Winning and Wowing Referral Sources

Referrals are the core of any HME business, but that doesn’t mean they are easily established or kept. From company to company, the number and type of referral sources varies greatly. And though they all want patients to remain safe, healthy and at home, their needs can be as diverse as the consumers they serve.

“There’s the clinical referral source who is interested in your clinical programs, such as disease management, and they have one perspective, and the operationally concerned referral source may have another,” says Louis Feuer, MA, MSW, president of Pembroke Pines, Fla.-based Dynamic Seminars & Consulting.

Feuer explains that clinicians want to hear about the features and benefits of products as well as disease state management programs. Hospital-based social workers’ primary focus is reducing the patient’s length of stay in the acute care setting as well as preventing readmissions. Payer-based case managers are concerned with insurance plan coverage and the most cost-effective means of stretching these dollars.

“Providers have to break down all the categories and realize that every one of these referral sources has a different perspective,” says Feuer.

Frank Brown, executive vice president of Homecare Concepts in Farmingdale, N.Y., adds that among the groups of referral sources HME providers target, the model can vary even in the same setting, such as a hospital.

Providers could be working with “a social worker, a discharge planner or a case manager,” he says.

That’s why it is essential to know each referral source’s goal and how you can best accomplish meeting that goal through service, patient care and operational efficiency.

Gary Wolfe, RN, CCM, is the executive vice president of the Academy of Certified Case Managers and an independent case manager in Salinas, Calif. He says it is important that the referral source and the HME provider understand each other’s roles and responsibilities.

“Get to know each other and what level of expertise each of you has,” he advises. “As a case manager, I explain what I will do, what I have the authority to do and how I can help the HME provider in the situation. I want to build a relationship that will work over time.”

A seamless transition from an acute care setting to the home care setting is essential.

When Mindy Owen, RN, CRRN, CCM, principal of Phoenix HealthCare Associates, Coral Springs, Fla., entered the field, the intent of case management was to reduce the barriers between transitions of care and make it a seamless process.

“To me, that was and still is the intent of case management,” says Owen, whose firm specializes in case management, disease management, development and education.

“What we’ve seen over these last 20 years is more fragmentation inside of the transitions of care, meaning there is more paperwork and there are more people who have their hands on different elements of the discharge plan. Unfortunately, the more people involved, there is greater potential for miscommunication, which leads to mistakes.”

Talk Is Not Cheap

For many, the answer to this problem is communication that is clear, consistent and meaningful. Communication can take on many forms, depending on referral source preferences and needs. What is the first step? Owen says providers should determine who is primarily responsible for the discharge.

“Discharge planning is everyone’s responsibility, and that is why we need the tools in place to enhance communication between the medical equipment and/or home care provider and the case manager who is accountable for the discharge plan. That is why it behooves the medical equipment provider to ask right out of the box who is accountable for the overall discharge planning process,” she says.

Wolfe says communication should be specific and should address the products needed and the benefits they offer to the client. He also stresses how communication can work to achieve the best outcomes.

“We are all human and something will often go wrong,” he says. “As the case manager, I want to be notified immediately. Many times, I can run interference and still ensure a good outcome.”

Effective communication can also prevent misunderstandings, which will reassure the referral source and the client of your HME company’s capabilities.

“One of the most important things in providing rehab equipment is to keep your consumer and referral source updated along the way,” says Julie Mannlein, PT, ATP, a physical therapist with the University of Michigan’s Home Care Services Wheelchair Seating Service in Ann Arbor.

“There are few things more frustrating to the end user than not knowing when their new equipment is going to be delivered. Oftentimes, the clinician ends up being the middleman in this process and helps to facilitate communication between the supplier and either the referral source or the client.”

Owen says providers should maintain a direct line of communication with the referral source that has been designated as the decision-maker to ensure everything — both clinically and financially — is in place to accomplish the discharge plan. This includes educating the family and the patient about the equipment, determining who will accept the equipment and selecting the key family member responsible for communicating with the HME provider.

Mannlein adds that email is an “excellent means to communicate to all parties involved and keep them updated on any glitches that may come up along the way.”

Adrienne Bergen, PT, ATP/S, a rehab consultant for The MED Group, Lubbock, Texas, says timely communication is imperative. She agrees that email can be effective because it offers a timely response but also has the added benefit of creating a written record.

Bergen, who has more than 30 years of experience in the rehab and assistive technology field as both a physical therapist and a rehab technology supplier, also says reliability is critical.

“Always tell the truth,” she says. “Sometimes, papers get lost and sometimes the process does not go as smoothly as it should. However, when this information is shared with the team and even the consumers, providers build their credibility.”

Information is Golden

A few years ago, Bergen conducted a survey of referring physical therapists and asked them what they desire from a rehab provider. Results showed over 60 percent of those who responded said it was important for rehab providers to keep therapists up to date on new equipment and technology.

But this can be more challenging than it might appear. Often, referral sources from all settings are overworked and have little time to learn about new products and their benefits. Yet they still want to learn.

“Yes, referral sources do want to know what is new — we need concise and critical information, but we are so inundated with so much at this point of time,” says Phoenix HealthCare’s Owen.

She does offer suggestions on how providers can deliver their message.

“There are some case managers I know that are very attached to their BlackBerries and to their computers. They are very happy to get information, say once a week or once every couple of weeks, in a very quick memo-type of format — one that you could read in 60 seconds or a couple of minutes that gives the highlights of a new piece of equipment.”

She adds that other case managers may be interested in attending local meetings where they can get a hands-on demonstration of a piece of equipment and actually go through a much more in-depth presentation.

“It’s not like there’s one way that fits all,” explains Owen. “I think HME providers need to look at a variety of different ways to educate case managers, because they are all different.”

Educating referral sources is not limited to new technology. Often, helping them understand the order process and reimbursement guidelines is just as vital.

“The more you teach the referral source — not just about the products and the benefits and the features — but exactly what the order intake process is, the better off you’re going to be,” says Feuer. “It can be hard to get them to sit down and listen, but if you’re going to do an in-service on seating systems, for example, leave five minutes at the end of the in-service just to review the 10 key points on taking an order.”

UM’s Mannlein offers some creative ideas to reach referral sources. “There are several methods that could be used, including continuing education courses, trade shows, in-service programs, newsletters, fax broadcasts and annual physician conferences,” she says, pointing out that it depends on the individuals as to which method will work best for them and their learning preferences.

“One of the best ways to keep referral sources informed is the use of a newsletter that details what is new in the industry and what population would likely benefit from that new piece of equipment,” explains Mannlein. “This method could also be used to educate them on the ever-changing requirements of the funding sources.”

“Lunch and Learn” programs have been around for decades, but their effectiveness can vary. When Homecare Concept’s Brown attempts to use these as a marketing tool, he wants to ensure they offer value — not just a “lousy lunch.”

“Everybody likes to eat for free, but when you can also offer them the ability to enhance their requirement for education, it’s an additional incentive to come,” he says. “The manufacturers have responded to this, and we are able to bring their clinicians into a classroom setting for an hour.

“The attendees are able eat, but, more important, they are able to leave with an additional item on their resume.”

Walk the Walk

When referring a patient for home medical equipment, whether it is for a wheelchair, oxygen or standard DME, referral sources are very specific about what they expect.

They want timely delivery of the specified product or products. They want the patient to be informed on how the product works. And, without question, they do not want the patient to be readmitted to the acute care setting or to visit the emergency department.

“ED visits are where we lose, so if together we can prevent that ED visit or the readmission, we have been fiscally responsible as well as clinically responsible to keep the patient in the environment where he or she probably wants to be,” advises Owen.

“If the HME provider can help us do this, then we have an all-win situation.”

Bergen says failure to deliver the right equipment the first time is a big issue: “The product can be completely incorrect even though it was specified correctly; it can be as specified and still not work because the client grew or changed and no one checked, or it can be correct but set up incorrectly.

“This is bad for everyone involved. The therapist has wasted time setting a delivery appointment, the consumer has wasted time and is disappointed, and the supplier cannot deliver or bill the item or must spend hours at the setting taking apart and rebuilding the equipment.”

Jackie Birmingham, RN, BSN, MS, CMAC, vice president for regulatory compliance at Newtown, Mass.-based Curaspan Inc., has over 20 years’ experience in discharge planning and case management. She says there are certain “deal killers” that exist for discharge planners and case managers when it comes to working with HME and rehab providers.

“Lack of freedom of choice regarding products and aggressive marketing negatively impact the relationship,” she notes.

Birmingham also believes that focusing solely on products and not service is a crucial mistake. She says referral sources are interested in the product’s capabilities, its uses and the potential end users.

Additionally, satisfying referral sources is more than just making promises or saying you are “the best provider” in your area.

“To go to a discharge planner and say our service is ‘better’ than others is such an undefined word,” says ACCM’s Brown. “You truly have to come out with a compelling statement about how you’re going to make a difference in the patient’s life post-discharge.

“There are an awful lot of people out there with promises — it’s not about promises, it’s about performance.”

Brown adds that the last thing a referral source wants to hear is that something went wrong. “Overwhelmingly, it is a reflection on the hospital, and the case manager does not want to look incompetent,” he says.

Winning — then wowing — your referral sources begins with a simple step. Get to know them, and learn their needs.

“Referral sources are so diverse … salespeople should talk about them with others in the office and learn about them,” says Feuer. “Then, talk to the referral source. Ask them what they do — and say exactly what you can do for them.”

What Else Your Referral Sources Wish You Knew

“Suppliers need to be an integral part of the assessment, including the physical assessment. They need to be skilled at interacting with consumers, including how to ask permission to touch. It is often the supplier who must explain the process to the consumer before anything happens and periodically prompt update discussions, especially if the team becomes involved with using clinical jargon that might leave the consumer outside of the conversation. Suppliers who can do this are invaluable to clinicians, setting up a comfort and trust level where almost anything can be discussed during the evaluation session.”
— Adrienne Bergen, PT, ATP/S, rehab consultant, The MED Group, Lubbock, Texas

“The OIG is reviewing readmissions for home health care. A recent study showed 49 percent of patients are readmitted during the first episode of care — every other patient. HME providers should be addressing these issues with home health agencies to do their part to reduce these numbers.”
— Jackie Birmingham, RN, BSN, MS, CMAC, vice president for regulatory compliance, Curaspan Inc., Newtown, Mass.

“In the competitive bidding scenario, there will be referrals and subcontracts with other HME providers. You have to evaluate who your partners are going forward. You need to be very careful when you start referring your patients to other companies because it’s going to be guilt by association if things do not go well.”
— Louis Feuer, MA, MSW, president, Dynamic Seminars & Consulting, Pembroke Pines, Fla.

“One of the best ways providers can meet the needs of their referral sources is to utilize computer technology. Providers need to strive to minimize the amount of paper shuffling and convert every possible piece of paper to an electronic version. This will increase the efficiency of the work, decrease the frequency of errors and speed up the process time from evaluation to delivery.”
— Julie Mannlein, PT, ATP, physical therapist, University of Michigan’s Home Care Services Wheelchair Seating Service, Ann Arbor, Mich.

“Case managers need HME providers to recognize the importance of patient safety and how it is being measured. HME providers need to recognize patient safety issues in the discharge plan, and that their role is not only recognizing it but ensuring patient safety in that home environment, and how they then work together to improve patient outcomes.”
— Mindy Owen, RN, CRRN, CCM, principal, Phoenix HealthCare Associates, Coral Springs, Fla.

“I always ask about accreditation and level of expertise. Many times, I am an extension of the HME provider and they of me. I want to know a lot about them, so we can work together. We are all part of the client’s health care team, so we must work together to achieve good outcomes for the client.”
— Gary Wolfe, RN, CCM, executive vice president, Academy of Certified Case Managers, and independent case manager, Salinas, Calif.

VIPs (Very Important Points) for HMEs

To find out what physical and occupational therapists find valuable in an HME provider, rehab consultant Adrienne Bergen, PT, ATP/S, conducted a survey. Following are the results:

• 94 percent said it is important the equipment is correct when it is delivered the first time.
• 94 percent said it is very important that providers are able to supply equipment from all manufacturers.
• 88 percent thought it was very important for providers to keep therapists educated on equipment.
• 81 percent said providers should have a repair department with staff able to go to the client’s home, school or work.
• 75 percent of therapists rated assistance with assessment at the highest level of importance.
• 75 percent felt assistance from providers on taking measurements was critical.
• 69 percent felt providers should offer assistance with product choices.
• 69 percent said it is important to work with a provider whose office staff is easy to work with. However, 80 percent said working with a company whose office is reliable is critical.
• 56 percent said having RESNA certification is important.

Doing Your Part to Ensure Patient Safety

The National Transitions of Care Coalition was formed in 2006 to address the serious issue of filling the gaps that occur when patients leave one care setting and move to another care setting.

According to the 27-organization coalition, the U.S. health care system often fails to meet the needs of elderly patients during these transitions because care is rushed and responsibility is fragmented, with little communication across care settings and multiple providers. The focus of NTOCC is to bring together thought leaders and health care experts from various settings to address this critical issue, define solutions and develop tools to address the gaps impacting patient care.

Does this matter to the HME industry? You bet it does, says Mindy Owen, RN, CRRN, CCM, principal of Phoenix HealthCare Associates in Coral Springs, Fla.

“Although medication error was the driver of this initiative, this is a big deal. If HME providers are not aware of it, they need to be aware of it and what their role is in the process,” she says.

“This coalition is looking at the interventions necessary to do seamless transition, at the outcomes that need to be measured in terms of transitions of care, at breaking down the barriers, at communication modalities and all of the components to move a patient seamlessly, and having all the players participate in moving the patient seamlessly.”

For more information, visit www.ntocc.org.