Learn about our response to COVID-19 Read Here

Learn more about Healthcare, Marketing,
Networking, and Business Practices

Read Here

Ambulatory referral is the mainstay of physicians’ business startup, growth and expansion. 

In the US private practices are businesses delivering healthcare services. This business has the same fiscal demands as any other, it has to make a profit, or at least break even over the long run. Though, there are some unique components to the fiscal health of a medical practice. Practices often utilize relationships with insurance carriers to support payments for their services. This in itself is often complex and can absorb a lot of the money needed to operate a practice.

But this topic is about the topline, the revenue generators. Just like every business owner, every physician has to attend to existing patients(clients), while simultaneously attempting to bring in new ones. The popular philosophy is that it’s much easier to generate revenue from an existing client than a new client is both crucial and accurate. Inherently, physicians understand they have to treat their patients well so that they come back. There are exceptions for specialty practices but our topic on ambulatory referral is relevant to most physician practices(although not all.)

A typical business will hang out a shingle, as well as network within medical and social circles. All of these techniques and many more bring new patients in. One of the most important marketing strategies is the networking employed to generate patient referrals. These come from other physicians and healthcare providers and could include a pharmacist, a nurse practitioner, or even a dentist. 

Having referrals helps you and reciprocating when possible is step one. What if you want to accelerate the referrals? In this instance, deliberate observations and research along with concrete steps moves you in the realm of marketing. Marketing is simply identifying channels and communicating in them in ways that increase the buzz or attention on you. 

Practitioners earn much of their living from these interdisciplinary referrals and such arrangements are the mainstay of many specialties.

An analysis of overall health referrals reveals only half of the annual 100 million are completed, while the rest are lost in communication or never followed through. The responsibility of followup care is dumped on the patient who can become misunderstood, disinterested, or unavailable to the practitioner. Practitioners often forget to follow up after referring their patient, leading to a deficit of care, and what was intended to be a legitimate and efficient means of redirecting patients has become a confusing mass of loose ends. 

Healthcare legislation has allowed more people to take advantage of specialized medical services, however, uncompleted referrals remain an issue. Not only does it create an economic loss for practitioners but the disconnects lead to a decline in medical welfare. The Institute of Healthcare Improvement created a panel to devise a mechanism that would address the problem and through this, the Ambulatory Referral Guide was born. “Closing the Loop: A Guide to Safer Ambulatory Referrals in the EHR Era” acknowledges that a definite system is lacking and directly addresses the major issues.

The panel for the Ambulatory Referral Guide proposed the uniform implementation of the nine-step, closed-loop EHR referral process below:

  1. The primary care physician orders a referral.
  2. The primary care physician or a designated staff person communicates the referral to the subspecialist.
  3. The referral is reviewed and authorized.
  4. An appointment is scheduled.
  5. The consult appointment occurs.
  6. The subspecialist communicates the plan to the patient.
  7. The subspecialist communicates the plan to the primary care physician.
  8. The primary care physician acknowledges receipt of information from the subspecialist.
  9. The primary care physician communicates the plan to the patient and the family.


 This framework received a lot of praise in an article published by the American Association of Family Physicians (AAFP), as family medicine is a foremost practice in dealing with these referrals. The AAFP acknowledges that although lost referrals are quite problematic, the guide looks to handle the situation by placing responsibility on the referring doctor and subspecialist, requiring them to comply with documentary requirements and communicate with the patient.

The following two tabs change content below.

Rey Palmares

Writing should be one part informative and one part entertaining. It's what differentiates a generic piece of text from a well-written article. Rey Palmares dedicates much of his time to fine-tune that craft, juggling the joys and frustrations of writing with those of his law school life outside of the office. He's making it work so far.