Cultivate referrals with education, communication
Better information gives way to physician allies
A hospice’s relationship with the physicians in its community can spell the difference between high census and low census; a median length of service of 25 days vs. 14 days; a second referral and a disillusioned physician.
So what should hospices do to nurture those relationships that are so important to the success of their organizations? Experts say they need to move away from expensive lunches and holiday gift baskets and focus instead on old-fashioned methods such as communication, outreach, and education.
First impressions count
Physicians want to be assured their patients are well taken care of; they want a basic understanding of what hospice is; and they want help getting the hospice services their patients need.
"If a physician is referring a patient to your hospice for the first time, you have one chance to get it right," says Lisa Spoden, PhD, MBA, executive vice president of Strategic Healthcare, a Columbus, OH-based consulting firm, and executive director of The Kentucky Association of Hospices and Palliative Care in Lexington.
"We aren’t into any fancy gifts," says Sally Aldrich, RN, MSN, director of Methodist Alliance Hospice in Memphis, TN. "Instead, we try to find out how satisfied a physician is with our care."
Typically, hospices have engaged legions of volunteers to help spread the hospice message. In addition to taking the message to community health fairs and shopping malls on the weekends, those same volunteers come calling on physicians in their offices or solicit a few minutes of their time over the phone.
Give em what they want
With mounting administrative challenges and increased demands on their time, physicians have less time to spend with volunteers trying to pitch the hospice philosophy. There was a time when volunteers — and hospice administrators, for that matter — could coax physicians into lunch meetings, but today’s time constraints have left many physicians less willing to give of their time.
Also, volunteers are less effective because physicians are more receptive to those who have a similar level of clinical knowledge. In the event that they have a clinical question regarding hospice care, physicians expect to have the query answered by someone who has a strong clinical background, such as nurse or, preferably, another physician.
Typically, volunteers are faced with an office clerk, manager, or practice administrator who screens requests for the physician’s time. The result is likely to be a polite refusal, leaving the volunteer no other option but to place a stack of brochures in the physician’s office.
All this underscores an important point in the struggle to nurture physician relationships: rather than focusing on short, ineffective meetings with physicians or their office aides, hospices should go to greater lengths to identify physician needs and fulfill them. Those needs include:
• basic hospice information;
• easy referral process;
• frequent updates about patient condition;
• pain management information;
• timely response to orders and requests.
"Most physicians are unsure of how hospice is financed. We hope that by informing physicians how this works that we will help to decrease late referrals," says Aldrich. "What we are trying to do is promote more communication."
Physician liaison
Spoden agrees that communication is important. She advises hospices to designate one person who is responsible for communicating with physicians. The physician liaison should have a health care background and be a member of the hospice’s administration. This is important to ensure that physicians are confident with the information being provided to them, Spoden says. "It takes a special kind of nurse to do this job. You need someone who is open to opportunity, a problem solver."
Methodist Alliance Hospice assigns a marketing person to the task of physician communication. But the position goes far beyond the traditional idea of communicating the hospice philosophy. According to Aldrich, the physician liaison at Methodist Alliance Hospice is responsible for communicating admissions guidelines to physicians and explaining the Medicare hospice benefit.
By educating physicians on proper hospice admission, Methodist Alliance Hospice has been able to add days to its median length of service (LOS). A year ago, the hospice had an LOS of 25 days. This year, its LOS is 29 days, says Aldrich.
The liaison is still responsible for communicating basic hospice information, such as the role of the treating physician in hospice care. The marketer also provides information to physicians showing the cost-effectiveness of hospice care.
The hospice tracks physician satisfaction, understanding that continued improvement will help bring more referrals. Following a patient’s death, the treating physician is surveyed by the liaison to track ease of referral, responsiveness to physician needs, and level of communication.
Since the hospice has begun tracking physician satisfaction, physician response has prompted improvements in the hospice’s referral and intake process. "We’ve streamlined our process," Aldrich says.
The most notable change has been the elimination of several phone numbers, so that physicians and hospital discharge planners have only one number to call and are directly connected to personnel who can help. Another change has been adding nighttime admission, to accommodate physicians and hospitals looking for hospice care outside normal business hours.
Acknowledging physicians for their referral is important, as well. Following a patient’s death, a list of hospice services rendered to the patient and family during their stay can be sent to the physician, Spoden says. The correspondence should include number of nursing visits, CNA visits; MSW, chaplain, volunteer, and bereavement follow-up; who was present at death; and a personal, handwritten note by a coordinator or administrator to thank the physician and staff. Experts offer a similar system to nurture physician referrals:
• Members of the administrative team are assigned key doctors.
• The team member is responsible for establishing a working relationship with doctors or key members of his or her staff.
• Means and frequency of communication should be determined between staff member and doctor/staff member.
• Team member communicates patient care issues, assesses physician/patient needs, and relates new program ideas within these established guidelines.
• Team member reports findings to hospice leaders.
It is important to provide clinical and administrative staff with feedback from all referral sources. That feedback might include: changes in policy with managed care groups; physician feedback — good or bad; and updates on changes in the marketplace, says Spoden. "The purpose is to help staff realize that your referral resources are important to your program."
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