Marketing: Keep ‘Em Coming

June 1, 2007

Building a decent flow of referred patients requires more than just hanging your shingle. You need to develop positive relationships with their primary physicians. Here’s a step-by-step approach.


The 16 physicians at Coastal Orthopedics & Sports Medicine of Southwest Florida know how to get the word out. Every other Thursday, the Bradenton, Fla.-based practice offers free, hour-long lectures on selected clinical conditions, such as back problems or total hip replacement, for anyone interested. The benefit is two-fold: “You’re clearly providing a community service about important issues, and it gets people into your practice,” says practice administrator Jim Needham.

The programs attract much more than current patients. “Ninety percent are newcomers,” he says, “not just repeat-comers who want a free sandwich.”

After the lecture, participants can request a free in-office consultation, and, boy, do they. “On average, 15 percent of the people sign up for a visit,” says Needham. One lecture on shingles drew an audience of 105 people, and roughly a third of them signed up for a free consultation afterward. Indeed, Coastal Orthopedics locks in 30 to 60 new referrals a month just with its biweekly lectures. That’s a very respectable return on investment.

As a specialist, you know your practice depends on a steady influx of referred patients, and that being - or becoming - well known and highly regarded is essential to channeling new referrals in your direction. Is yours a recognized practice with a top-notch reputation? Ideally, the answer is yes. But if you’re not so sure, then it’s time to do something about it.

First, read the directions

Before getting started, you need to know some important ground rules: Physicians are not free to do absolutely anything to boost referrals. The federal Medicare/Medicaid Anti-Kickback Statute, for example, essentially prohibits a physician from offering or receiving anything of value to increase referrals. “And it doesn’t say ‘money’; it says ‘remuneration,’” says Lori-Ann Rickard, a healthcare attorney and president of St. Clair Shores, Mich.-based Rickard & Associates.

This doesn’t mean that picking up the tab for a referring doctor’s toasted bagel while you brief him on the latest advances in your field will land you in jail. But routine, expensive catered lunches sent over to his office might trigger suspicion. The Department of Health and Human Services’ Office of the Inspector General does make clear some “safe” limits, Rickard says. You can spend up to $10 on a single patient gift, or you can spend as much as $50 annually on multiple gifts for an individual patient.

Some states have regulations similar to the federal statute, so be sure to learn what they are before undertaking any referral-related initiative. A good place to start might be your state medical society.

Michigan, for example, now has 28 entities that monitor healthcare fraud. The state doesn’t maintain spending limits, but Rickard advises providers to spend $25 or less “to be conservative.”

Don’t get nervous. There are plenty of ways to legally and successfully increase referrals. Once you’re familiar with the rules, you’ll be ready to start considering techniques.

Getting to know you

Referrals are the natural result of healthy human relationships and connections. Not unlike a romantic relationship, first you court the object of your affection, and then you spend time taking care of that person.

Therefore, make it a priority to forge positive relationships with area physicians who might refer patients to you. Make a list of possible contacts, and simply call them up. Say you’d like to stop by for a quick introductory chat, or suggest meeting for lunch.

“It’s really about physician to physician,” says orthopedist Rocco Monto of Monto Orthopedics, located in West Tisbury on Martha’s Vineyard, Mass.

Making contact is particularly important for physicians who have just graduated, relocated, or opened a new solo practice. After all, if area docs don’t know you, how can they recommend you?


Don’t go empty-handed. Bring along materials relevant to your specialty, both to apprise the physician of the latest treatment advances in your field and to educate his patients on what your practice has to offer.

Even if you’re a veteran physician, you must maintain your existing relationships to keep those referrals coming. Twice a week, Coastal Orthopedics staff members bring lunch to one of the practice’s primary-care or other referring physicians to nosh on while they discuss, say, new technologies on total knee replacements.

And for goodness’ sake, remember to say thank you after accepting a new referral. As soon as the exam is finished, dash off a quick thank-you note to the physician for recommending you. It takes only a second, and it will reinforce the cooperative bond between two professionals.

When a newly referred patient comes in for an exam, shore up the emerging three-way relationship by complimenting the patient’s referring doctor. People like to hear they’ve made a good decision in a healthcare provider, and, presumably, your comment will be sincere. You wouldn’t pursue a relationship with a doctor you didn’t trust or like, would you? Your small words of praise are very likely to make their way back to the patient’s doctor as well as to her friends and family.

Don’t forget about appearances, either. Looks do matter. When patients and fellow doctors visit your office, what do they see? “We have a nice building. People walk in and say, ‘Wow!’” says Needham. Is your office attractive and welcoming? If not, make it so. (This subject was covered in Physicians Practice’s March 29 e-newsletter, PEARLS. You can subscribe to PEARLS on our home page.)

Your patients can be major players in boosting referrals, too. During an exam, cement in their minds a memory of your friendly demeanor. Make good eye contact, focus your attention, project an unrushed attitude, and, most important, respect patients’ thoughts and opinions. Why does this matter? Because patients tell friends about their medical experiences, both good and bad. Naturally, you want the former.

Note that “respect” does not necessarily mean “endorse.” If Mrs. Higginbotham believes a mint poultice is just the ticket for her heel spurs, your only obligation is to grant her the right to think this. Use the opportunity to exchange ideas on the best treatment options. At her next garden club meeting, she’s likely to mention to her friend Luella how well you listen and that Luella really should go see you for that achy hip. Voilà! A new referral, and all you did was be nice.

Be the best you can be

A successful referrer-specialist relationship relies heavily on the timely exchange of information about the referred patient. When you finish an exam, give the patient a copy of the note. This is very easy if you use an EMR, although surprisingly only 41 percent of hooked-up doctors bother, reports a recent study by the Medical Records Institute.

Along with the note, put technology to work for you: Coastal Orthopedics dumps all its pictorial test results onto a CD for patients to carry back to their physicians. There are multiple benefits to doing this, Needham says. “A CD proves you know what you’re doing. [Primary-care physicians] get the impression that you’re really on top of your game. And CDs are easier to carry. I don’t know why, but patients lose films more than CDs. And they get loaded onto the physicians’ computers. They can zoom, pan, flip the images. Doctors say they can’t even remember how to read regular films.”

Of course, you’ll also need to send a complete report back to the referring provider, pronto. Note that a timely, succinct report trumps a delayed, personalized one any day. Coastal Orthopedics makes a commitment to faxing a report to the referring physician as soon as it comes back from transcription. “We had a huge reaction,” says Needham. “We thought they’d be [angry] at us for tearing down their fax machines. Exact opposite: We had physicians calling us, saying how thrilled they were. It’s incredible what the value was in doing that.”

Needham’s recommended goal: Never allow the patient to return to the referring physician’s office before the report does.

If you have an EMR, go one step further, says Monto: “Make sure the referring doctors have access to your EMR. Give them a password.” They will deeply appreciate this open exchange of information, he says, and keeping communication lines like this open will greatly help to “combat the impression that you’re inaccessible.” (Of course, you’ll need to make sure you stay in compliance with pertinent HIPAA regulations concerning patient privacy.)

To help keep your reputation as a stand-up doctor, respond to e-mails and phone calls as soon as possible. Monto even lists his cell phone on his after-hours phone message for anyone to reach him. “Be open and affable, and answer their questions,” he says.

You should also teach your staff how to encourage referrals. Front-desk workers have a lot of patient contact. Create a brochure describing your practice, position copies prominently on the counter, and have staff routinely point them out and suggest patients take one.


As for your patients, your natural inclination to provide the highest level of care will serve you well, and this excellent treatment needn’t be limited to the exam room. Attending a Friday night cocktail party or a weekend church retreat? Be generous with your medical knowledge, if asked. Not only is this an easy and decent way to give back to the community, but you’ll also promote a reputation that you care about people.

You might even consider taking out-of-office contact one step further by making house calls. True, not always feasible, but if you can reinstate this bygone service within your practice even part of the time, your patients will deeply appreciate it - especially the senior set and parents of young children. Monto does, on the island of Martha’s Vineyard as well as on neighboring Nantucket. “That level of accessibility makes a huge difference. It’s worth a thousand ads,” Monto says.

To market, to market

As a specialist, you must engage in some form of marketing, or your practice won’t grow. You may feel a strong aversion to this; many physicians do. But fear not. The type of marketing needed here is not the stuff of the desperate or unethical. Think of it more as education and an offering of your services to the public - which is exactly what it is. Consider these ideas:

  • Press releases - Monto just returned from Guatemala after accompanying the U.S. soccer team as the on-staff physician. The experience made for a terrific human-interest story that the public would surely enjoy reading. His practice sent a short press release to the local newspaper. “We’re very big with press releases - very helpful,” he says.

What newsworthy activities do you and your staff members engage in after hours? Let others know. It’ll anchor your practice’s name in the public, and if what you’re doing is of a charitable nature, you’ll be giving the cause some free advertising. A win-win, for sure. One note of caution, says Monto. “One [press release] a quarter. You can’t do too many, or it becomes self-promotion.”

  • Newsletters - Coastal Orthopedics sends a newsletter to every physician in town (about 350 practices). Consider sending one to surrounding physicians, both current referrers and future hopefuls. Encourage them to leave it in their waiting rooms for patients to see. Largely informational, with educational materials on topics relevant to your specialty, newsletters can mostly be put together with content pulled from reputable sources, such as WebMD, suggests Needham. Of course, you’ll need to credit the sources and gain written consent to print their information, but this is usually not a problem. After all, it’s free advertising for them.

Also include clear contact information and newsy, practice-related items. Have you brought a new doc on board? Opened a new location? Expanded your office hours? These are all useful tidbits for both physicians and new patients. And don’t forget a blurb on how yours is the best practice in town for your specialty.

  • Education - If you decide to launch a lecture series à la Coastal Orthopedics, you’ll need to publicize it to draw people in. With this, easy and direct is best: “I put up a big sign outside announcing the talk,” says Needham. The practice also hands out reminder notices to current patients, and runs a simple newspaper ad four days prior.

  • Public proclamations - Craft an eye-catching announcement. For example, “Our patients are our best ambassadors. Thanks for referring us to your friends and family!” Frame it, and post it in your waiting room. Your patients will feel appreciated and acknowledged for their loyalty to your office. If your offices are large, try hanging multiple copies throughout, where patients will be sure to see the message.

  • Ask your patients - Embarrassing? Nah, it’s actually very easy: Simply comment in passing that you appreciate having that person for a patient and you’d certainly welcome his friends - and there you go. The recommendation seed is planted.

Keeping it real

Bumping up your referral stats doesn’t have to be difficult. If you’re in doubt at all about the legality of your referrals - or, indeed, any growth idea - tap into the expertise of a healthcare lawyer. This can be a real sticking point for some doctors, says Rickard. “Once in a while I’ll sit down with a very entrepreneurial doctor who has 20 ideas on how to boost referrals. I’m never very popular during those conversations.”

The best approach by far is to keep your tactics simple and concentrate on what’s most important. “The doctors who I think can boost referrals and boost their patient base are the ones who provide great patient care and a great patient experience, and the same with their referring physicians,” says Rickard. “All of that is what they need to focus on instead of all this poppycock like sliding someone hockey tickets. Focus on running a good business. That’s the message we should be giving physicians.”

Shirley Grace, senior writer for Physicians Practice, holds an MA in nonfiction writing from The Johns Hopkins University. Her articles have appeared in numerous publications, including The Washington Post and Notre Dame Business magazine. She can be reached at sgrace@physicianspractice.com.
This article originally appeared in the June 2007 issue of
Physicians Practice.