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Beth Israel Deaconess Medical Center:
Customize the Solution with
a
Niche Physician Relations Effort
Authors: Sarah Miller, RN, MBA, & David Zirkle, PhD
Creating new referral development techniques helps provider organizations stay ahead. In a scattered, dynamic marketplace where strategic alliances are continuously shifting, the challenge starts with knowing which physicians to target and then determining the approach that will be most successful in connecting with them.
This case study represents the techniques used, lessons learned and insights gained in building referrals with physicians likely aligned with a competing tertiary care medical center. Barlow/McCarthy was retained to support the organization in implementation of the pilot.
Targeting New Referral Sources
Determine the Need
There are many approaches to help build referral volume with referring physicians. The leadership of a major Northeast tertiary medical center (NTMC) determined that their efforts to target strategically aligned physician groups was working well. Going forward, the obligation was to add new referral sources to increase the existing referral base.
Criteria
The physician relations team leadership constructed a special pilot project that was designed to increase inpatient referrals from designated new referral sources.
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By definition, these referring physicians would be geographically dispersed providers who referred once over the last 12 months but not in the 12 months previous to that.
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Initially, the in house data management department generated a list of physicians that fit this referral designation. The list was prioritized by market and strategic clinical area of interest.
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These strategically focused services included Cardiology, Cardiac Surgery, GI, General Surgery and Orthopedics.
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First time referring physicians within a reasonable proximity to NTMC's location were selected for outreach while physicians from outlying areas including upstate New York and Florida were excluded from the list.
Key Project Elements
To measure and track what was learned, several tools were created and employed. Targeted physicians received letters thanking them for the referral and introducing the intent to initiate a follow-up call to gather feedback around a specific patient case. A phone interview guide was developed to ensure accurate and consistent questions were posed and answers were categorized into groups. Beyond assessment of the referring physician's service satisfaction, the interview also captured other information including:
- Reason for the referral,
- Use of tertiary competitor's services,
- Familiarity with other medical center services,
- Interest in access to the electronic medical record of the referred patient,
- Interest in being invited to a networking event with other sub specialists, and
- Interest in receiving a physician referral guide.
The calls were done by B/Mc consultant, Sarah Miller, given both her physician relations and clinical nursing background. Two different call cycles were incorporated into the project work scope so as to examine the results and outcomes with a couple of different "test" groups.
The interview data was logged into the physician relations tracking system as reference documentation for future interactions between the field representatives and the physician. The tracking system was used to generate quantitative and qualitative reports to summarize the interview findings.
The Results
To determine if there was impact from this special outreach initiative, the hospital inpatient system was used to run referral volume reports by physician and assess impact over time. The initial analysis incorporated a control group "A" and two experimental groups "B" and "C". All groups involved physicians who had not referred to NTMC in the 12 months prior to the test period. The control groups received no outreach efforts whatsoever while the experimental groups received the letters and phone calls. Referral volume from these groups was tracked at six and 12 months for all groups and compared to assess the impact of the special outreach effort.
Based on the hypothesis that referral volume could increase in the outreach groups by either more physicians referring patients and/or physicians referring more patients, two metrics were compared and analyzed:
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Percentage of physicians referring patients, and
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Average number of patients referred by individual physicians (average based on number of patients referred and total number of physicians in each group).
Standard t-tests were used to assess statistical differences among the different groups.
The percentage of physicians referring patients after six and 12 months is not statistically different among Groups A, B and C (see Chart 1). In other words, the outreach efforts applied in Groups B and C do not seem to result in more physicians referring patients. However, outreach does appear to impact the number of patients referred by individual physicians (see Chart 2). The average number of patients referred by physicians in Groups B and C is statistically different than Group A at the end of six months. The Group C average is 0.59 patients per physician or 64 percent larger than the Group A average of 0.36 patients. The Group B average is 0.45 patients per physician or approximately 25 percent larger than the Group A average. These results suggest that outreach efforts are not convincing more physicians to refer but rather physicians are referring more patients.
After 12 months, whatever outreach impact occurred at six months in Group B seems to be lost. On the other hand, Group C continues to show a significant outreach impact at 12 months as measured by the average number of patients referred by physicians (Group C average = 1.46 compared to Group B = 0.99 and Group A = 1.11). For whatever reason, the apparent impact of outreach appears to be much larger in Group C at both six and 12 months than what was witnessed with Group B.
Given the discrepancy between the two-outreach groups, we believe Group B should be used to support any financial analysis since it provides the most conservative estimate of the outreach impact. A "multiplier" based on Group B data at six months was developed to estimate the number of incremental patients one would expect if similar outreach efforts were directed towards a similar group of physicians. The multiplier is derived by comparing the increase in the average number of patients referred in Group B to Group A (Group B=0.45, Group A=0.36, Multiplier = 0.45/0.36 = 1.25).
Based on the analysis, one could expect a 25 percent increase in the number of patients referred from a group of physicians provided outreach compared to a group not provided any outreach efforts. For example, if we consider a group of 100 physicians that would normally refer 36 patients without any outreach effort (100 x 0.36 = 36), then we would expect that group to refer 45 patients (100 x 0.45 = 45) with outreach for a net gain of 9 patients or 25 percent.
Response and Outcome
This referral development approach provided a "door opener" to ongoing interaction with the target physicians. The new referral sources were integrated into the ongoing efforts of the physician relations team including face to face meetings, communication, clinical education and networking event invitations. The pilot project's initial connection provided a platform to begin positioning other services to the referring physician.
The study findings were communicated internally to the medical center administrative and clinical leadership. This enhanced their appreciation of the "triggers" that might cause a new referral source to utilize a tertiary facility outside of their commonly used resource and the ongoing work necessary to continue to shift additional referrals from this target physician pool.
Most importantly, the statistical results validated the return on investment of physician relations in a very tangible way. The results were used to calculate the cost/benefit of adding another member to the physician relations team with primary responsibility for new referral source management. While other economic challenges ultimately hindered adding that staff member, the organization can still estimate the projected contribution of that target population as an integrated part of its ongoing physician relations efforts.