Case of poached referrals

A vision therapy doctor accidentally develops a reputation for
stealing patients. How can she keep her referral sources happy?

Premier Vision Associates, a large optometry office in Missoula, MT, hired Dr. Mindy Steele just over a year ago. As a residency-trained vision therapy subspecialist, she was hired in part to create and grow a clinic to serve the VT needs of the community.

ABOUT REAL DEAL

Real Deal scenarios are inspired by true stories, but are changed to sharpen the dilemmas involved. The names of the characters and stores have been changed and should not be confused with real people or places.

ABOUT THE AUTHOR

NATALIE TAYLOR is an experienced optometry practice manager for Advanced Care Vision Network and a consultant with Taylor Vision. Learn more at tayloreye.com.

As Mindy’s confidence in her clinic grew, she began reaching out to other optometrists in the community. She handed out her card at CE and state meetings, and even visited a few offices in person. 

One day, Mindy got a call on her cell from Mark Snow, a local OD. 

“Hi Mark, are you checking up on your convergence insufficiency patient, Alice?” said Mindy. “She’s doing great.”

“No, though I’m glad to hear it,” said Mark. “I don’t know if you realize Alice’s entire family has left my practice.”

“Left?” she asked. “I’m not sure I understand.”

“If you check your records you’ll see that all five are now patients at Premier,” said Mark, an edge in his voice. “I referred another case to you a few months ago. Same deal. I wanted to tell you myself that I can’t refer you any more patients if you’re going to keep stealing them,” he said.

Mindy was stunned. “I certainly don’t want this to happen, Mark — please give me some time to make it up to you, or to solve this problem?” 

“It’s a business decision, not personal, and I think you’ve got a great track record for success with VT. I’m all ears if you want to make some changes,” he said, before hanging up. 

Curious, she launched the practice’s EMR on her computer and started checking out the VT schedule. She found that over the last six months several patients, not just Mark’s, had elected to book eye exams … often with her. 

How have I not put this together myself? she wondered. 

Mindy immediately tracked down the two people who would know how to help: her boss and the office manager. 

“Vision therapy is largely referral-based. How am I going to keep patients from leaving their doctor?”

“Why would you want to do that?” replied manager Kate. 

Owner Steve nodded. “We have a lot to offer. Our optical selection is bigger than Mark’s, and we have better hours.”

“Plus,” said Kate, “while vision therapy is moderately profitable, bringing in new patients really helps our bottom line. This is a big plus.”

Mindy shook her head. “Without a steady stream of outside referrals, the VT clinic won’t last. And I hate the idea of a patient not getting the care they need because of their doctor’s legitimate fear of losing business.”

“It’s a patient’s decision where to receive care,” Kate said reassuringly. “Your reputation should be based on success in vision therapy, not practice management.” 

Mindy wasn’t convinced. In fact, she left the meeting intent on brainstorming how to save her referral sources.  

The Big Questions
  • How can Mindy preserve her reputation without sabotaging her office? 
  • Is it appropriate for a referral doctor to persuade a patient to remain with his or her original office? 
  • Other than professional courtesy, are there any obligations in a VT referral relationship?
 

Expanded Reader Responses

Bob M.
Edina, MN

She has done a nice job building her practice by reaching out to local ODs. Her new patients should all fill out a form that identifies who referred them. She should contact all referral sources and thank them and ask when the patient is due back for routine eyecare. I think there is an expectation that they will be returned for routine eyecare. She should have an open house for referral sources so they become familiar with her and she could report the progress she has made with VT.

Kristy S.
Reynoldsburg, OH 

Customer service is priority here. Patients leave practices for so many reasons; insurance, friends’ opinions/referrals, sales. The only thing a practice can do is offer the best customer service possible, your entire team needs to be focused on this goal. I don’t believe Mindy has any reason to feel bad. Obviously, patients were referred to her and the staff in her office took over and showed how to take care of their patients.  
The other doctor should have called and said, "what are you doing differently?" and used it as a learning experience to grow his own practice.

Viki C.
Pittsburgh, PA 

It is the responsibility of Mindy and her staff to make a note on the patient’s chart that the patient has been referred by “Dr. ___.” This reminds all office staff to be diligent not to dispense glasses and to send patients back to the referring doctor. Mindy should have a standard few sentences to say to all referred patients at their first visit informing them in advance that they will be returned back “to the excellent care of your own doctor.” If a patient asks to continue care at a later date, it is her responsibility to say: “Although I would love to continue seeing you, I will have to refer you back to your doctor.” 

Zuraida Z.
Tucson, AZ 

Where and who the patients choose to see is the patients’ choice. Dr. Mindy needs to be confident in her skills and know that those people left the original office for a reason — they found something or someone better to suit their needs. She can send a progress note to the referring doctor and enclose a sentence that says: “Patient has completed VT sessions and referring patient back to Dr. XXX for future eyecare, etc.” She can also tell the patient after the session ends about returning to the original doctor for their visual needs.

Andrew D.
Washington, DC 

In a business sense, referral relationships are meant to be mutually beneficial. This being said, the primary impetus behind the referral process is patient health and satisfaction. The only thing Mindy should do is to be fair-minded with those referred to her. If patients feel more comfortable at her practice for their routine vision care, she shouldn’t deny them that choice. Mindy could also include the patients’ ODs in their VT care, encouraging optometrists to follow up with patients on the progress of their vision therapy. Too often referring doctors wash their hands of the issue being addressed with a referral; more involvement in patient care would dissuade patients from switching doctors.


This article originally appeared in the May 2017 edition of INVISION.



 
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