Which referring physicians actually send patients?

The number practices think they know

Ask a specialty practice who refers to them and you get names, in roughly the right order. Ask how many patients Dr. Patel sent in the last ninety days and the answer is a pause. The referral came by fax, or by the patient saying “my doctor told me to call you,” and it went into the chart as a line nobody reports on. The practice knows Dr. Patel is important. It does not know whether Dr. Patel is sending more or fewer than a year ago, and it will not know when he stops.

Attribution at intake, in both languages

The intake form asks who referred the patient, as a required field with a searchable list of known referrers and a free-text option, in English and in Spanish. When the referral arrives as a fax or a call, the coordinator sets the same field on the card. Either way the source is on the record from the first day, and it stays there as the card moves.

The medical pipeline

• • Referral received. The card exists, the source is set, the language tag is set, and the immediate reply has gone out in that language.
• • Records requested. A stage of its own, because a visit that cannot be scheduled until records arrive is waiting on something outside the practice, and a card that has sat here for nine days should look different from one that sat in scheduling for nine days.
• • Visit scheduled. Reminders in the patient’s language; the hand-off record ready for the front desk.
• • Ongoing care. The card closes into the clinical record; the intake system keeps what reminders and reactivation need.

The aging thresholds are set per stage. Records requested might be allowed two weeks before it turns red; referral received might be allowed a day.

What the report says, and what it does not

Per referring physician: patients sent, patients scheduled, median days from referral to first visit, patients who never reached a visit. By month, by language. That is enough to see that Dr. Patel’s referrals dropped by half in the spring, or that Spanish-speaking referrals from a particular clinic wait twice as long, or that a new referrer started sending in March and nobody thanked her.

Closing the loop

The practices that keep their referrers are the ones that tell them what happened. A short note each quarter (“you sent six patients; five were seen within nine days; one we could not reach and we tried three times”) is information almost no referring physician receives from anyone. It is also the moment to mention that the practice takes Spanish-speaking referrals directly, in Spanish, from the first message, which for a referring clinic with a bilingual patient panel is a reason to send more.

The concierge and DPC version

For a concierge or direct-primary-care practice the referrals come from members, from spouses, and from professionals down the street rather than from physicians, and the expectation on response time comes with the membership fee. The same attribution field and the same report apply; the stage names change. That practice type gets its own post.

Questions we get asked about this

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