A referral from a primary care practice to a specialty practice, such as optometry, creates a link between providers
and sets in motion the patient’s specialty and primary care plans moving forward. The referral from a primary care provider (PCP) should be initiated when a specific condition or issue occurs past a reasonable level of care for a PCP. The referral should include a brief description of the issue the patient is having and sufficient historical information about the patient. Appropriate, clear, and complete referrals increase the likelihood that an eyecare provider (ECP) can provide thorough and efficient care.
In this article, we’ll review several key ways to increase and optimize referrals between primary care and specialty medicine providers. To streamline the referral process, we have provided two downloadable templates
, one is a patient referral letter, and the other is an eyecare provider summary referral report.
Laying the foundation for a successful optometry referral
Optometrists should always remember to write a consult or summary letter back to the referring medical provider every time they see a patient. When other medical providers see an OD’s signature or letterhead, it is a reminder of the level of quality care that was provided and can be a big driver of practice growth. Make yourself available with an up-to-date office and cell phone number, as well as a personal email address. Returning calls and messages promptly
lets other providers know you are available to answer simple questions, even without a patient referral.
It is important to instill a sense of confidence in the referring PCPs. Until this is shown through your quality of care, it can be beneficial to provide a copy of your CV and references when introducing yourself and making connections in the local healthcare community.
Many studies have revealed that recipients of referral letters are dissatisfied with the content and quality of the letter.1,2 Studies have also found that time constraints and a lack of clerical support have been identified as possible reasons for poor-quality referral letters.3,4
Overcoming common barriers
Common barriers can include poor communication from nearby ECPs, difficulty in scheduling an eyecare appointment, and a patient’s lack of insurance coverage/limitations on the insurance that the ECP accepts
. The most frequently mentioned challenge that primary care providers encountered with ECP referrals was not knowing whether the patient had been seen by the ECP. Most PCPs end up needing to ask the patient verbally since no communication occurred and/or a summary report was never sent.
The current referral system could be improved by implementing electronic medical records (EMR), receiving appropriate and timely feedback from ECPs, and seeing medical visits in the same clinic as the PCP (e.g., multidisciplinary practice modalities such as Community Health Centers
, Veteran's Affairs
, and Indian Health Services
“Physician-to-physician communication is vital to the success of the referral and also to patient health outcomes.”
Breakdowns in communication can lead to poor quality of care, delayed diagnoses, polypharmacy, increased litigation risk, and unnecessary testing. Many referrals between PCPs and specialty medicine providers do not occur within the same practice or location. This can cause difficulty in communication between both providers when it comes to patient care. Fortunately, the Affordable Care Act and Patient Protection Act of 2010 increased the use of EMRs and assisted in communication between two providers who are seeing the same patient.
Download the Optometry Referral Templates
Optometry Referral Templates
Use these referral templates to improve communication between healthcare providers and increase the number of referrals to your practice.
Following up with referring providers
After seeing a referred patient, complete a referral summary and email or fax it to the referring physician. Other clinical support staff
can be in charge of this process. Check-in with the physician to see if they received your summary and if they have any additional questions about the care you provided for your mutual patient. This shows that you value their opinion and are striving to optimize care and service for the patient.
Studies have shown that as much as 50% of patients do not actually receive an annual eye examination when referred by their PCP.1,3,5 A lack of communication appears to be a primary limitation regarding referrals to ECPs.
Studies have also found that PCPs prefer a report of the eye exam summary in a format that non-ECPs can understand. A few studies have also included specific details that should be mentioned in the reports, including the condition found, treatments recommended, and duration of the condition. A select few providers have also recommended receiving a no-show notice
from ECPs when patients do not show up for their eyecare examinations.6,7,8
Developing relationships with PCPs
The first step to building a rich referral network
involves face-to-face interaction. Make sure to introduce yourself and provide business cards when connecting with your local healthcare community. Today, many providers elect to communicate digitally, but an in-person interaction can have a significantly greater impact. Visiting other providers’ offices to say hello and let their team know you are available to provide medical and refractive eyecare can go a long way.
Communicating with the receptionists and staff at the PCPs’ clinics ensures that they recommend you to patients seeing the provider. Online medical communities like Sermo, Doximity, or LinkedIn can help virtually connect you with local providers and also alert you to live events for medical professionals in the area.
Patient referrals are an important source of growth and continued revenue for your practice. At first, referrals can seem to require a lot of effort. However, technology has made it easier for clinics to not only engage with both patients and providers. Once PCPs become familiar with your name and the quality of care you offer, new patients will be sent your way.
By visiting the PCP yourself, you and your practice will stand out above the competition. Most other specialists send their scheduler or office manager. Make sure to build rapport by following up by phone or email and checking in occasionally.
Initial PCP referral instructions
One study found that 68% of ECPs received no communication from the referring PCP.9 When a referral from a first-time provider comes in, ensure the patient is scheduled and seen in a timely fashion. Before sending a summary report, make sure to call the PCP’s office to clarify the preferred method they’d like to receive your summary letter.
Confirming that reports are satisfactory and easily understood can also help. ECPs should thank them for the opportunity to assist in the care of their patient and ask for a referral the next time a patient needs specific care related to your field.10
Three things to include in reports to PCPs
In order to ensure communication with PCPs is clear and concise, three points must be included:
- Assessment: State what the patient was referred for and what was or was not found during the examination.
- Examination: State what you are doing for the patient regarding the issue found. Mention if any other eye diseases are being managed for this patient.
- Plan: The follow-up interval in order to manage this condition and the name of the disease or condition.
Over 90% of both PCPs and specialists agreed that a clear statement of the problem, current medication, and reason for referral should be included in the referral letter. However, several studies have also shown that letters from general practitioners lack critical information, explicit reasons for referral, or a plan for follow-up.11-12 One study found that the patient background was in 98% of referrals, but the purpose of the referral was only explicit in 76%.13
Speed and accuracy are key to PCP referrals
Promptly getting results back to referring physicians is key. Typically fax and email are the preferred and most practical routes. If a delay presents itself for the written report, a phone call may be necessary. Keeping the PCP in the loop will ensure consistent referrals. Clear and succinct results in your report can provide clarity of the eye-related health of their patient.
PCPs in one study noted the three biggest problems with the current referral system were lack of urgency regarding consult notes from specialists, the repetitiveness of the current referral system, and time required to create adequate referral notes.14
Specialists in a different study noted the three biggest problems with the current referral system were the lack of urgency of notes from PCPs, the time required for insurance approval, and the lack of clarity regarding the reason for referral.14
Two tips for increasing PCP referrals
1) Simplify your physician referral process
In order to increase the number of physician referrals, your referral process should be as straightforward and effective as possible. No one likes filling out repetitive paperwork, especially busy PCPs. If a PCP or their team has to spend time on the phone for every patient they send your way, the referrals will be few and far between. Referral templates can also improve the clarity and speed of referrals for specialty care.
2) Actively maintain relationships and help them help you
Work to understand what is important to your partners and their patients, as this will allow you to better serve both the provider and the patient. Many providers like offices that are close in proximity to their office and also like timeliness in sending out follow-up summaries. Most important is making the provider feel comfortable about sending patient referrals your way.
“Meeting with potential referring physicians and thanking them for sending patients your way ensures they will think of sending you more patients.”
Additionally, nurture and maintain the relationship with referring physicians. Consider taking them out for lunch, calling to check in and see how their families are doing, a random small gift around the holidays (Starbucks gift cards are a great choice), or even an annual thank-you card for referring to you. Make sure it isn’t over the top, but making a continual effort shows that you value their partnership and want to maintain a consistent relationship. Phone calls, letters, and emails can work to continue the relationship but never discount the value of face-to-face interaction. In-person visits are always more memorable and appear more genuine.
Referrals from other medical specialties
Referrals from specialty care physicians primarily come from going out and visiting specialists’ offices. Face-to-face interactions, if possible, increase the likelihood of being memorable when a patient presents with an issue that the specialist cannot manage. Make sure to bring plenty of business cards and have a handout summary of the report that the specialist receives after the patient visit.
The following are specialties that I have canvassed and successfully received referrals from:
- Emergency medicine
- Sleep medicine
A referral from a PCP or other medical specialty
to an optometrist creates a link between providers and optimizes the quality of healthcare a patient receives. Using one of the provided templates will not only increase communication between the two providers but will also increase the likelihood of further referrals to your practice.
Initially, this might seem like a time-consuming process, but nurturing the relationship with other providers will bring added value to your practice for years to come. Don’t miss this opportunity to enhance patient care while also building your practice!