The Changing Roles of Physicians in the Home-Care Referral Process
There has been a shift in the key decision makers in home-care referral, as we recently discussed in a previous article. In this month’s feature, we help you understand the changing roles of physicians in the home-care referral process and how you can use that information to capture more referrals in your market.
Understanding the Changing Landscape of Home Health Referrals
The home health referral world will eventually split in two – facility-based and community-based referrals. On average, facility-based referrals represent about 60% of the market. In the early days of Medicare prospective payment systems (PPS), the physician who ordered Medicare home health services also signed the 485 forms and monitored their patients’ care at home, including those patients who were discharged from a hospital. So in the past, the ultimate referral position was to get physicians to write standing orders to use a particular home health agency.
Since then, the landscape has changed. Hospitals have increasingly called upon “in-house” physicians – referred to as hospitalists – to manage patients during their inpatient stays for the purpose of achieving better patient throughput. At the same time, primary-care doctors, internists, and family-medicine specialists have abdicated the hospital patient rounding responsibility, finding it increasingly inefficient to split their time between the outpatient office and an inpatient setting. These primary-care physicians are not completely out of the referral loop, however, since the hospitalists have no desire to be involved in post-discharge patient care. The hospitalists typically order the home health evaluation visit and leave it to primary-care colleagues to authorize the treatment plan. So although primary-care physicians are still in control of community-based home-care referrals, they are becoming more of an influencer in the facility-based “brand” selection process.
Medical specialists are yet another group of physicians to consider in the referral process. To monitor their patients’ chronic conditions, for example, such medical specialists as cardiologists, nephrologists, and oncologists may take the lead role in post-discharge care. Because of this, they are likely more invested in the choice of the home health agency. Surgeons also may be concerned about which home health agency serves their patients since they are reimbursed differently from other physicians: A surgeon’s procedure fee includes all physician follow-up care for a 90-day period. Orthopedists are yet another group of medical specialists to be considered in the referral process as they tend to closely monitor their patients’ progress and control when they are ready for outpatient therapy.
Consider the Referring Power of Each Physician to Optimize Your Sales Calls
The home-care referral process has become more complex as a result of the changing roles of physicians. For home health agencies, this means the focus of their sales calls may need to change, as well as their expectations from individual physicians. In other words, you need to consider the referring power of each physician as you look to grow your physician referral base. The primary-care physicians in your market are still important for community-based referrals and may also have an influence on facility-based referrals, for example, while hospitalists/medical directors and the facility discharge professionals are now more in control of the facility-based referrals. Therefore, home health agencies may need to re-evaluate their programmatic offerings to capture more office-based referrals, especially if they see themselves being closed out of the facility-based market.
The ability to generate physician referrals also varies significantly from market to market throughout the United States, so be sure to also take a close look at your local market when developing a strategy to build your physician referrals. In markets like Florida, for instance, physicians have been well trained by home health agencies to look for patients with certain chronic conditions who could benefit from home health services.
Who are the key physicians to target in your market? Healthcare Market Resources has the information to help you answer that question. Email us or give us a call at 215-657-7373 today to learn more.