Physician Referral: Evolving Beyond The Call

By Paul Spiegelman

Spring, 2004

Teresa and her family have just moved to a new city.  It's 7:00 a.m., Tuesday, and Teresa's little girl is running a fever.  Where to turn?  Teresa opens the yellow pages directory and finds that a local hospital nearby offers a physician referral service.  Teresa dials the phone number looking for help.

Hospital-sponsored physician referral programs have existed for several decades.  Early versions used manual processes to select appropriate physicians to whom referrals were sent.  Documentation of the referral was via paper, pencil, and index cards.  Today, physician referral programs are at the very core of hospitals' patient acquisition and retention programs.  They can represent an organization's largest single marketing expense, sometimes representing a million dollars or more, and generating tens of millions of dollars in new revenue.

Objectives of Physician Referral Programs: There are two primary objectives that drive hospitals to develop and offer physician referral services to their communities: (1) endear physicians to the sponsoring hospital, and (2) provide great service to clients and prospects of the hospital.

Without physicians, hospitals would have no business.  Virtually all services delivered by a hospital are provided only after an order from a physician has been written.  Thus, hospitals need positive relationships with physicians in order to drive revenue-generating business.

Strategies that endear physicians to a hospital are funded by the hospital with little hesitation, and physician referral services have proven a very successful strategy.  Why?  Because they help grow physician practices by sending physicians qualified patients - patients the hospital is hoping will be referred back to the hospital by that physician for inpatient, outpatient, or emergency care.

Hospitals also frequently invest in another strategy to endear physicians to their organizations - telephone nurse triage.  This service, when offered on an after hours basis for physicians, allows physicians an improved quality of life.  Calls received in the physicians' offices after hours are triaged by registered nurses.  Whenever possible, the nurses provide callers comfort measures to follow until the patient can be seen by a physician.  The nurses can direct callers to appropriate sources for care that are open at the hour of the call.  When necessary, the nurses can forward the calls to the physician.

As in every business, there are multiple targets.  For hospitals, physicians represent one target.  Consumers represent another.  Especially in today's environment where consumer directed healthcare is growing in popularity, hospitals are focused on providing outstanding customer service to the public.  Since the physician referral program is often the very first touch point for a consumer, hospitals are working harder than ever to ensure that every caller enjoys an exceptional customer experience.  That requires specialized, ongoing training of call representatives and continuous quality improvement.  This is where many hospital-based call centers fall short.

Hospitals Often Need Help: Obviously, operating a call center is far from the core competency of a hospital or hospital system.  Because hospital-based call centers are often operating with 10 or fewer employees, the call centers have to make concessions.

Usually those concessions are in the form of limited hours of operation, limited recurrent training of call representatives, limited quality checks on calls, and limited improvement coaching with call representatives.  The result is substandard customer service.

Skilled hospital marketers know that when consumers have to wait on hold or have to wait until the next morning to get help, the hospital is losing potential clients; every call means revenue to the hospital.  A 2003 study by Solucient, the nation's leading source for health care business intelligence, revealed that the average call center caller generates almost $14,000 in hospital charges within 12 months following a call versus a little more than $5,500 for patients overall.  It also revealed that every call to the call center represents more than $4,000 in downstream charges within 12 months.  

When hospital-based call centers make concessions, they also frequently include lackluster performance building relationships with affiliated physicians and physician office staffs.  Hospitals' physician referral programs must establish and maintain those relationships in order to gain and maintain physician's loyalty to the hospital.  Outsourcing has helped many hospitals avoid these pitfalls and minimize concessions.

Beyond Telephone-Based Physician Referral: Today, many hospitals nationwide outsource their physician referral programs to organizations that specialize in that service.  By outsourcing, hospitals are able to access additional expertise and state-of-the-art human and technological resources.  This gives the hospitals access to solutions that go beyond traditional telephone-based physician referral programs.  In addition to physician referrals, strategically focused call centers also provide consumers referrals to hospital services, community services, hospital-sponsored seminars and classes and more - and not only by telephone.

Now consumers can get physician referrals via the Internet as well.  They can sign up for hospital-sponsored seminars and classes both via live agent and online.  While navigating a hospital's website, a consumer can even ask that a call center representative to telephone the consumer at a particular time and on a particular day.  Or the consumer can have an email conversation with a call center representative.  During these interactions, the call center representative can "push" pages of requested or related information directly to the customer's desktop.  Consumers are better informed and more eager for information than ever before.  Online resources help to provide those consumers the information they seek.

As you can see, the consumer can interact with a hospital's call center in many ways.  Call centers can reach out to consumers in traditional and new ways as well.  Through Advanced Speech Recognition (ASR) technology, hospitals can deliver thousands of recorded messages all at the same time, personalized to each consumer.  This automated outbound calling technology dials the consumer, speaks the consumer's name, provides the consumer with important information, allows the consumer to answer questions in their own voice capturing all responses for future reporting to the hospital, and allows the consumer to opt out to a live call center representative whenever desired.  This technology has far reaching applications for hospitals wanting help with appointment confirmations (physician appointments, pre-admissions, scheduled procedures, classes, screenings), notifications (new services, new facilities, watch for mailer), research (post-discharge satisfaction surveys, post-class evaluations, perception studies), and employee applicant screening.

A New View - Customer Interaction Centers: With the advent of the many live agent services, Web-based services, and automated services now available, call centers are evolving into "customer interaction centers" - centralized storehouses of information for and about consumers.  Consumers have a variety of options for communicating with the hospital, and hospitals have a variety of options for communicating with the consumer.

Now that we know that each caller represents nearly $14,000 in future revenue to a hospital, we must refocus our thinking.  We must realize that each call represents a transaction, a revenue-generating opportunity for the hospital.  Continuing to develop relationships with the callers is crucial.  Marketing efforts from television to direct mail need to focus on returning callers to the customer interaction center for further dialogue.  That will result in more business, more revenue, and more profits for the hospital.

Way Beyond The Call: Even for hospitals that operate well-run call centers, few are utilizing the information they collect in their call centers to most effectively and cost-efficiently market their organizations.  Imagine taking the tens, even hundreds of thousands of records your call center has collected, then segmenting those records into common groups each of which has predispositions to purchase certain goods or services.  Now imagine producing a mailer to be sent to the group most predisposed to purchase cardiac services, each mailer featuring the recipient's name in the headline, the recipient's physician's picture and signature, and an offer to attend a seminar in the recipient's neighborhood with a map to the seminar location.  The result?  Reduced waste and increased response, revenue, and profit.

It's not the future.  It's here today.  Household view segmentation of any database helps hospitals understand what offers to send to which consumers.  Variable digital printing allows for name personalization, different photos, different signatures, different offers, inclusion of maps and more within each mailer that is printed - each unique to the recipient. 

This is the current state we've evolved to since the early days of physician referral.  Not only does Teresa's child get the care she needs, the hospital is gaining more loyal physicians and customers, and the hospital is reaping greater financial rewards.

Paul Spiegelman is co-founder and C.E.O. of Bedford, Texas-based The Beryl Companies.  Beryl provides product information, physician/service referrals, health information, telephone nurse triage, and class/seminar registration to more than 15 million callers.

A Better Physician Referral Program

• Promote the availability and benefits of participating in the referral service to physicians and their office personnel.

• Create accurate profiles of every participating physician; update the information on a regular basis.

• Integrate the referral service with additional live agent and web-based services to provide customers more options for communicating with your organization.

• "Warm transfer" referred callers to the physician's office to immediately schedule physician appointments.

• Capture and report the number of referrals made to each participating physician so each understands the value the physician referral service is bringing them.

• Use your data to market effectively and create more frequent dialogue with your customers.