Physician Referral Service

By Peter Dehnel, MD

Spring, 2004

Imagine the following four scenarios:

1)   You are a physician in outstate Minnesota.  It's 2 PM on a Sunday afternoon and a confusing and concerning set of laboratory results just came back on one of your moderately ill patients; you really need to contact a kidney specialist that afternoon.  You know of the hospital where the specialist works, but that's it.  You are not even quite sure of the name of the group in which he or she practices.  What would your options be at that time? 

2)   You are the administrator for a referral hospital in a metropolitan area and you are seeing the referrals to your specialists decrease.  When you survey the primary care providers who normally refer to you, their biggest dissatisfaction is difficulty in contacting the specialists they need at the time that they need them.  They also report that competing hospital 30 miles away, "St. Elsewhere," has an apparently seamless system to connect them with the specialist that they need.  All that they need to know is a single toll free number and/or an email address that is monitored "around the clock."  What can you do to counter this change in preferences?

3)   You are a GI specialist with a "brand identity crisis."  You have moved to a new location in a distant city to help fill a void identified by a leading hospital in that city.  Because of the convoluted system of insurance networks present there, it has been difficult for primary care physicians to find a way to get referrals to you.  This is in spite of the fact that you are in network and typically do a great job with the patients you see.  It is just easier for the primary care providers to refer to the large and unresponsive Multi-Specialists, Inc.  How can you work with the hospital to change this situation?

4)    It is late in the evening on the Fourth of July.  You are a consulting physician for a patient who has suddenly taken a turn for the worst and needs a surgical evaluation ASAP.  The ideal solution would be to have a three-way conference call with the primary care provider and the surgeon, but how is that going to be set up at 9:45 PM on a holiday?  Instead, you bite your lower lip and proceed to coordinate the flow of information between all interested parties over the next hour and a half.  Fortunately, the patient gets well and is discharged a week later.

The solutions to each scenario can be boiled down to one key process, improving communications.  The primary need in each of the above scenarios is an improved communications process to connect one medical provider to another - and sometimes multiple parties at once.  That is well within the scope of a leading edge physician referral service.  Providing updated information on providers, practice location, specialty information, and contacting the appropriate person at the time of need on a "24/7" basis is the foundation of a quality referral service.  This in itself is an advancement in patient safety and quality of care.  Added to these benefits are improvements in customer satisfaction and efficiencies in delivering a higher quality of care.

Going beyond this foundational level of service, referral services can act as "conduits and coordinators" of communication.  Helping to facilitate the flow of patient information from one provider to the next is a key challenge in patient safety as well as quality of care.  Many less than favorable outcomes have their origin in communications problems between a primary care physician and a specialist, or between a physician in the Emergency Department and the patient's usual physician.  Helping to bridge that gap is a natural function of an engaged and proactive referral service.

Finally, there is the opportunity to go beyond cell phones and faxes.  Helping to bridge the technology gap is a function that a referral service can perform more effectively and efficiently than a single practice or even group of practices.  Conveying the needed information at the time of need to the most appropriate provider is possible right now given the current state of technology.  A service that works with both the hospital and physician practices - both primary care and specialty care - will have advantages that the hospital, acting on its own, can't come close to matching.  The biggest beneficiaries are ultimately the patients who are served by those practices and hospital.

All of this is not free, of course, and represent a sizable investment of time and capital resources.  In the end, increased patient volume and growth of market share is what you have to prove to the sponsoring organization.  That is not a hard job to do, as long as you are set up to track the appropriate information from the start of the program.

So, does all of this actually work, or does it just sound good in theory?  Based on our experience, we know that the gains are very real and measurable.  Our organization, Children's Physician Referral (CPR), was established to connect outstate physicians with Children's Hospitals and Clinics specialists and to facilitate the transfer of critically ill patients.  In 2003, the Nurse Triage Service staff handled 1,902 physician referral interactions.  Because CPR is contained within our Nurse Triage Service, the communications systems and information systems needed to perform this function are readily available.  If needed, the ability to show the return on investment can be quickly shown to our sponsoring organization.

The next step for CPR is to enhance its functionality to include the transfer of information from provider to provider.  As Children's Hospitals and Clinics expands its electronic medical records and has that available to the community through a remote access function, the more information will be available to coordinate and communicate.  When that becomes fully implemented, it will be exciting to see the future possibilities for a physician referral service.

Peter Dehnel, MD is the Medical Director at Children's Physician Network Triage Service.  Their Physician Referral is called Children's Physician Referral (CPR).