Okay, let's start with the two polling questions. They are regarding to one of the KPIs I mentioned earlier. So does your practice require a referral for a new patient? Yeah, about two third don't need that. Usually GI practices don't require referral. Let's go to the next one. So does your practice keep track of referring physicians or providers as a KPI? Yeah, good. So two third actually do keep a track of who's referring the patients. Good. So we're gonna just go to our talk now. Building a high performing physician referring network. In this talk, we are going to go over some of the fundamentals of developing a high performing physician referring network. We will look at certain factors that have not changed over the years, while things that are relatively new and should be considered. We will also look at some of the key indicators that should be included in a dashboard to help monitor your referral base. Then we will look at some of the characteristics that can help to develop this referral network, the drivers of the referrals, and also some of the basic ideas that can be utilized by a practice to develop a referring network. Briefly, what is new due to COVID-19 and that has affected in developing your network and also for your referrals. You have to make sure that whenever there is a shutdown or slowdown of the services, your referring sources know when you're open and you have taken measures to protect against the pandemic. Also, availability of telehealth should be made known so that patients can be referred accordingly. What's not new is same old, that you have to have access. You need to make sure that your referring base continues to send patients and they don't have to face the problems at the wait times and there are workings available for urgent needs. Although there has been COVID-19, there have been shutdowns, but people are still getting sick and colorectal cancer is still there that needs to be screened. It is an important factor that we need to measure our referral sources. So, the referral sources should be a key indicator that should be included in our dashboard as well. If we don't measure where our referral sources are, we cannot analyze if there is a change in there. So, you have to look at your traditional referral sources, keep a measure of them and review them periodically to see if there has been any change or there is a pattern of change there. Similarly, it is important and sometimes startling to have a referral source and sometimes startling to understand who in a practice makes a referral. Many times the physicians or the providers just write for a consultation or a referral without even mentioning who to refer and it's the front desk or their checkout that makes a decision where this referral is going. This is an old saying, but still holds true. These three A's being affable, able and available does make a difference. If nice guys may have finished last, but if you're not nice, the referrals will dwindle away. It is an important factor that you can be able, you might have an availability to see the patient, but if you're not nice, the most common referrals are not going to come to you. You should be able to solve the problem, take care of the patient, provide best care because when people need help for their patients, especially if they have major problems, healthcare issues, they will think of someone who can solve that issue. Availability is also an important factor. If the wait time is three months, those referrals will go somewhere else. Affable and likable is an important ability and it is not only important for developing this referring network. Overall in life, it is important as well. So real business of medicine is sales. You have to sell yourself and it's difficult to sell something which is unlikable. No matter what type of referral or consult it is, you just say, thank you. And this goes long ways because for that one person you are going to get more referrals in the future. Every time you see a physician, you meet a provider, you build your practice. It is important to be able to take care of the problems, but sometimes people get too carried away by ensuring their ability to take care of complicated issues. And that will result in missing out on lots and lots of simple referrals as well. So you should position your services as one stop for everything related to gastroenterology and educate your referring physician so that you don't facilitate your competition. Availability again is an important factor in developing a robust referring network. No matter how good you are in what you do, if you are not available, those referrals will go somewhere else. Similarly, every referring physician or provider should be treated the same. It is important to communicate and speak to your referring physician. And you should ask yourself when was the last time you had the chance to talk to your referring physician because that does indicate your availability to them. There is another strategy that can be used to develop a good referring network and develop a practice that is more conducive to get referrals from other physicians. And we call it a CARE strategy where the CARE stands for Communication, Availability, Resourcefulness and Engagement. Where communication means that it is important to call the referring physicians. At times when it is important, it is not enough just to send your note. It does matter if you call a physician, call the referring provider, it makes a difference. Similarly, if there has been some issue or a screw up, it matters if you call and apologize. These small things on personal basis result in developing a personal rapport which goes long ways. Similarly, when you send letters, it is important to personalize them. Maybe just start with the first name. And also this helps to communicate your findings as well as developing these personal relationship. Now coming to availability, this is one of the most important things for a referring physician that when they need help, you are available. As a gastroenterologist or a gastroenterology provider, you are a specialist. And many times the referring physicians need help right away. So the staff should know how to contact you, how to find you when a provider calls. And if you were not available or not able to talk at that time, you should call back sooner. Similarly, it is important to make yourself visible among the provider community. Go to the meetings. If there are hospital staff meetings, you should be available or be there so that people know your presence. This goes along the paradigm of availability as well. It is important to have a problem-solving attitude. GI practices tend to be busy. There is always a long wait time. But if a referring source is calling about a help or a question, you should be able to work those patients in. That type of behavior or attitude goes a long way. Similarly, engagement in patient care, helping the referral sources out by engaging in actively in that care helps. Communication is one of the most important factors in developing long-term relationships with other practices and providers. Unfortunately, this is one thing that lack among a lot of physicians. And when done appropriately, it can not only be better for your practice, but also for patient's health care as well. There are small things that can be done. And they can make a huge difference in the behavior and attitudes towards the other providers. Simple phrases like, thank you for allowing me to help you in taking care of your patient. Similarly, if there is an issue, do write an apology letter. Sometimes just including your cell number in the letter to the physician makes a difference. It just shows how you care and you want them to call you if they need your help. There are certain drivers of referrals that are more behavior-based. So it is interesting to look at these surveys. So there was a survey of 100 primary care providers who were told that it is important to keep the referrals in the network, yet they continue to refer outside the network. Similarly, there was a survey of practice or hospital administrators to look at the leakage of referrals because they wanted to keep those referrals in-house as well, but yet their providers were sending these referrals outside. This is quite intriguing that although in both these surveys, the physicians or the providers knew that it is important to keep those referrals in network or to certain providers, but they would still refer their patients outside. The question is, why? Why would they do that? But Camus was a French philosopher and he had a saying that the truth is that everyone is bored and devotes himself to cultivate habits. So the bottom line is that although these physicians or providers were told that they should refer in-house or in a certain network, yet they continue to refer outside is because of their habit. Once providers develop the habit to refer to certain physicians, they continue to do that. And it is difficult to change that habit. Another study of 1000 physicians across multiple specialties and geographies looked at whom these referrals are going to. And it was interesting to see the same type of behavior. This study, almost all of the respondents of this survey reported that when they started their careers, so they started referring to whoever the whole practice was referring to. So you can imagine this is more of a group or collective habit that starts and then it becomes an individual habit as well. So it is important to know that majority of the primary care physicians who participate in a rural medicine rotation tend to stay over there after graduation. These residents that are rotating in certain areas, they tend to practice in the same area as well. The same residents become your referring network. So it is important to provide an opportunity to resident physicians or under-training APPs to come and rotate in your offices. And that also can help to harbor that type of relationship in the future with them where they can refer those patients to you. You have developed some referring sources. What do you need to do? Of course, you have to keep your referral sources satisfied. So what is required? So referring providers, not just physicians, APPs, nurse practitioners, PAs, they want three things. They want the patient to return to them and not to be siphoned off to some other place. They need a timely letter or a summary of what you have done, what treatment you are going to do, and what are the follow-up plans about that. And also they don't want drama. They want things to be taken care of. They don't want phones not to be answered. They don't want patients to get frustrated because they have to wait a long time to face a rude staff. So all of these things matter. And as I mentioned twice earlier, communication is one of the key factors here. So whatever is being done, make sure that the referring provider gets a summary of that, some sort of communication so that they know they are in the loop. As the saying goes about the early birds, it's very important to know about the new providers, the specialists, the primary care providers coming to your locality. You need to know about these new providers coming in because when you go in and be the first one to introduce yourself or your practice, you are going to create their habit that they will refer patients to you. And as we mentioned earlier, once the habits are formed, it's difficult to break them. And that's how the referral pattern goes. Summary, although you have a lot of referral sources right now, it doesn't matter. It doesn't mean that they're gonna stay that way. So you need to keep them happy. You have to keep that network alive. Similarly, remember the three A's, affable, able, available. And when you or your practice commits a mistake, make sure you get out in front of the problem, go to the referring source, to the patient so that they know you have come clean and you are not trying to hide anything. If you are too busy to speak to a referring physician, there's a solution. You can talk to them.

physician referring network

gastroenterology practice

referral processes

referring physicians

communication