O.D. to O.D. Patient Referrals

Leverage a colleague’s technology or specialty care, or become the referred O.D. yourself.

MARY ANNE C. MURPHY, O.D., BROOMFIELD, COLO.

An Asian, 56 year-old female patient presents for an initial glaucoma work-up. IOP is high, angles are open and unobstructed, VF shows scattered losses, and ONH cupping is asymmetric, but nothing is pathognomonic for glaucoma. An OCT NFL could potentially provide the missing piece of the puzzle, but you don’t yet have one, as you simply don’t have the patient base to substantiate its need or support its cost.

Do you tell the patient that test results are inconclusive, and, at best, you can recheck her in three-to-six months? Or, do you say you’ll be sending her to an optometric colleague for an OCT, which may provide the pivotal information you need in finalizing her diagnosis? My hope is that you chose and choose the latter.

In my office, I have an OCT. However, because I share it with other O.D.s, it is at our location only once a month. As a result, I don’t hesitate to send a patient who has an urgent need for a scan to a nearby O.D. who has a permanent OCT and with whom I’ve established a clear relationship (e.g. the stipulation patients are to be returned to my care). I request just the technical component (TC), as I am comfortable with the professional component (PC), or interpretation and report.

In addition to providing optimal patient care, leveraging your peers’ technology enables you to easily track the demand of the technology to aid you in making your own purchasing decisions when the time is right.

Here, I discuss how you too can successfully leverage a colleague’s technology and/or specialty care through referrals or, if your practice has all the latest equipment and provides an array of specialty services, how you can become the go-to O.D. for such referrals.

Referring to peers

To provide your patients with the needed technology and any specialty services required:

1. Survey local O.D.s. Assess the technology, specialty areas and accepted insurance plans of local O.D.s. This information is often readily available on their practice websites. Reach out to this list of referral resources to discuss your intentions. If a single practice in your area has everything you need, consider just creating one referral destination. If multiple practices are required to cover your equipment and specialty care needs, branch out as necessary. (See “Examples of Desired Specialty Equipment/Services,” below.)

2. Establish the O.D. to O.D. relationship. Contact the doctor (or doctors) you’d like to refer patients, and say: “I’d like to send my patient to you for specialized testing, with the expectation the patient will be returned to my care after the tests have been performed.” Of course, if you practice where you do not accept medical insurance, such as in retail, you may want to completely transfer the patient’s comprehensive disease care to a colleague who has the needed equipment, with the stipulation the patient be returned to you for their annual comprehensive eye exam.

3. Have a patient script ready. Be prepared with a script that explains to the patient the test(s) or special care you’d like him/her to undergo and why and where you’d like him/her to get it. It is not necessary to apologize for lacking the test or special care you feel the patient requires. Just as patients don’t expect their primary care doctor to have every piece of technology or acumen in every area of care, you are not expected to either.

A script for referring for testing only: “Based on my findings during your exam, I am concerned about your risk for [name the condition]. To provide the most comprehensive care, I feel we need additional information that is available through special testing. Therefore, I am going to send you to [ name the doctor, not the practice] for these tests. I work closely with this practice when I need this information, as it has the specialized testing equipment readily available.” (Feel free to use blood work or an MRI as an analogy.) “After you undergo the test(s), I will receive communication from [the practice], and you and I will meet again to discuss the next steps.”

A script for referring for continued medical care (i.e. outside your specialty or not in insurance network): “Based on my findings during your exam today, I am concerned about your risk for [name the condition]. To provide the required comprehensive follow-up in the most cost-effective manner, I am referring you to Dr. ____. He/she is a provider within your insurance network who possesses the special testing devices required for me to form the most complete picture of your condition. Dr. ____ and I work closely together and will continue to communicate about you and your eyes. I will continue to have you see Dr. ____ for visits related to your medical condition, and I always welcome you for care related to your glasses and contact lenses.”

4. Create a referral follow-up procedure. You want to track these referrals from your office. Most practice management systems have reports that can inform you when a patient was referred, to whom, for what and whether you have received correspondence from the referred doctor. Have a staff member monitor this report monthly. Also, sending the patient an e-mail after you review his/her test results or notes from the corresponding doctor can ensure the patient returns to your care: “Hi. I just got your test results, and I’m looking forward to seeing you.”

Becoming the referred O.D.

Unless your practice is bursting at the seams with patients, having extra patient revenue to support the high cost of your specialty equipment and/or services can be a bonus. Follow these three steps to garner referrals:

1. Create brochures. Develop clear and attractive brochures (i.e. images of data output outlining pertinent information, photos of patients undergoing special care, such as vision therapy, etc.) that explain the technology and/or special services your practice provides, ideal candidates, as well as the insurance companies with which the practice participates.

2. Simplify the referral process. Streamline the referral process to make patients happy, the referring doctor happy and you and your staff happy. To start, provide a clear and easy-to-fill-out form that should include fields for whether the referring doctor is transferring temporary or complete care, the patient’s insurance, TC, PC or both and the referring practice’s phone number and/or e-mail address. This form can be made available on your website or preprinted on pads to be distributed to surrounding offices.

Next, verify that the referring practices have the form available to distribute to the patient prior to his/her visit. To do this, enlist a point person. Having a dedicated staff member familiar with the referring practice as well as details about insurance coverage goes a long way in strengthening your referral network. Finally, provide preprinted directions to the practice for the patient. (Some referred doctors include a tear-off map on the last page of their brochures with a space for a small personal note, such as, “We’re only 1.5 miles from your practice.”)

3. Return patients. Return the patient to the referring practice, unless clearly directed otherwise on the referral form. Consider making an extra effort here by creating a time in your schedule where referred patients interact only with the technicians required for specialized testing, such as corneal topography, photography or OCT, and make possible referring O.D.s aware of this. They are paying you the highest compliment by trusting you with the care of their patients. Show them this trust is a two-way street.

Our duty to patients

In today’s connected society of Internet-savvy, self-diagnosing and self-treating patients, we can be sure our patients are “googling” their condition after their diagnosis and will certainly find out about diagnostic technologies and specialty eye care. How does it make you, their eye doctor, look when you not only fail to discuss the diagnostic technologies and specialty care options available, but also fail to temporarily or permanently send the patient to a fellow practitioner who has it? The answer is it makes you look incompetent, spurring patients to leave your practice. If, on the other hand, you “have it all,” let your colleagues know, so you can provide care to patients who need it. For optometry to continue to provide the highest level of care, we must ensure our patients are educated about all their options. OM

Dr. Murphy is a 2002 graduate of the U.C. Berkeley School of Optometry. She is the owner of a four O.D. group practice in partnership with three ophthalmology specialty partners in-house. In addition, she speaks professionally for companies, such as Eyefinity, Bausch + Lomb, Allergan and SynergEyes, and she serves on the advisory boards for several ophthalmic industry companies. E-mail her at drmurphy@fr-ea.com, or send comments to optomet ricmanagement@gmail.com.