician practices use a common patient accounting system.

• Through access to the scheduling software used by the office(s).  If your call center has access to office scheduling software, you can obtain a report on appointments kept within a specified time range.  Record the kept appointments and if possible, track the average revenue collected per new patient visit that is typical for that practice.

• Manually, enlisting the help of the practice staff.  This process requires you to send a list of callers who have either been referred to or scheduled for an appointment with the practice.  The office staff must then cross-reference your list to their scheduling or billing system and indicate which of the callers did, in fact, keep appointments.

• Manually, by following up with callers.  This practice is time-consuming, but can yield valuable information about your callers' (and physicians') behaviors.  Develop a process to follow-up with (physician referral) callers approximately two weeks after your referral, or one to two days after the appointment you scheduled for them.  The critical information to obtain is whether they made and kept an appointment with (one of) the doctors to whom you referred them.

Indirect Revenues: Incremental Revenues: Incremental revenues to the hospital or health system may result from new patient referrals beyond physician office revenues.  These are viewed as "indirect revenues" because the call center directs the caller to a physician, who then may order the patient to be admitted or to have ancillary or diagnostic testing (lab, radiology, and so forth).  Tracking the financial value of these indirect services can be done through revenue reconciliation.

The revenue reconciliation process consists of matching patient accounting, demographic, and revenue data against registration data captured (from callers seeking a physician referral or appointment) in your call center software.  You will also need to obtain a download (or extract) from your sponsoring organization's patient accounting system.  Your software vendor should be able to supply a list of the data elements needed for the match.

If callers have visited departments or facilities within the sponsoring organization or integrated delivery network that are on separate patient accounting systems, you will need to obtain an extract or download from each additional patient accounting system to analyze downstream revenues across your network.

Questions to consider include:

• What definition of "incremental business" or "new business" is accepted by your CFO and senior managers?

• What time parameter from the last call center contact to service utilization is acceptable to your CFO and senior managers?

• Will you count the revenues of the first, last, or an aggregate of the services utilized within the time parameter specified?

Labor Savings via the Internet: Web applications can offload a volume of calls that would otherwise be performed by call center staff.  This saves time, which can be converted into wage and benefit savings.

There is one caveat with this.  If the Internet referral process requires staff to fulfill the request (via email), it does not save time.  In fact, this can be a less efficient process than a live call.  Time and cost-savings come from Internet products that fully integrate with your call center software.  Ideally, your Internet product allows physician referral to be fully self-service and also provides the ability to track consumer match criteria, such as specialty, zip code, and gender.

As alluded to earlier, the Internet is not merely an alternative mode for processing referrals and appointments by the same consumers.  A growing population segment is more comfortable seeking information on physicians and health issues via the web instead of, or prior to, making a more personal contact, by either phone or a visit.  The time and effort you put into your Internet tools may be rewarded by an increase in kept appointments.

Sue Altman is Vice President, Consulting Services, for LVM Systems.  Sue has focused on the healthcare call center industry for 16 years.  She spent six years in call center operations and service line management with two Midwest hospitals.  She has provided strategic and operational consulting to more than 100 medical call centers in North America and the Caribbean.  Sue may be contacted at sue@lvmsystems.com.

Are the Physicians Meeting Your Needs?

Saint Barnabas Management Services (SBMS) has operated an Employee Assistance Program (EAP) for 18 years.  To be awarded both regional and national contracts, they needed to establish both a vast provider network and a set of quality standards that could be guaranteed to participating members, regardless of location. 

"Customers like Schering-Plough and the foundations on Wall Street demand the highest quality for their employees," says Joe Ferrera, Chief Operating Officer of SBMS.  "They want assurance that we know these providers and monitor them closely."

Therefore, Saint Barnabas implemented a comprehensive tool to evaluate providers and the physical locations in which they deliver care.  This assessment tool has been in place for the past five years.

In 2003, Saint Barnabas brought their physician referral and appointment services in house, developing a call center that now serves their nine-hospital network, spanning most of New Jersey.  It is no surprise that they are applying this same standards-based approach to their physician referral network.  Much work goes into maintaining and furthering their health system's reputation of quality, extending to the physicians practicing there. 

How do the physicians like being evaluated?  "There were some issues at first.  It was new; they weren't used to it.  But what they love is the feedback!" says Ferrara with a smile.  Doctors are hungry for information on what is done at other offices such as the magazines, seating, or lighting and what patients say they like.

Saint Barnabas performs patient satisfaction calls after each new referral and appointment.  The reports are given to the evaluation staff who share the details with the physicians.  Therefore, the evaluation process becomes an exchange of information.  Ferrera adds, "It's not disciplining; it's really a tool for education and marketing.  That's what it's all about.  And in turn, it helps Saint Barnabas sell the quality of their doctors."

Customers feel more comfortable knowing what to expect at a when they visit a Saint Barnabas physician.  This helps the call center convert an inquiry into a kept appointment.  In addition, patient feedback is heeded.  Listening and acting on what they learn helps the physicians of Saint Barnabas stand out from all the others. 

Physicians Online: Directory or Referral System?

A first tier website initiative for many healthcare organizations is to establish a means to promote their affiliated physicians.  Most deploy a ‘search by specialty' function, but the resulting list is presented in alphabetical order.  "Great!" as far as Dr. Anderson is concerned.  "Of no value," says Doctor Zimmerman.  The bigger the organization, the less likely it is that Dr. Zimmerman's notable talents are ever viewed online.

This describes an important difference between Physician Directories and what you should demand from an Online Physician Referral product - the power of equitable rotation!  When choosing physician referral software (for call center use), the selection and rotation capabilities are essential.  Hospitals want to be able to rotate equitably by physician, solo, or group, and ensure that no participating doctor is underserved.  It is important to remember that these concerns are just as valid on the web!

Look for products that provide equitable rotation to better serve your organization's physicians.  It should also track the consumer's search criteria so you can report consumer preferences by specialty, location, gender, and other attributes.

One example of software that provides these benefits is LVM Systems' Web3 product, which integrates with its call center software counterpart, E-Centaurus.  The number of physicians presented to the consumer is your choice.  If the consumer wants more physicians to choose from, they can simply select the "Show Me More" button.

Utilizing physician rotation software is a very practical solution for your online customers.  They want a manageable number of physicians to view or contact and they may choose to request an appointment online.