Is there such a thing as over-referral?

I wanted to share this interesting abstract with you all: Referral patterns to a pediatric orthopedic clinic: implications for education and practice. (Pediatrics. 2004 Mar ;113(3 Pt 1):e163-7.)

While this study focuses on pediatric orthopedic referrals, the issue of over-referral is relevant to all surgical specialties. The authors argue that there is a lack of knowledge at the primary care level, leading to misdiagnosis and unnecessary referrals. In their eyes, this is undesirable - wasting surgeons' time and resources and driving up healthcare costs unnecessarily.

On the other side of the coin, research also shows that orthopedics and neurosurgery battle the issue of under-referral. For every patient that is referred unnecessarily, there is another that is not referred who could benefit from a specialist's care. A percentage of surgical candidates get caught in the primary care web for years - bouncing back and forth between PT, pain management and their PCP.

Balancing these two phenomena - over-referral and under-referral -  is a challenge, but an important one. Educating referring physicians in your area is absolutely essential to ensuring that the right patients have access to the right treatment. Primary care docs have a lot on their plates. Providing them with some clear, concise criteria for referral will better equip them to evaluate patients' conditions AND increase the likelihood that they'll refer to your practice when they do refer.

What are your thoughts on over-referral? Does it bother you when physicians refer patients unnecessarily, or do you prefer to take all comers?

Practice Marketing or Propaganda?

I came across this really interesting Bloomberg article on the online marketing practices of the Laser Spine Institute, and couldn't help but contribute my own thoughts to the discussion.

As a past marketing professional for a large spine company's minimally invasive platform, laser spine surgery has long been on my radar - and along with most of the spine community, I have dismissed it as marketing fodder. Laser surgery isn't backed by much (if any) scientific evidence, but that doesn't stop groups from using it as a headline to appeal to desperate sufferers of back pain. Who among us hasn't seen the ads showcasing bikini-clad women with a band-aid, enjoying the beach presumably days after surgery? To the layman, that's far more appealing than the longer recovery offered by their local spine surgeon. Unfortunately, laser procedures don't always live up to their promises, and once hopeful patients are left disillusioned.

I've noticed that many surgeons shy away from marketing their own practices, afraid of being lumped into the same category as the Laser Spine Institutes of the world. However, there is an ethical, honest way to promote surgical practices. By focusing less on "advertising" and more on the education of patients and referring physicians, you can increase referrals to your practice and feel good about it. Of course, at the end of the day, the best practice marketing out there is word of mouth; be meticulous with your patient selection and conservative with your treatment, and you'll soon establish a positive reputation among patients and referrers in your community. That's more valuable than any print ad - no matter how attractive that swimsuit model is.

Worker's Comp Challenges

As a consultant, one of my jobs is to strategically drive the referrals of specific patient segments. For some surgeons, we segment patients by pathology (the surgeon specializes in tumor cases, for example.) For other surgeons, there is a focus on profitability. In these instances, worker's compensation is often identified as a target patient segment due to attractive reimbursement.

However, there are some caveats with treating worker's comp patients. As I'm sure most of you have seen in the literature, surgical outcomes are often poorer for worker's comp patients. I recently came across this article that discusses some best practices for the treatment of worker's compensation cases and thought I'd share it with you all.

Do you approach worker's comp cases differently than other (Medicare or private payor) cases? What are you doing in your practice to attract worker's comp referrals?