Should Primary Care Docs Pay To Make Referrals?
June 21, 2008 – 6:00 amWhen I refer a patient to a specialist, I’ve noticed that my staff seem to waste a lot of time playing “piggie-in-the-middle.” They have to call the specialist’s office to schedule the patient’s appointment, then call the patient with the appointment information (and possibly repeat this process), get a pre-cert from the insurance company if needed, and then communicate that information to the specialist’s office. In an effort to free my staff from some of that extra work, we tried getting specialty offices to speak directly with the patient to schedule appointments and to work on getting pre-certification for the visit and/or needed procedures. It’s worked with a few of the specialty offices, but the majority have pushed back and communicated their expectation that the primary care doctor do the grunt work (and foot the bill for said grunt work). Shouldn’t specialists pay some (or all) of the administrative cost of doing those referrals since it is our referrals that make it possible for them to earn that higher income?
2 Responses to “Should Primary Care Docs Pay To Make Referrals?”
Good thought….as a surgical subspecialist I agree that the primary care or referral source should not have to harbor all the time and expense of a ‘referral’
I think this problem should be approached according to the means of payment.
If it is a PPO or HMO contract going through an IPA…the IPA should be responsible for the referral.
EMRs that are interoperable should help with this chore. Automated faxing also would help.
Many subspecialty practices, at least in So. Cal. are ca pitated, and the referral expense should be in the contract.
Push back…don’t take it any more!!
If the insurance company wants a pre-cert…tell thelm to pay for it….Some of these companies make billions in profits (the CEOs get multimillin dollar reimbursement contracts and golden parachutes w hen their companies belly up.
Don’t take it out on other physicians…..file your complailnts with the insurer, write articles that the public can read…..and keep on blogging!
Customer service is one thing,you should have a policy for your patients to refer to, how referrals are made….If you have a very sick patient I would do all that is possible..for the walking wounded I would phone the specialist and tell them your pateint is calling. i give the patient the tel. number to call.
If the specialty office wants all the information I tell t hem to call the patient…I am not an insurance office, nor a clerical business. If the patient does not like it,tell them to call their customer service tel no and bitch. You willl probably get a complaint and maybe even a threat from the insurer or IPA. Make a note of it,,,,if they do cut you off then take action legally. Also be sure you read the fine print about administrative work that primarycare vs specialists have to do for the payor or IPA. If there is something in there..you are cooked. If so then on your next contract round negotiate that out..or raise your fees.
Doctors unite!!
By Gary Levin on Jun 25, 2008
As an oral surgeon we shoulder all of the responsability whether the referral comes from a family physician that sends 2 people a year or a GP that sends 300. In it’s simpliest form they just email me the referral information and we take care of it. I think it’s wrong for them to compensate the GP for a referral (even as an administrative fee) because it wreaks of kickback for referrals.
By Ian Furst on Jun 25, 2008