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How to stop losing patients through the referral cracks

Aug. 24, 2020
Have you ever been surprised to find out that patients you referred never followed up? You aren't alone. How can this be prevented? Belle DuCharme and JoAnne Tanner share ideas that have worked for some of their clients.

For years, referring patients from the general dentist to the specialist has been the same. But many say there are problems with the "way we’ve always done it." Handing a referral form to a patient can be like giving them a one-way ticket out of town; the practice often doesn't see them again. The entire responsibility is placed on the patient to complete the process.

The story of two dentist brothers

Dentistry is a family affair for brothers Sam Ahani, DDS, and Rowshan Ahani, DDS, MS. Busy general dentist Sam Ahani relies on his brother, Rowshan Ahani, a board-certified endodontist, to take care of his patients who need endodontic services. Their close relationship has become symbiotic as they share patients through the referral process. Their social conversations inevitably turn to work, and sometimes they learn that patients have fallen through the cracks. Their problem is not unlike the one that has plagued general dentists and specialists for decades.

Drs. Ahani vowed to make a difference. They first examined the current referral methods. They determined that the old paper system is quickly becoming extinct with the new technology that’s available. Plus, handling paper in the current environment is frowned upon.

Many general dentists refer by email and send a current radiograph or other document along with the patient's contact information. However, this is rudimentary at best and often is not HIPAA compliant. Once the specialist receives the referral, he or she either calls the patient to schedule or waits for the patient to contact their office. There are too many chances that the referral will not be completed, and the lack of a reliable tracking system adds to the problem.

When he surveyed some dentists, Dr. Sam found that the number of referred patients who didn’t show up was troubling. “Our studies show that patients given paper referral forms with instructions to phone the specialist for an appointment fail to do so about 30% to 40% of the time,” he said.

Even if the general dental office sets up the patient's appointment, there’s no way for the referring dentists to know if the patient shows up unless the specialist reports the cancellation. The general dentist assumes the patient kept the appointment and waits for a post-treatment report. If the patient doesn’t show, they’re often lost to the general dentist.

Are there consequences if the patient doesn't follow through with the referral? Many of the malpractice claims filed against dentists are due to failure to diagnose and failure to refer the patient to a specialist. In his research, Dr. Sam spoke to a representative at The Dentists Insurance Company (TDIC) liability insurance for dentists. The representative explained that an estimated 50% of complaints against dentists originate from miscommunication about treatment. This includes the importance of seeing a specialist for an opinion or care.

It is important for dentists to take the time to document their decision for the recommendation. The American Dental Association's General Guidelines for Referring Dental Patients states, "In some situations, a dentist could be held legally responsible for treatment performed by a specialist or consulting dentists.”

A software system can help

Advantages of a dental software system to manage dental referrals

  • There are no paper referral forms to lose. The process is entirely paperless and provides improved documentation to support clinical notes.
  • Patients are not lost. You can track each step the patient takes on one system.
  • It offers improved specialist and patient service. The system is available after hours and by video chat.
  • It decreases the risk of litigation. The patient, dentist, and specialist are connected.
  • It keeps patients in “the loop” with video chat and a teledentistry platform.
  • It’s HIPAA compliant and secure.
  • It has a virtual meeting capability with the team

 Referral information should include the following:

  • Patient information and attachments of supporting information
  • Date of the referral and any other expected times
  • Evaluation and treatment completed to date
  • Copies of diagnostics performed
  • Diagnosis and prognosis
  • Dental services the specialist is requested to complete
  • Your plan for follow-up or continuing care after the specialist’s intervention
  • Consultation reports and ongoing care reports

Tracking patient referrals should include the following:

  • Easy tracking process separate from the patient’s record
  • Display timeframe from the patient’s referral to the return visit to the general dentist
  • Prompt to schedule patient for a visit after specialist intervention or documentation for why it has not progressed
  • If the patient is amiss, directions for follow-up provided

Drs. Sam and Rowshan want to improve the lives of patients by helping them receive the care they need in a way that is supportive and professional. The goal is to eliminate the cracks in the referral system by improving communication and access to care in an easy and seamless fashion.

JoAnne Tanner, MBA, is a dedicated professional with a solid track record in the dental consulting/practice transition arenas. Tanner has become one of the nation's leading influences in the innovative development of dental practices. She has worked closely with hundreds of dentists across North America to design and implement their customized dental practice management, marketing, and consulting programs. For information about the software for tracking referrals, contact her at [email protected] or visit joannetanner.com/.

Belle DuCharme, CDPMA, is a seasoned dental clinical and management professional and a devoted writer, speaker, and instructor for the dental profession. She is a senior writer and contributor to eAssist Dental Solutions newsletter and blogs, and is published in other trade journals and magazines. She's been a senior instructor and writer for McKenzie Management for 15 years. Contact her at [email protected] or visit belleducharme.com.