How easy is it to refer? We are really focusing our efforts in this area - making one point of contact to sort out issues - a physician liason. Previously, they might have had multiple contacts from the various service lines. In addition, we have just implemented a scheduling and access center that can be "one call" for the office to schedule lab, radiology and rehab for instance. And as a rehab manager, we have same day appointments for our own primary care offices and are trying to re-consolidate our offices into pavillions to house all service lines - physician practices, lab, radiology, and rehab under one roof. EMR is also helping with this integration and ease.

Like Shannon, ease of referral is on our radar screen. When I entered my organization, I was amazed to learn that the hospital expected physicians to contact three separate departments individually for any scheduled service. We've streamlines this by using an electronic fax server that automatically points referral info from a single source to the appropriate departments...We also encounter referral problems when it comes to services that physicians are increasingly bringing in-house (i.e. Nuc Med, U/S, lab) or they have ownership interests in ASC's. We are countering the latter by establishing a JV with a physician owned ASC company.

Physician culture is shifting towards better quality of life and increased business involvement. Efforts to make their hospital work simpler and finding a way to provide an equity position are both appealing.

At my hospital we use a physician opinion survey that gets at this question. it drills down and asks reasons why the physician may refer away from the hospital. We also meet with the physicians individually to address the specific question. Sometimes we do not always get the real honest response. However, I believe you must use a variety of techniques to approach this issue. In many cases a physician may not like a certain physician and thus, bypasses him or her. At times, there are barreirs to refferrals that the hoapital may not be aware of. So several fact finding attempts may be needed to get at the core of the matter. Perhaps the CMO can be an important resource to assist with this issue. Physicians will often talk with another doctor - on liu of providing information to an administrator.

Pat Murtha

The concern over whether a physician will refer to a facility generally implies competition in the area. We compete with several hospitals for referrals and admissions. Regardless of the longevity of a physician at a HCO, when they are dissatisfied it is the amorphous “they” or “them” that hold responsibility. Shannon’s suggestion about a physician liaison is good because it puts an easy to contact face on the problem. The presence of competition allows physicians to make comparisons that sometimes stretch the truth, usually in the form of how much easier the competing facility makes their life. Generally this behavior happens at all the facilities.

As Patrick points out, the CMO can sometimes get a better handle on the problem, especially if that person has been a medical staff member for some time. If discreet problems are not addressed, however, it can undermine the CMOs effectiveness.


Scott Larsen